Research on psychotherapy integration: Recommendations and conclusions from an NIMH workshop

Pretreatment correlates of the therapeutic bond

This study examined the association between pretreatment client characteristics and the therapeutic bond, which is defined as the emotional aspect of the therapeutic alliance. Three types of interpersonal problems and four indicators of emotional distress were measured and compared to the therapeutic bond and its subscales (role investment, empathic resonance, and mutual affirmation) measured early in treatment. Interpersonal problems related to being overly detached were associated with a poorer quality bond and, in particular, with a tendency to feel as if the therapist does not understand what the client is thinking and feeling (lower empathic resonance). Higher levels of distress were correlated negatively with the therapeutic bond. Analyses indicated that interpersonal problems were better predictors of the bond than was distress. The relevance of these findings for practitioners is discussed.

Escala de Aliança Psicoterápica da Califórnia na versão do paciente

OBJETIVO: A aliança terapêutica corresponde a um conceito central do processo psicoterápico. Este estudo produziu a tradução para o português e examinou a confiabilidade da Calpas-P (Escala de Aliança Psicoterápica da Califórnia - versão do paciente). MÉTODOS: Para a tradução, foi adotada a técnica da retrotradução, realizada por indivíduos bilíngües. Para o estudo de confiabilidade, uma amostra de profissionais de saúde mental, atendidos em psicoterapia individual, foi convidada para responder a versão em português da Calpas-P. RESULTADOS: Um total de 83 questionários foi devolvido. As médias das quatro escalas da Calpas-P foram: 5,66 para a PC; 5,20 para a PWC; 6,10 para a TUI; e 5,99 para a WSC. As escalas mostraram uma alta correlação entre si, com valores variando de 0,57 a 0,74. O Alpha de Cronbach para a Calpas-P também foi alto: 0,90 para todos os itens; 0,71 para a PC; 0,56 para a PWC; 0,71 para a TUI; e 0,84 para a WSC. CONCLUSÃO: Esses coeficientes apresentaram índices superiores, quando comparados àqueles do estudo original, na versão em inglês. A presente investigação, que tornou disponível a versão em português da Calpas-P e algumas de suas características psicométricas, pode contribuir para uma mensuração mais cuidadosa da aliança terapêutica por meio de sua inclusão em pesquisas futuras na psicoterapia.

Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review

To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.

Psychotherapy for patients with complex disorders and chronic symptoms. The need for a new research paradigm

BACKGROUND

A clear distinction has been made between efficacy and effectiveness in relation to the methods of evaluation of new psychological treatments in psychiatry. Efficacy trials target patients with relatively pure conditions, who may not be representative of the patients who are usually referred for psychological treatment in a clinical setting. Few studies have explored the benefits of psychotherapy in patients with complex disorders and enduring symptoms.

AIMS

To explore the rationale for the distinction between efficacy and effectiveness, particularly in relation to outcome studies of patients with complex and enduring disorders.

METHOD

A narrative review with examples drawn from the literature, and an illustration of a recent naturalistic outcome study which combines features of both efficacy and effectiveness.

RESULTS

Studies of patients with complex and mixed disorders can be designed so that they retain internal validity, but also have external validity and are relevant to clinical practice.

CONCLUSION

Studies which evaluate psychological interventions should be carried out in populations of patients clinically representative of those who are likely to receive the intervention, should it be shown to be of benefit.

Role of theoretical bias in therapeutic interventions: to see or not to see?

Considering the role of theory in child psychosocial treatment, it is important to acknowledge some of its associated problems. Among the shortcomings of theory discussed in this article are its potential for biasing what we see and do clinically, the arbitrary nature of some theoretical explanations, and the way that theory-based jargon can interfere with communication. A bottom-up approach to the development of clinical principles is advocated instead, especially when these principles are derived from the convergence of clinical observation and research findings.

The therapeutic alliance--a conceptual analysis

The role and function of the therapeutic alliance in psychotherapy has increasingly been the focus of clinicians' and researchers' interests over the last decade. Alliance concepts have, however, been criticized for lack of conceptual clarity. The paper presents a generic model as a heuristic means for clarifying the conceptual meaning of the therapeutic alliance. The model distinguishes between the personal relationship aspect, and the collaborative, task-related aspect of the alliance, with therapist, patient, and common contributions to each of these aspects. The model is compared to other alliance conceptualizations, and its implications for alliance theory and research are discussed. A content analysis of four widely used alliance scales in relation to the model shows the scales to represent conceptually different, yet overlapping constructs. It is argued that the componential nature of the therapeutic alliance will render difficult any interpretation of findings regarding the relationship between alliance and outcome in traditional process-outcome research. More complex research strategies guided by theory are called for, if the therapeutic alliance should remain a vital field of research.