A moderating factor for patients with vindictive interpersonal problems.

Clinical Impact Statement—Question: Can more positive alliance expectations serve as a resilience factor in the early process and outcome of treatment for patients with vindictive interpersonal problems. Findings: Patients with higher levels of vindictive interpersonal problems who are able to hold higher expectations from the therapist before the start of treatment are less at risk to show early confrontation ruptures and more likely to have early reduction in distress from interpersonal relations. Meaning: The study highlights an optimistic view for patients with vindictive interpersonal problems, in which positive expectations from the alliance before the start of treatment may function as a resilience factor enabling a better process and early outcome. Next Steps: Future studies should systematically examine the long-term effects of positive alliance expectations as a resilience factor for treatment success in patients with higher levels of vindictive interpersonal problems.