151
|
Abstract
Twelve individuals (four homeless, two formerly homeless, and six low-income) received 12 weeks of free health coaching, an intervention normally undertaken by clients who pay $40 to $200 out of pocket for coaching services. The health coaching relationships were conducted with protocols developed for managing executive health at a Fortune 100 firm. This experimental model was constructed to explore what happens when coaching conversations for change and possibility are delivered to marginalized and underserved communities that typically undergo vastly different interactions with authorities in law, healthcare, and social services. Phase 1 of the project recruited the homeless individuals from street sites throughout San Francisco, California, and a temporary shelter. Phase 2 of the project worked with low-income and formerly homeless individuals who occupied a subsidized housing complex. Of the coaching recipients, three were black, five were Hispanic, three were of mixed race, and one declined to disclose his ethnicity. Half were Spanish speaking; immigrant status was recent for five of the 12. None had ever talked with a health coach before; only three knew how to utilize low-cost public health clinics. This case report illustrates how the motivational power of coaching conversations was a modestly useful methodology in breaking through the social isolation and loneliness of street-dwelling adults with chronic health problems. It also was a useful methodology for developing capacity for accomplishing short-term goals that were self-identified. Additionally, health coaching presented an opportunity for transitioning poverty-level individuals from passive recipients using public health sector services to more empowered actors with first-stage awareness who initiated preventive health actions.
Collapse
Affiliation(s)
- Meg Jordan
- California Institute of Integral Studies, San Francisco, United States
| |
Collapse
|
152
|
Abstract
OBJECTIVE The purposes of this article were to compare the characteristics of the vocal quality of therapists and patients in change and stuck episodes, and to depict patient-therapist interaction sequences of vocal properties, in order to analyze micro-regulatory processes within the psychotherapeutic interaction. METHOD Application of the Vocal Quality Patterns coding system to a study of a sample of change and stuck episodes, taken from six psychotherapies. RESULTS The results made it possible to show that the 15 psychotherapeutic change process are embodied in the modes of vocal expression of their participants, and that the way in which these different modes are coordinated within the interaction makes it possible to observe regulatory micro-sequences that participate in the therapeutic change process.
Collapse
Affiliation(s)
- Alemka Tomicic
- a Department of Psychology , Universidad de Los Andes , Santiago , Chile
| | | | | |
Collapse
|
153
|
Cronin E, Brand BL, Mattanah JF. The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. Eur J Psychotraumatol 2014; 5:22676. [PMID: 24616755 PMCID: PMC3946510 DOI: 10.3402/ejpt.v5.22676] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/05/2013] [Accepted: 01/22/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Research has shown that the therapeutic alliance plays an important role in enhancing treatment outcome among individuals with a variety of disorders, including posttraumatic stress disorder (PTSD). However, the therapeutic alliance and treatment outcome has not yet been studied in dissociative disorders (DD). OBJECTIVES The current study sought to investigate the impact of alliance on treatment outcome for DD patients. METHODS Data from a naturalistic, longitudinal international treatment study of DD patients and their therapists were analyzed to determine if the alliance, as reported by patients and therapists, was associated with treatment outcome. RESULTS Patients with higher self-rated alliance had fewer symptoms of dissociation, PTSD, and general distress, as well as higher levels of therapist-rated adaptive functioning. Over time, self-rated alliance scores predicted better outcomes, after controlling for patient adaptive capacities including symptom management at the time when the alliance ratings were made. Patient-rated alliance was more strongly associated with outcome than therapist-rated alliance. CONCLUSION Therapists who work with DD patients should understand the importance of the alliance on treatment outcome. These findings are consistent with previous literature demonstrating the importance of developing and maintaining a strong therapeutic alliance, although the effect sizes of individuals with DD were stronger than what has been found in many other patient groups. A greater understanding of the impact of the alliance in traumatized individuals may contribute to better outcomes for these individuals.
Collapse
Affiliation(s)
| | - Bethany L Brand
- Department of Psychology, Towson University, Towson, MD, USA
| | | |
Collapse
|
154
|
Roosevelt LK, Holland KJ, Hiser J, Seng JS. Psychometric assessment of the Health Care Alliance Questionnaire with women in prenatal care. J Health Psychol 2013; 20:1013-24. [PMID: 24155197 DOI: 10.1177/1359105313506027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current study assessed the reliability and validity of the Health Care Alliance Questionnaire, which was developed using a Delphi process and embedded in an ongoing perinatal outcomes study. The Health Care Alliance Questionnaire exhibited content and face validity and high reliability. Results indicated concurrent validity in relation to satisfaction with practitioner and discriminant validity in relation to interpersonal sensitivity and posttraumatic stress disorder. The Health Care Alliance Questionnaire demonstrated predictive validity in relation to perceptions of practitioner's care during labor and postpartum depression. Overall, results suggest that alliance may be an important factor in maternity care processes and outcomes. Further psychometric work is warranted.
Collapse
|
155
|
Arnow BA, Steidtmann D, Blasey C, Manber R, Constantino MJ, Klein DN, Markowitz JC, Rothbaum BO, Thase ME, Fisher AJ, Kocsis JH. The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression. J Consult Clin Psychol 2013; 81:627-38. [PMID: 23339536 PMCID: PMC3742444 DOI: 10.1037/a0031530] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study tested whether the quality of the patient-rated working alliance, measured early in treatment, predicted subsequent symptom reduction in chronically depressed patients. Secondarily, the study assessed whether the relationship between early alliance and response to treatment differed between patients receiving cognitive behavioral analysis system of psychotherapy (CBASP) vs. brief supportive psychotherapy (BSP). METHOD 395 adults (57% female; Mage = 46; 91% Caucasian) who met criteria for chronic depression and did not fully remit during a 12-week algorithm-based, open-label pharmacotherapy trial were randomized to receive either 16-20 sessions of CBASP or BSP in addition to continued, algorithm-based antidepressant medication. Of these, 224 patients completed the Working Alliance Inventory-Short Form at Weeks 2 or 4 of treatment. Blind raters assessed depressive symptoms at 2-week intervals across treatment using the Hamilton Rating Scale for Depression. Linear mixed models tested the association between early alliance and subsequent symptom ratings while accounting for early symptom change. RESULTS A more positive early working alliance was associated with lower subsequent symptom ratings in both the CBASP and BSP, F(1, 1236) = 62.48, p < .001. In addition, the interaction between alliance and psychotherapy type was significant, such that alliance quality was more strongly associated with symptom ratings among those in the CBASP treatment group, F(1, 1234) = 8.31, p = .004. CONCLUSIONS The results support the role of the therapeutic alliance as a predictor of outcome across dissimilar treatments for chronic depression. Contrary to expectations, the therapeutic alliance was more strongly related to outcome in CBASP, the more directive of the 2 therapies.
Collapse
Affiliation(s)
- Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5722,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
156
|
Abstract
Research into psychosocial interventions (particularly cognitive-behavior therapies and social skills training) for social-communication deficits among individuals with autism spectrum disorder (ASD) has proliferated over the past decade. While this research has provided some empirical support for the efficacy of these interventions, little work has begun to elucidate therapeutic mechanisms-the when, why, how, for whom, and under what conditions an intervention may produce change, identification of mechanisms underlying these effects should help advance ASD intervention research. This article describes methods for assessing such mechanisms (ie, mediators and moderators) and presents promising candidates for common mechanisms impacting treatment response: behavior modification, therapeutic relationship, social knowledge, social motivation, social information processing, executive functioning, and internalizing comorbidities. Finally, future directions are discussed as a program of psychosocial intervention research designed to identify predictors of individual differences in treatment response (including biomarkers), isolate active therapeutic ingredients, and promote dissemination of optimized interventions.
Collapse
Affiliation(s)
- Matthew D Lerner
- Department of Psychology, University of Virginia, Charlottesville, VA 22904-4400, USA.
| | | | | |
Collapse
|
157
|
Johansen R, Iversen VC, Melle I, Hestad KA. Therapeutic alliance in early schizophrenia spectrum disorders: a cross-sectional study. Ann Gen Psychiatry 2013; 12:14. [PMID: 23656747 PMCID: PMC3661357 DOI: 10.1186/1744-859x-12-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/30/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The therapeutic alliance is related to better course and outcome of treatment in schizophrenia. This study explores predictors and characteristics of the therapeutic alliance in recent-onset schizophrenia spectrum disorders including the agreement between patient and therapist alliance ratings. METHODS Forty-two patients were assessed with demographic, neurocognitive, and clinical measures including the Positive and Negative Syndrome Scale (PANSS). The therapeutic alliance was measured with the Working Alliance Inventory - Short Form (WAI-S). RESULTS Patient WAI-S total scores were predicted by age and PANSS excitative symptoms. Therapist WAI-S total scores were predicted by PANSS insight. Patient and therapist WAI-S total scores were moderately associated. Neurocognition was not associated with working alliance. CONCLUSION Working alliance is associated with specific demographic and symptom characteristics in patients with recent-onset schizophrenia spectrum disorders. There is moderate agreement between patients and therapists on the total quality of their working alliance. Findings highlight aspects that may increase therapists' specificity in the use of alliance-enhancing strategies.
Collapse
Affiliation(s)
- Ragnhild Johansen
- Forensic Department Brøset, Centre for Research and Education in Forensic Psychiatry, St, Olav's Hospital, Trondheim University Hospital, P, Box 3008 Lade, Trondheim, 7441, Norway.
| | | | | | | |
Collapse
|
158
|
Mander J, Teufel M, Keifenheim K, Zipfel S, Giel KE. Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa. BMC Psychiatry 2013; 13:111. [PMID: 23570454 PMCID: PMC3626571 DOI: 10.1186/1471-244x-13-111] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/27/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with high rates of chronicity and relapse risk is a considerable therapeutic challenge in the disorder. The aim of the present study was to investigate the association of stages of change and outcome with a focus on the relapse struggle in the maintenance stage in patients with predominantly chronic AN. Further, therapeutic alliance and stages of change associations were explored. METHODS As an instrument measuring relapse struggle in the maintenance stage, we applied the short form of the University of Rhode Island Change Assessment-Short (URICA-S). We assessed stages of change in 39 patients with a predominantly chronic course of AN in early, middle, and late stages of inpatient psychotherapy. General symptom severity as assessed by the SCL-90-R and weight change were investigated as outcome measures. RESULTS In-line with earlier evidence, contemplation significantly predicted therapeutic alliance. Further, we demonstrated that relapse risk as operationalized by URICA-S maintenance is an important predictor of general psychopathology. BMI change was not predicted by stages of change. CONCLUSIONS The URICA-S maintenance scale might be applied to help identify patients at relapse risk. High URICA-S maintenance scores could be considered as one critical aspect of AN patients who might especially benefit from relapse-preventing aftercare programs.
Collapse
Affiliation(s)
- Johannes Mander
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Katharina Keifenheim
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| |
Collapse
|
159
|
Abstract
This study examined the psychometric properties of the Therapeutic Alliance Scale for Caregivers and Parents (TASCP) in a sample of 209 caregivers whose children (4-13 years of age) presented with disruptive behavior problems to a publicly funded outpatient mental health clinic in San Diego County. Information about therapeutic alliance was collected from caregivers, children, and their therapists across the course of therapy (up to 16 months). Results support the reliability, temporal stability, convergent validity, and discriminant validity of scores on the TASCP. The multilevel factor structure of this new measure was consistent with the parallel child-report version, with 2 within-level factors and 1 between-level factor. Furthermore, predictive validity was strong, with stronger caregiver-reported alliance associated with less treatment dropout, more sessions attended, and greater satisfaction with perceived improvement.
Collapse
Affiliation(s)
- Erin C Accurso
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, MC 3077, Chicago, IL 60637, USA.
| | | | | |
Collapse
|
160
|
Thompson L, McCabe R. The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry 2012; 12:87. [PMID: 22828119 PMCID: PMC3528426 DOI: 10.1186/1471-244x-12-87] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/06/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nonadherence to mental health treatment incurs clinical and economic burdens. The clinician-patient alliance, negotiated through clinical interaction, presents a critical intervention point. Recent medical reviews of communication and adherence behaviour exclude studies with psychiatric samples. The following examines the impact of clinician-patient alliance and communication on adherence in mental health, identifying the specific mechanisms that mobilise patient engagement. METHODS In December 2010, a systematic search was conducted in Pubmed, PsychInfo, Web of Science, Cochrane Library, Embase and Cinahl and yielded 6672 titles. A secondary hand search was performed in relevant journals, grey literature and reference. RESULTS 23 studies met the inclusion criteria for the review. The methodological quality overall was moderate. 17 studies reported positive associations with adherence, only four of which employed intervention designs. 10 studies examined the association between clinician-patient alliance and adherence. Subjective ratings of clinical communication styles and messages were assessed in 12 studies. 1 study examined the association between objectively rated communication and adherence. Meta-analysis was not possible due to heterogeneity of methods. Findings were presented as a narrative synthesis. CONCLUSIONS Clinician-patient alliance and communication are associated with more favourable patient adherence. Further research of observer rated communication would better facilitate the application of findings in clinical practice. Establishing agreement on the tasks of treatment, utilising collaborative styles of communication and discussion of treatment specifics may be important for clinicians in promoting cooperation with regimens. These findings align with those in health communication. However, the benefits of shared decision making for adherence in mental health are less conclusive than in general medicine.
Collapse
Affiliation(s)
- Laura Thompson
- Unit for Social and Community Psychiatry, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK
| | - Rose McCabe
- Unit for Social and Community Psychiatry, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK
| |
Collapse
|
161
|
Jansen M, van Doorn MMEM, Lichtwarck-Aschoff A, Kuijpers RCWM, Theunissen H, Korte M, van Rossum J, Wauben A, Granic I. Effectiveness of a cognitive-behavioral therapy (CBT) manualized program for clinically anxious children: study protocol of a randomized controlled trial. BMC Psychiatry 2012; 12:16. [PMID: 22404798 PMCID: PMC3316128 DOI: 10.1186/1471-244x-12-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 03/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Netherlands, the prevalence of anxiety disorders is 20%; and children with anxiety are at increased risk for psychopathology throughout adulthood. Recently, a revised version of a cognitive behavioral therapy manualized program called 'Thinking + Doing = Daring' (TDD) was developed for children between 8 and 12 years old with an anxiety disorder. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of TDD. METHODS/DESIGN The CBT program will be tested with a RCT with 120 clinically anxious children (8-12 years old) referred to one of three mental health care agencies. Children will be randomly assigned to the experimental (N = 60, TDD) or to the control condition (N = 60, treatment as usual). The primary outcome measure will be the child's anxiety symptoms level. Secondary outcome measures will be externalizing (e.g. aggression) and internalizing problems (e.g. depression). Two potential mediators of change will be examined in the current study: therapeutic alliance and parenting. Mother and child in both the experimental and control condition will be surveyed at baseline, post treatment and after 6 and 12 months (follow-up). It is hypothesized that children in the experimental condition will show a stronger decrease in anxiety symptoms compared to children that receive treatment as usual. Moreover, we expect that a strong therapeutic alliance and decreases in parental control and rejection will contribute to treatment success. DISCUSSION Early treatment for anxiety problems has the potential to not only result in anxiety reductions, but also to prevent future problems such as substance abuse and psychopathology throughout adulthood. Our results will be immediately relevant to practice, since we are partnering with 'real world' community agencies. If the CBT program proves more effective than treatment as usual, it could be implemented in community mental health care agencies across the Netherlands and beyond. Moreover, it has the potential to make treatment in these community settings shorter, more efficient and therefore cost-effective. TRIAL REGISTRATION Nederlands Trial Register NTR2967.
Collapse
Affiliation(s)
- Mélou Jansen
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands.
| | - Marleen MEM van Doorn
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands,Pro Persona Youth Arnhem, Klingelbeekseweg 19, 6812 DE Arnhem, The Netherlands
| | - Anna Lichtwarck-Aschoff
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | - Rowella CWM Kuijpers
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands,Ambulatorium Nijmegen, Montessorilaan 10, 6525 HR Nijmegen, The Netherlands
| | - Huub Theunissen
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands,Ambulatorium Nijmegen, Montessorilaan 10, 6525 HR Nijmegen, The Netherlands
| | - Mirjam Korte
- Pro Persona Youth Arnhem, Klingelbeekseweg 19, 6812 DE Arnhem, The Netherlands,Pro Persona Youth Nijmegen, Tarweweg 2, 6534 AM Nijmegen, The Netherlands
| | - José van Rossum
- Pro Persona Youth Nijmegen, Tarweweg 2, 6534 AM Nijmegen, The Netherlands
| | - Annemiek Wauben
- Pro Persona Youth Nijmegen, Tarweweg 2, 6534 AM Nijmegen, The Netherlands
| | - Isabela Granic
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| |
Collapse
|
162
|
Noyes R, Kukoyi OA, Longley SL, Langbehn DR, Stuart SP. Effects of continuity of care and patient dispositional factors on the physician-patient relationship. Ann Clin Psychiatry 2011; 23:180-5. [PMID: 21808749 PMCID: PMC4920260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND We developed a questionnaire to examine the influence of physician and patient variables on the quality of the physician-patient relationship. METHODS More than 300 family medicine patients completed self-report measures of the physician-patient relationship and variables likely to influence it. RESULTS The quality of relationship was related to continuity of physician care (having a primary physician, duration of that relationship, and frequency of visits) and to patient dispositional variables (neuroticism, positive and negative affectivity) but not to demographic variables. The regression model included having a primary physician, duration of relationship with that physician, and positive affectivity. Relationship quality was, in turn, associated with outcomes (adherence to care, treatment response, satisfaction with care, and commitment to physician). CONCLUSIONS The quality of physician-patient relationship is influenced by physician continuity and patient dispositional variables. Better understanding of these may contribute to the therapeutic potential of this important relationship.
Collapse
Affiliation(s)
- Russell Noyes
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
| | | | | | | | | |
Collapse
|
163
|
Gibbons CJ, Nich C, Steinberg K, Roffman RA, Corvino J, Babor TF, Carroll KM. Treatment process, alliance and outcome in brief versus extended treatments for marijuana dependence. Addiction 2010; 105:1799-808. [PMID: 20840200 PMCID: PMC3422659 DOI: 10.1111/j.1360-0443.2010.03047.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome. DESIGN Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated. FINDINGS Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence. CONCLUSIONS Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence.
Collapse
Affiliation(s)
- Carly J. Gibbons
- Yale University, VA CT Healthcare Center (151D), West Haven, CT, USA
| | - Charla Nich
- Yale University, VA CT Healthcare Center (151D), West Haven, CT, USA
| | - Karen Steinberg
- University of Connecticut Health Center, Farmington, CT, USA
| | | | - Joanne Corvino
- Yale University, VA CT Healthcare Center (151D), West Haven, CT, USA
| | - Thomas F. Babor
- University of Connecticut Health Center, Farmington, CT, USA
| | | |
Collapse
|
164
|
Strauss JL, Hayes AM, Johnson SL, Newman CF, Brown GK, Barber JP, Laurenceau JP, Beck AT. Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. J Consult Clin Psychol 2006; 74:337-45. [PMID: 16649878 PMCID: PMC3268072 DOI: 10.1037/0022-006x.74.2.337] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last session. Alliance variables were patients' first alliance rating and "rupture-repair" episodes, which are disruptions in the therapeutic relationship that can provide corrective experiences and facilitate change. Stronger early alliances and rupture-repair episodes predicted more improvement in symptoms of personality disorder and depression. This work points to potentially important areas to target in treatment development for these personality disorders.
Collapse
|