Alliance process in a successful case of online psychodynamic psychotherapy for anxiety

The therapeutic alliance (TA) is one of the main predictors of good psychotherapeutic outcomes. Currently, intensive studies of the TA process in online psychotherapy are scarce. This study aimed to describe the TA process throughout the online treatment, considering indicators present in the psychotherapeutic process in general and the perception of the dyad regarding its level throughout the sessions (macroprocess). Studies involving the multilevel analysis of TA contribute to a better understanding and establishment of this in treatments. This was a naturalistic design through a systematic case study. A psychoanalytic therapist and a young adult patient with complaints of anxiety symptoms participated. The treatment consisted of 24 online sessions, videotaped, and transcribed and its outcome was considered successful. Data were collected using the Psychotherapy Process Q-Set, Working Alliance Inventory and the Rupture Resolution Rating System and analyzed using descriptive data. The results indicated a general collaborative process and high values on the part of the patient and the therapist in the domains of the TA (tasks, goals, and bond). In the microprocess, there were more avoidance disruptions and greater global impact of resolutions than there were disruptions. These findings were discussed from a psychodynamic perspective and constitute idiosyncrasies of care with this public. Finally, the limitations and suggestions for further studies regarding the alliance process in online psychotherapy are discussed.