Processes that lead to normal development of the representations of self and others are also central to understanding processes of therapeutic change. These processes primarily manifest themselves through the dialectical interpersonal exchanges of gratification and frustration, of disruptions and repair that are central to the development of the self.

To evaluate the contribution of different attributes of interpersonal relationships to the development of the self and patients’ well-being during the course of psychotherapy of adolescents and young adults.

To map the different paths to positive therapeutic gains in psychotherapy.

36 adolescents and young adults were evaluated during the course of 12-month intensive psychodynamic psychotherapy. Main outcome measures were changes in the Differentiation-Relatedness scores of mother, father, significant other, self and therapist and GAF scores.

We found that changes in the level of differentiation-relatedness in patients’ self-representation were primarily associated with changes in the level of differentiation-relatedness of their description of their therapist. A best-fit model indicated that beyond change in the patient's description of the therapist and of a self-designated significant other outside the family added significantly to the explained variance predicting change in self-representation. Exploratory structural equation modeling also suggested that patients’ growing recognition of the therapeutic relationship (measured by a more matured representation of the therapist) is associated with the patients’ overall level of clinical functioning.

These results add further support to the importance of the therapeutic relationship in building more differentiated and integrated representations of self and of significant others.