Dissertations and Theses
Date of Award
2026
Document Type
Dissertation
Department
Psychology
First Advisor
Sasha Rudenstine
Second Advisor
Paul Wachtel
Third Advisor
Diana Puñales Morejon
Keywords
Working alliance, affect, short-term psychodynamic psychotherapy, therapist interventions, psychotherapy outcomes, process-outcome research
Abstract
ABSTRACT
I See That You’re Smiling:
An Exploration of Affect and the Working Alliance in Short-Term Psychotherapy
by
Helen Feldman
Advisor: Sasha Rudenstine, PhD
Therapist engagement with patient affect and the working alliance are both regarded as essential ingredients of change in short-term psychodynamic psychotherapy, yet little is known about how these two variables relate to one another or jointly contribute to therapeutic outcomes. To the best of the author's knowledge, this study is among the first to directly examine this relationship using a session-level coding system alongside patient- and therapist-rated alliance measures. Using data from the Therapeutic Alliance Assessment Project (TAAP), this study examined 17 therapist-patient dyads participating in a 20-session short-term psychodynamic treatment. Therapist interventions focused on patient affect were coded from videotaped sessions at early, middle, and late phases of treatment (Sessions 1, 4, 8, 12, 16, and 20) using the Approach Tally Coding System (ATCS). Post-session patient- and therapist-rated working alliance was assessed using the Working Alliance Inventory–Short Revised (WAI-SR), and patient psychological well-being was measured using the Outcome Questionnaire-45.2 (OQ-45.2). A total of 679 therapist approach moments were identified across 102 coded sessions, with affect engagement present in 98% of sessions and remaining stable across treatment phases. Therapist engagement with affect was not significantly associated with patient-rated alliance or psychological well-being across most sessions; however, significant associations emerged between mid-treatment affect engagement and therapist-rated alliance, particularly at Session 8. Working alliance emerged as a robust predictor of psychological well-being, with mid- to late-treatment ratings most strongly associated with improvement. These findings suggest that therapist engagement with affect functions as one component within a complex, relational therapeutic process, underscoring the importance of examining both variables as dynamic, evolving elements across the full course of psychodynamic treatment.
Recommended Citation
Feldman, Helen, "I See That You’re Smiling: An Exploration of Affect and the Working Alliance in Short-Term Psychotherapy" (2026). CUNY Academic Works.
https://academicworks.cuny.edu/cc_etds_theses/1325
