Clients’ TAT Interpersonal Decentering Predicts Psychotherapy Retention and Process

Abstract

This naturalistic pilot study examined interpersonal decentering, a form of social cognitive maturity and self–other mentalizing scored from the Thematic Apperception Test, as a client personality variable that might predict psychotherapy retention and clients’ perceptions of in-session process. Clients having difficulty with mature decentering might struggle to engage in therapy, need different interventions, and be at risk for therapy dropout. Thematic Apperception Test stories were gathered from new outpatient therapy clients soon after their intake session. Interpersonal decentering scores from the nine stories were used to predict outpatients’ therapy attrition or perceptions of psychotherapy process four to six sessions later. Clients’ perceptions of therapy events commonly associated differentially with psychodynamic and cognitive-behavioral therapies were measured using self-rated items from the Psychotherapy Process Q-set. Lower decentering scores predicted early attrition (before Session 6). Clients with more mature decentering scores reported more frequent psychodynamic relative to cognitive-behavioral therapy process events in these early sessions. Lower decentering maturity may limit clients’ processing of psychodynamic interventions. Interpersonal decentering may be a valuable, easy-to-score assessment tool for predicting attrition risk and making treatment planning recommendations for intervention strategies.