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their use of transference interpretations they experienced problems in the alliance,
resulting in negative outcome for patients with a history of problematic high-quality
object relations.
In their later work, Piper and colleagues (1999) examined a sample of dropouts
and conducted a qualitative analysis of the last sessions prior to drop out. Piper and
colleagues discovered that in the dropout cases, patients often would start treatment by
expressing dissatisfaction with therapy and therapists would respond with transference
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interpretations. When patients would start to withdraw in the session, therapists tended to
increase their adherence to the transference issues, further complicating the alliance.
Furthermore, Henry and colleagues (1993) assessed the effects of training in
short-term dynamic therapy. Therapists were given a year of intensive training in a
manualized form of psychodynamic treatment. The training focused on helping therapists
detect and manage maladaptive interpersonal patterns enacted in the therapeutic
relationship. Following their training, the therapists treated a cohort of patients. Findings
showed that therapists were able to shift their work to correspond more closely with the
treatment manual. At the same time, researchers found that when therapists attempted to
handle alliance strains, they did so in a mechanical, rigid way. Rather than being able to
treat their patients more skillfully, therapists failed to be empathic and supportive,
resulting in negative outcomes.
Henry and colleagues (1993) concluded that "one of the apparent paradoxical
results of training was that at the same time therapists were becoming more intellectually
sensitized to the importance of in-session dyadic process, they were actually delivering