Patient coordination: Contrasts with other conceptualizations of patients' contribution to the alliance and validity in insight-oriented psychotherapy

This article describes how the patient coordination construct contrasts with the bond and collaboration conceptualizations of the alliance, and reports on an initial investigation of the validity of patient coordination in the context of insight-oriented psychotherapy. In contrast with other approaches, the coordination construct focuses on the kinds of complex defensive patterns that appear prominently in clinical discussions of problematic patient behavior. As predicted, a group of relatively higher functioning outpatients was significantly more coordinating in interpersonal behavior in therapy than a group of more seriously disturbed hospitalized patients. In another comparison, patients in therapy with experienced therapists were significantly more coordinating than patients treated by untrained 'alternate' therapists. Results also offered preliminary demonstration of the discriminant validity of patient coordination. Discussion includes consideration of how the coordination construct could contribute to future research on the alliance.