Antisocial personality traits and outcome in psychotherapy: Does the therapeutic alliance mediate negative effects?

IF 2.6 2区心理学 Q2 PSYCHOLOGY, CLINICAL

Psychotherapy Pub Date : 2025-05-19 DOI:10.1037/pst0000583

Bianca H Cersosimo, Mark J Hilsenroth, Caleb J Siefert, Mark A Blais

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Abstract

Process and outcome studies focusing on antisocial traits (ANT) are limited (Van den Bosch et al., 2018), especially in nonforensic/nonoffender outpatient settings (Thylstrup & Hesse, 2016). ANT can impact outcomes through several mechanisms, such as treatment rejection, premature dropout, or poor alliance formation (Van den Bosch et al., 2018; Messina et al., 2002). In a prior study (Cersosimo, Hilsenroth, Bornstein, & Gold, 2022), we found that patient-rated alliance early in outpatient psychotherapy was negatively related to pretreatment ratings on Personality Assessment Inventory scales assessing ANT. The present study extends this work by examining ANT, alliance, and treatment readiness with outcome. We found that ANT, treatment rejection, and patient-rated alliance were significantly related to patient-rated outcome (n = 65). Regression analysis indicated that both ANT (β = -.29, p = .014; f² = 0.09) and treatment rejection (β = -.28, p = .019; f² = 0.09) were unique, negative, predictors of outcome, explaining 18% of the variance. Adding the significant, positive, patient-rated alliance to the model (β = .34, p = .003; f² = 0.13) increased explained variance to 25%. Subsequent analyses revealed that the negative impacts of treatment rejection on outcome occur separate from both ANT and alliance, while the negative impact of ANT on outcome is partially mediated by the positive effects of alliance (indirect effect = -.10, lower level confidence interval = -.208; upper level confidence interval = -.003). We discuss how early assessment of ANT and treatment readiness informs treatment planning. Limitations of the study and next steps for research are noted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

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心理治疗中的反社会人格特质与结果：治疗联盟是否介导负面效应？

专注于反社会特征（ANT）的过程和结果研究是有限的（Van den Bosch等人，2018），特别是在非法医/非罪犯门诊环境中（Thylstrup & Hesse, 2016）。ANT可以通过多种机制影响结果，如治疗排斥、过早退出或不良联盟形成(Van den Bosch等人，2018；Messina et al., 2002)。在之前的一项研究中（Cersosimo, Hilsenroth, Bornstein, & Gold, 2022），我们发现，在门诊心理治疗早期，患者评价的联盟与评估ANT的人格评估量表的预处理评分呈负相关。本研究通过检查ANT、联盟和治疗准备与结果来扩展这项工作。我们发现，ANT、治疗排斥反应和患者评价的联盟与患者评价的结局显著相关（n = 65）。回归分析表明，β = -。29, p = 0.014；F²= 0.09)和治疗排斥反应(β = -。28, p = 0.019；F²= 0.09)是唯一的、负的结果预测因子，解释了18%的方差。在模型中加入显著的、阳性的、患者评价的联盟(β = .34, p = .003；F²= 0.13)使解释方差增加到25%。随后的分析表明，治疗排斥对预后的负面影响与ANT和联盟无关，而ANT对预后的负面影响部分被联盟的积极影响所介导（间接效应= -）。10、下水平置信区间= - 0.208；上水平置信区间= - 0.003)。我们讨论如何早期评估蚂蚁和治疗准备通知治疗计划。指出了本研究的局限性和研究的下一步。（PsycInfo Database Record (c) 2025 APA，版权所有）。

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来源期刊

Psychotherapy PSYCHOLOGY, CLINICAL-

CiteScore

4.60

自引率

12.00%

发文量

期刊介绍： Psychotherapy Theory, Research, Practice, Training publishes a wide variety of articles relevant to the field of psychotherapy. The journal strives to foster interactions among individuals involved with training, practice theory, and research since all areas are essential to psychotherapy. This journal is an invaluable resource for practicing clinical and counseling psychologists, social workers, and mental health professionals.