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Sulaman I, Hartley S, Elvins R. Therapeutic alliance in the treatment of adolescent substance misuse: a systematic review. Child Adolesc Ment Health 2024; 29:226-241. [PMID: 37528449 DOI: 10.1111/camh.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Therapeutic alliance has been found to play an influential role in predicting outcomes for adults and adolescents in psychotherapy. However, thus far, the information concerning the impact of therapeutic alliance on outcomes for adolescents in treatment for substance misuse has not yet been critically synthesised. METHODS In accordance with PRISMA guidelines, the current review aimed to systematically collate published research investigating the association between alliance and outcomes for adolescents undergoing substance misuse treatment. Database searching produced 1083 records, with 16 studies meeting eligibility criteria. RESULTS Twelve out of the 16 studies (75%) reported significant alliance-outcome relationships, whereby higher alliance ratings predicted better treatment outcomes, as well as improved engagement and retention in treatment. In addition, the review explored the conditions whereby alliances better predict outcomes, with reference to the alliance rater, the timing of the alliance rating and comorbid diagnoses. These results, however, largely remain inconclusive. CONCLUSIONS The evidence as it stands demonstrates the importance of the therapeutic alliance in predicting outcomes for adolescents in substance misuse treatments. The implications of the review's findings and recommendations for future research are discussed.
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Affiliation(s)
- Iniyah Sulaman
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- GMMH NHS Foundation Trust, Manchester, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- CAMHS at Pennine Care NHS Foundation Trust, Manchester, UK
| | - Rachel Elvins
- Royal Manchester Children's Hospital & Salford CAMHS, Manchester, UK
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2
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Lalk C, Steinbrenner T, Kania W, Popko A, Wester R, Schaffrath J, Eberhardt S, Schwartz B, Lutz W, Rubel J. Measuring Alliance and Symptom Severity in Psychotherapy Transcripts Using Bert Topic Modeling. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:509-524. [PMID: 38551767 PMCID: PMC11196307 DOI: 10.1007/s10488-024-01356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 06/25/2024]
Abstract
We aim to use topic modeling, an approach for discovering clusters of related words ("topics"), to predict symptom severity and therapeutic alliance in psychotherapy transcripts, while also identifying the most important topics and overarching themes for prediction. We analyzed 552 psychotherapy transcripts from 124 patients. Using BERTopic (Grootendorst, 2022), we extracted 250 topics each for patient and therapist speech. These topics were used to predict symptom severity and alliance with various competing machine-learning methods. Sensitivity analyses were calculated for a model based on 50 topics, LDA-based topic modeling, and a bigram model. Additionally, we grouped topics into themes using qualitative analysis and identified key topics and themes with eXplainable Artificial Intelligence (XAI). Symptom severity could be predicted with highest accuracy by patient topics ( r =0.45, 95%-CI 0.40, 0.51), whereas alliance was better predicted by therapist topics ( r =0.20, 95%-CI 0.16, 0.24). Drivers for symptom severity were themes related to health and negative experiences. Lower alliance was correlated with various themes, especially psychotherapy framework, income, and everyday life. This analysis shows the potential of using topic modeling in psychotherapy research allowing to predict several treatment-relevant metrics with reasonable accuracy. Further, the use of XAI allows for an analysis of the individual predictive value of topics and themes. Limitations entail heterogeneity across different topic modeling hyperparameters and a relatively small sample size.
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Affiliation(s)
- Christopher Lalk
- Department of Psychology, Osnabrück University, Osnabrück, Germany.
| | | | - Weronika Kania
- Department of Psychology, Osnabrück University, Osnabrück, Germany
| | - Alexander Popko
- Department of Psychology, Osnabrück University, Osnabrück, Germany
| | - Robin Wester
- Department of Psychology, Osnabrück University, Osnabrück, Germany
| | - Jana Schaffrath
- Department of Psychology, University of Trier, Trier, Germany
| | | | - Brian Schwartz
- Department of Psychology, University of Trier, Trier, Germany
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Julian Rubel
- Department of Psychology, Osnabrück University, Osnabrück, Germany
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3
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Clements-Hickman AL, Reese RJ. The person of the therapist: therapists' personal characteristics as predictors of alliance and treatment outcomes. Psychother Res 2023; 33:173-184. [PMID: 35634653 DOI: 10.1080/10503307.2022.2080610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objective Studies examining the unique contribution that the therapist has on outcomes (i.e., "therapist effects") have increased in recent years. Therapist effects are believed to occur via how the therapist's interpersonal and intrapersonal qualities influence the therapeutic relationship, which in turn influences outcomes. The current study focused on the extent to which professional self-doubt, counseling self-efficacy, and humility are therapist qualities that influence treatment outcomes. Methods: Data were collected from 46 therapists at a multi-site community behavioral health organization. Therapists completed measures of therapist characteristics. Therapists' responses were matched with de-identified archival client data (N = 1, 817) that contained an outcome and alliance measure administered every session. Multilevel modeling was used to determine the extent to which therapists' personal characteristics predicted client outcomes. Results: Results of the unconditional model for the alliance measure indicated a lack of growth in alliance scores across treatment. Approximately 5% of the variance in rate of growth for treatment outcome was between therapists. When controlling for the effects of counseling self-efficacy, professional self-doubt was marginally significant. When counseling-self-efficacy was removed from the model, professional self-doubt was no longer marginally significant. Conclusion: The findings highlight the complexity of therapist effects and the need for future research on this topic.
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Affiliation(s)
| | - Robert J Reese
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, AL, USA
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Chandra S, Shirish A, Srivastava SC. To Be or Not to Be …Human? Theorizing the Role of Human-Like Competencies in Conversational Artificial Intelligence Agents. J MANAGE INFORM SYST 2022. [DOI: 10.1080/07421222.2022.2127441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Anuragini Shirish
- Université Paris-Saclay, Univ Evry, IMT-BS, LITEM, Evry-Courcouronnes, France
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5
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Validation of the French versions of two brief, clinician-friendly outcome monitoring tools: the ORS and SRS. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Meier ST. Investigation of causes of ceiling effects on working alliance measures. Front Psychol 2022; 13:949326. [PMID: 35936314 PMCID: PMC9353022 DOI: 10.3389/fpsyg.2022.949326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
The presence of ceiling effects on measures of working alliance is important because they (a) may moderate the observed size of the alliance-outcome correlation and (b) have implications for how quickly the alliance is formed and when. Despite this, little is known about ceiling effects on alliance measures, particularly about potential causes. This study attempted to replicate findings of ceiling effects using a 7-item version of the Working Alliance Inventory (WAI) (Horvath and Greenberg, 1989) accessed in an archival database of 616 parolees enrolled in a drug abuse treatment study. Item response patterns on alliance and related measures were examined to explore potential methodological and theoretical factors that could produce ceiling effects. Analyses revealed ceiling effects on alliance measures assessing relationships with counselors and parole officers as well as floor effects (indicating highly positive appraisals) in measures of outcome expectations with counselors and parole officers. No ceiling effects were found with measures of drug use problems or negative affect. Item responses on the alliance and outcome expectations measures evidenced high consistency where many respondents endorsed the same choice on the 5-point response format across all items on the scale. Ceiling effects offer a potential marker of the working alliance at the scale level, while consistent response choice may provide a specific behavioral marker at the item level. Discussion focuses on theoretical implications and directions for future research in psychotherapy.
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7
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Quirk K, Drinane JM, Edelman A, Chow D, Lim J, Chandra D, Miller S, Owen J. The Alliance-Outcome Association in Couple Therapy: A Common Fate Model. FAMILY PROCESS 2021; 60:741-754. [PMID: 34037992 DOI: 10.1111/famp.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The working alliance has been shown to be a robust predictor of couple therapy outcomes. However, there are still questions regarding the best way to conceptualize and analyze the association between the alliance and outcomes in the couple therapy context. This study presents results from a relatively novel analytic approach for evaluating the alliance and therapy outcomes via the shared influence model (i.e., common fate statistical methodology) with 93 couples who had at least three sessions. Examining the alliance in couple therapy this way allows for nuance in conceptualizing the process of the alliance among partners and the therapist in couple therapy. Empirically, the question that remains is whether the shared experience of the alliance between partners is a stronger predictor of therapy outcome as compared to the unique individual experiences of the alliance. This approach has not yet been utilized to model the couple alliance-outcome association. Results revealed that the shared influence model demonstrated a significant association between the alliance and therapy outcome. Specifically, the couple-level alliance construct was adequately represented from the partners' alliance ratings with the therapist, and couples that report higher shared alliance experiences were also likely to have better therapy outcomes. These findings suggest that conceptualizing and analyzing the alliance at the couple level may be strongly advantageous. Implications for research and practice are provided.
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Affiliation(s)
- Kelley Quirk
- Colorado State University, Fort Collins, CO, USA
| | | | | | - Daryl Chow
- International Center for Clinical Excellence, Institute of Mental Health, Singapore, Singapore
| | - Joline Lim
- Eagles Mediation and Counselling Center, Singapore, Singapore
| | - Diana Chandra
- Eagles Mediation and Counselling Center, Singapore, Singapore
| | - Scott Miller
- International Center for Clinical Excellence, Chicago, IL, USA
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Hauber K, Boon A, Vermeiren R. Therapeutic Relationship and Dropout in High-Risk Adolescents' Intensive Group Psychotherapeutic Programme. Front Psychol 2020; 11:533903. [PMID: 33329172 PMCID: PMC7728845 DOI: 10.3389/fpsyg.2020.533903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Dropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the association between the therapeutic relationship and dropouts in an intensive mentalization-based treatment (MBT) for adolescents with personality disorders. Methods Patients (N = 105) included were either dropouts (N = 36) or completers (N = 69) of an intensive MBT. The therapeutic relationship was measured with the child version of the Session Rating Scale (C-SRS), which was completed by the patient after each group therapy session. For each patient, the treatment termination status (dropout or completer) was indicated by the treatment staff. The reliable change index (RCI) was calculated for the C-SRS to determine significant changes in the therapeutic relationship. Results While both groups started with similar scores on the C-SRS, the scores between dropouts and completers differed significantly at the end of the treatment period. On average, during therapy, an increase was seen in the scores of completers, and a decrease was seen in the scores of dropouts. While dropouts could not be predicted based on the C-SRS scores, a significant decrease (RCI) in C-SRS scores during the last two sessions occurred more often for dropouts than for completers. Conclusion Our findings show that to prevent dropouts, the patient’s judgment of the quality of the therapeutic relationship should be monitored continuously, and decreases discussed with the patient and the group.
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Affiliation(s)
- Kirsten Hauber
- Curium-LUMC, Oegstgeest, Netherlands.,Youz, The Hague, Netherlands
| | - Albert Boon
- Curium-LUMC, Oegstgeest, Netherlands.,Youz, The Hague, Netherlands
| | - Robert Vermeiren
- Curium-LUMC, Oegstgeest, Netherlands.,Youz, The Hague, Netherlands
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9
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Baier AL, Kline AC, Feeny NC. Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clin Psychol Rev 2020; 82:101921. [DOI: 10.1016/j.cpr.2020.101921] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
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10
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Meier ST. Construct Validity of Outcome Rating Scale (ORS) Scores in Clinical Samples: Extension of Harris, Murphy, and Rakes' (2019) Narrative Review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:648-661. [PMID: 32620070 DOI: 10.1080/26408066.2020.1784345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE A recent review of 24 studies primarily evaluated psychometric properties of the Outcome Rating Scale (ORS) related to coefficient alpha and convergent validity. METHOD To provide a fuller picture, this review examined effect size (ES) estimates and the full range of correlations between ORS scores and related measures. RESULTS Mean ORS ESs equaled 1.00 for 44 comparison periods. ORS scores correlated highest with measures of depression and evidenced larger ESs in depression treatments. DISCUSSION The ORS functions as a robust measure for detecting client progress in clinical samples that were primarily young, female, and Caucasian. Some results suggest ORS scores primarily reflect a rapid response to interventions. CONCLUSION AND LIMITATIONS Future research should assess ORS scores' psychometric properties in response to interventions with more heterogeneous client samples as well as its capacity to monitor change beyond initial sessions.
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Affiliation(s)
- Scott T Meier
- Department of Counseling, School, and Educational Psychology, University at Buffalo , Buffalo, NY, USA
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11
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Li L, Gan Y, Yang Y, Jiang H, Lu K, Zhou X, Nie Z, Opoku S, Zheng Y, Yu F, Lu Z. Analysis on professional identity and related factors among Chinese general practitioners: a National Cross-sectional Study. BMC FAMILY PRACTICE 2020; 21:80. [PMID: 32375674 PMCID: PMC7201728 DOI: 10.1186/s12875-020-01155-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies on professional identity and related factors among Chinese general practitioners (GPs) are unavailable. The objective of this study was to investigate the professional identity level of GPs in China and explore factors associated with GPs' perceptions of their professional identity. METHODS A multistage stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs working in community health service institutions (CHIs) in China between October, 2017 and February, 2018. Professional identity was measured by the 13 items scale. Descriptive statistics were calculated and groups' differences were estimated using nonparametric tests. Multiple linear stepwise regression analysis was used to analyze factors associated with professional identity among GPs. RESULTS Based on a total score of 65 on the professional identity scale, the average score for GPs' professional identity was 51.23 (SD = 6.56). Multiple linear stepwise regression analysis showed that GPs who practiced in Central China, with an administrative responsibility, at a moderate or higher income level, who frequently worked overtime, had more occupational development opportunities, with a higher level of job satisfaction and older GPs had higher levels of professional identity. CONCLUSIONS Professional identity level among GPs in China is high. Region, administrative responsibility, income level, working overtime, occupational development opportunities, age, and job satisfaction were significant predictors of professional identity.
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Affiliation(s)
- Liqing Li
- Department of Management Science and Engineering, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China.,Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yudi Yang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kai Lu
- Office of Student Affairs, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaogang Zhou
- School of Economics and Management, East China JiaoTong University, Nanchang, Jiangxi, China
| | - Zhiqiang Nie
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Sampson Opoku
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yanling Zheng
- Shouyilu Street Community Health Service Center of Wuchang District, Wuhan, Hubei, China
| | - Fang Yu
- Shouyilu Street Community Health Service Center of Wuchang District, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China.
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12
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Murphy MG, Rakes S, Harris RM. The Psychometric Properties of the Session Rating Scale: A Narrative Review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:279-299. [PMID: 32420833 DOI: 10.1080/26408066.2020.1729281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: The Session Rating Scale (SRS) is a measure used in psychotherapy practice. Given its application and frequent use in clinical practice settings, several studies including primary validation studies as well as outcome studies reporting psychometric properties have examined the validity and reliability of the SRS. Because the SRS is designed to be used in clinical practice, demonstration of reliability and validity is ideal with clinical populations instead of non-clinical populations. To our knowledge, there have been no reviews evaluating the psychometric properties of the SRS with clinical populations.Purpose: The aim of this study was to review and synthesize the psychometric properties of the SRS by examining all relevant outcome and validation studies.Methods: We completed an electronic literature search of several online databases in order to identify relevant articles. We identified 12 articles that met our inclusion and analyzed the reliability and validity evidence for the SRS with clinical populations.Results: Findings showed high internal consistency for the SRS and support evidence that the underlying dimension is a measure of therapeutic alliance. Test-retest reliability estimates were reported in 4 of the 12 studies included in this review (ranging from .54 to .70). The SRS had low to moderate concurrent validity with other longer measures of therapeutic alliance (.29 with ORS; .48 with HAQ II; .57-.65 with WAI).Discussion: Clinicians should be aware of the limitations in validity evidence for the SRS that may result from its brevity. However, clinicians should also consider the relative stability of the SRS as a pragmatic global measure of the construct of therapeutic alliance. Future research efforts should focus on validation of the SRS with larger, more diverse samples and specific clinical populations with a wider range of symptom severity.
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Affiliation(s)
- Melissa G Murphy
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Sarah Rakes
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Rachel M Harris
- College of Social Work, Florida State University, Tallahassee, Florida, USA
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Toland MD, Li C, Kodet J, Reese RJ. Psychometric Properties of the Outcome Rating Scale: An Item Response Theory Analysis. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1080/07481756.2020.1745647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Caihong Li
- University of Kentucky, Lexington, KY, USA
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de Oliveira Maraldi E. Response Bias in Research on Religion, Spirituality and Mental Health: A Critical Review of the Literature and Methodological Recommendations. JOURNAL OF RELIGION AND HEALTH 2020; 59:772-783. [PMID: 29770899 DOI: 10.1007/s10943-018-0639-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although a significant body of research supports the psychological benefits of religion and spirituality, more investigations are needed to understand the mechanisms by which they impact mental health. While some studies suggest a causal direct influence, the findings may still be subject to unmeasured factors and confounders. Despite compelling empirical support for the dangers of response bias, this has been a widely neglected topic in mental health research. The aim of this essay is to critically examine the literature addressing the role of response bias in the relationship between religion, spirituality and mental health. A survey of the diverse types of bias in this research area is presented, and methodological and theoretical issues are outlined. The validity and generalizability of the evidence are discussed, as well as the implications for mental health practice. A list of methodological remedies to reduce bias is suggested. The article is then concluded with a summary of the studies reviewed and directions for future research.
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Affiliation(s)
- Everton de Oliveira Maraldi
- Social Psychology of Religion Laboratory, Department of Social and Work Psychology, Institute of Psychology, University of São Paulo (USP), Prof Mello Moraes Avenue, 1721, Cidade Universitária, São Paulo, SP, 05508-030, Brazil.
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Østergård OK, Randa H, Hougaard E. The effect of using the Partners for Change Outcome Management System as feedback tool in psychotherapy—A systematic review and meta-analysis. Psychother Res 2018; 30:195-212. [DOI: 10.1080/10503307.2018.1517949] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Ole Karkov Østergård
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Hilde Randa
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
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16
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Siegel A, Niebling W. [Individual patient satisfaction in 'Gesundes Kinzigtal': Interim results of a trend study]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 130:35-41. [PMID: 29290571 DOI: 10.1016/j.zefq.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The integrated health care pilot model "Gesundes Kinzigtal" (GK) is recognized as a reference model for integrated healthcare in Germany. The aim of GK is to improve the health of the insured persons and, at the same time, to decrease their healthcare costs compared to usual care. The evaluation of GK has so far shown that GK might reach this aim. However, there are still no evaluation studies on GK focusing on patient-reported outcomes. This gap needs to be closed by a trend study, which is the main topic of this paper: We present interim results of this study, focusing on patient satisfaction with GK, insured persons' self-reported change of health behavior, their knowledge on health maintenance, and health-related quality of life. METHOD The baseline survey of the trend study was conducted in 2013: 3,034 members of GK were invited to complete a standardized questionnaire (by mail). In the first follow-up survey in 2015, 3,471 members were invited. Health-related quality of life was measured by EQ-5D and EQ-VAS; the other above-mentioned indicators were developed by our work group. Conducting variance analysis and logistic regression analysis using SPSS, it was analyzed to what extent the above-mentioned indicators changed between the first and the second survey. RESULTS The response rate was 23.4 % and 24.9 %, respectively. Overall patient satisfaction with GK and the mean EQ-5D value remained stable; the remaining indicators improved more or less over the course of time. Among these, the proportion of participants who indicated that they "now lead an overall healthier life" than before their enrolment into GK significantly increased from 25.6 % to 30.7 % (p=0.020). DISCUSSION AND CONCLUSION The significant increase in the proportion of respondents who "now lead an overall healthier life" might be attributed to the fact that patient activation and empowerment was (and is) a top priority of the GK management strategy. Caution is advised, though, with this interpretation because of the limitations inherent to trend studies without an appropriate control group.
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Affiliation(s)
- Achim Siegel
- Universitätsklinikum Tübingen, Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Tübingen, Deutschland.
| | - Wilhelm Niebling
- Universitätsklinikum Freiburg, Lehrbereich Allgemeinmedizin, Freiburg, Deutschland
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Gonzalez C. Recovering Process from Child Sexual Abuse During Adulthood from an Integrative Approach to Solution-Focused Therapy: A Case Study. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:785-805. [PMID: 28873043 DOI: 10.1080/10538712.2017.1354954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In recent times, strengths-based recovery approaches that focus on the present and build strategies that look toward the future have become popular. However, some cases require the consideration of experiences from previous stages of the clients' development. This single-case study explores the psychotherapeutic process of a middle-aged woman who presented with a history of child sexual abuse (incest) and a long-term adult diagnosis of depression that was treated in public health services. This psychotherapy involved an integrative approach to solution-focused therapy; specifically, the approach proposed by Yvonne Dolan to work with adult survivors of sexual abuse, in conjunction with techniques and strategies from the transtheoretical model. Measures incorporating therapeutic working alliance and outcomes were administered over sessions. Results showed positive outcomes from this therapeutic intervention, which remained at 3-month and 12-month follow-ups. Implications for practitioners' specialist practice in health services are discussed, given the complexity of comorbid mental health conditions with a history of child sexual abuse.
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Affiliation(s)
- Carolina Gonzalez
- a Parenting and Family Support Centre, School of Psychology , The University of Queensland , Brisbane , Queensland , Australia
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18
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Duncan BL, Sparks JA, Timimi S. Beyond Critique: The Partners for Change Outcome Management System as an Alternative Paradigm to Psychiatric Diagnosis. JOURNAL OF HUMANISTIC PSYCHOLOGY 2017. [DOI: 10.1177/0022167817719975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Critics claim that current psychiatric diagnostic systems lack reliability, validity, and clinical utility; are incompatible with known evidence of how change occurs in psychotherapy; are compromised by bias; and risk harmful effects for clients. This article argues that the Partners for Change Outcome Management System (PCOMS), a transparent, egalitarian process that collects and utilizes client feedback at each session, convincingly addresses these concerns. Furthermore, it suggests that PCOMS offers a viable alternative to the reimbursement and administrative functions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. The authors propose that PCOMS represents a radical realignment of the practitioner/client relationship via full, dialogical partnership at every level of psychotherapy practice and thus constitutes a step toward a new paradigm that reconnects psychotherapy and humanistic psychology with its core relational values.
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DePue MK, Lambie GW, Liu R, Gonzalez J. Investigating Supervisory Relationships and Therapeutic Alliances Using Structural Equation Modeling. COUNSELOR EDUCATION AND SUPERVISION 2016. [DOI: 10.1002/ceas.12053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mary Kristina DePue
- Department of Educational and Human Resources; University of Central Florida
- Now at School of Human Development and Organizational Studies; University of Florida at Gainsville
| | - Glenn W. Lambie
- Department of Educational and Human Resources; University of Central Florida
| | - Ren Liu
- School of Human Development and Organizational Studies; University of Florida at Gainsville
| | - Jessica Gonzalez
- Department of Educational and Human Resources; University of Central Florida
- Now at School of Education; Colorado State University
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Reese RJ, Mecham MR, Vasilj I, Lengerich AJ, Brown HM, Simpson NB, Newsome BD. The effects of telepsychology format on empathic accuracy and the therapeutic alliance: An analogue counselling session. COUNSELLING & PSYCHOTHERAPY RESEARCH 2016. [DOI: 10.1002/capr.12092] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Robert J. Reese
- Educational, School, & Counseling Psychology; University of Kentucky; Lexington KY USA
| | - Mary R. Mecham
- Educational, School, & Counseling Psychology; University of Kentucky; Lexington KY USA
| | - Igor Vasilj
- Educational, School, & Counseling Psychology; University of Kentucky; Lexington KY USA
| | - Alex J. Lengerich
- Educational, School, & Counseling Psychology; University of Kentucky; Lexington KY USA
| | - Holly M. Brown
- Educational, School, & Counseling Psychology; University of Kentucky; Lexington KY USA
| | - Nicholas B. Simpson
- Educational, School, & Counseling Psychology; University of Kentucky; Lexington KY USA
| | - Benjamin D. Newsome
- Educational, School, & Counseling Psychology; University of Kentucky; Lexington KY USA
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Kendrick T, El‐Gohary M, Stuart B, Gilbody S, Churchill R, Aiken L, Bhattacharya A, Gimson A, Brütt AL, de Jong K, Moore M. Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults. Cochrane Database Syst Rev 2016; 7:CD011119. [PMID: 27409972 PMCID: PMC6472430 DOI: 10.1002/14651858.cd011119.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routine outcome monitoring of common mental health disorders (CMHDs), using patient reported outcome measures (PROMs), has been promoted across primary care, psychological therapy and multidisciplinary mental health care settings, but is likely to be costly, given the high prevalence of CMHDs. There has been no systematic review of the use of PROMs in routine outcome monitoring of CMHDs across these three settings. OBJECTIVES To assess the effects of routine measurement and feedback of the results of PROMs during the management of CMHDs in 1) improving the outcome of CMHDs; and 2) in changing the management of CMHDs. SEARCH METHODS We searched the Cochrane Depression Anxiety and Neurosis group specialised controlled trials register (CCDANCTR-Studies and CCDANCTR-References), the Oxford University PROMS Bibliography (2002-5), Ovid PsycINFO, Web of Science, The Cochrane Library, and International trial registries, initially to 30 May 2014, and updated to 18 May 2015. SELECTION CRITERIA We selected cluster and individually randomised controlled trials (RCTs) including participants with CMHDs aged 18 years and over, in which the results of PROMs were fed back to treating clinicians, or both clinicians and patients. We excluded RCTs in child and adolescent treatment settings, and those in which more than 10% of participants had diagnoses of eating disorders, psychoses, substance use disorders, learning disorders or dementia. DATA COLLECTION AND ANALYSIS At least two authors independently identified eligible trials, assessed trial quality, and extracted data. We conducted meta-analysis across studies, pooling outcome measures which were sufficiently similar to each other to justify pooling. MAIN RESULTS We included 17 studies involving 8787 participants: nine in multidisciplinary mental health care, six in psychological therapy settings, and two in primary care. Pooling of outcome data to provide a summary estimate of effect across studies was possible only for those studies using the compound Outcome Questionnaire (OQ-45) or Outcome Rating System (ORS) PROMs, which were all conducted in multidisciplinary mental health care or psychological therapy settings, because both primary care studies identified used single symptom outcome measures, which were not directly comparable to the OQ-45 or ORS.Meta-analysis of 12 studies including 3696 participants using these PROMs found no evidence of a difference in outcome in terms of symptoms, between feedback and no-feedback groups (standardised mean difference (SMD) -0.07, 95% confidence interval (CI) -0.16 to 0.01; P value = 0.10). The evidence for this comparison was graded as low quality however, as all included studies were considered at high risk of bias, in most cases due to inadequate blinding of assessors and significant attrition at follow-up.Quality of life was reported in only two studies, social functioning in one, and costs in none. Information on adverse events (thoughts of self-harm or suicide) was collected in one study, but differences between arms were not reported.It was not possible to pool data on changes in drug treatment or referrals as only two studies reported these. Meta-analysis of seven studies including 2608 participants found no evidence of a difference in management of CMHDs between feedback and no-feedback groups, in terms of the number of treatment sessions received (mean difference (MD) -0.02 sessions, 95% CI -0.42 to 0.39; P value = 0.93). However, the evidence for this comparison was also graded as low quality. AUTHORS' CONCLUSIONS We found insufficient evidence to support the use of routine outcome monitoring using PROMs in the treatment of CMHDs, in terms of improving patient outcomes or in improving management. The findings are subject to considerable uncertainty however, due to the high risk of bias in the large majority of trials meeting the inclusion criteria, which means further research is very likely to have an important impact on the estimate of effect and is likely to change the estimate. More research of better quality is therefore required, particularly in primary care where most CMHDs are treated.Future research should address issues of blinding of assessors and attrition, and measure a range of relevant symptom outcomes, as well as possible harmful effects of monitoring, health-related quality of life, social functioning, and costs. Studies should include people treated with drugs as well as psychological therapies, and should follow them up for longer than six months.
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Affiliation(s)
- Tony Kendrick
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
| | - Magdy El‐Gohary
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
| | - Beth Stuart
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
| | - Simon Gilbody
- University of YorkDepartment of Health SciencesSeebohm Rowntree BuildingYorkUKYO10 5DD
| | - Rachel Churchill
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolUKBS8 2BN
| | - Laura Aiken
- University Hospital SouthamptonSouthamptonUK
| | | | - Amy Gimson
- University of SouthamptonFaculty of MedicineAldermoor Health Centre, Aldermoor CloseSouthamptonUKSO16 5ST
| | - Anna L Brütt
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyHamburgGermany
| | - Kim de Jong
- Leiden UniversityInstitute of PsychologyWassenaarseweg 52LeidenNetherlands2333 AK
| | - Michael Moore
- Aldermoor Health Centre, University of SouthamptonPrimary Care and Population Sciences, Faculty of MedicineAldermoor CloseSouthamptonUKSO16 5ST
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van Oenen FJ, Schipper S, Van R, Schoevers R, Visch I, Peen J, Dekker J. Feedback-informed treatment in emergency psychiatry; a randomised controlled trial. BMC Psychiatry 2016; 16:110. [PMID: 27095106 PMCID: PMC4837581 DOI: 10.1186/s12888-016-0811-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immediate patient feedback has been shown to improve outcomes for patients in mild distress but it is unclear whether psychiatric patients in severe distress benefit equally from feedback. This study investigates the efficacy of an immediate feedback instrument in the treatment of patients with acute and severe psychosocial or psychiatric problems referred in the middle of a crisis. METHODS A naturalistic mixed diagnosis sample of patients (N = 370) at a Psychiatric Emergency Centre was randomised to a Treatment-as-Usual (TAU) or a Feedback (FB) condition. In the FB condition, feedback on patient progress was provided on a session-by-session basis to both therapists and patients. Outcomes of the two treatment conditions were compared using repeated measures MANCOVA, Last Observation Carried Forward and multilevel analysis. RESULTS After 3 months, symptom improvement in FB (ES 0.60) did not significantly differ from TAU (ES 0.71) (p = 0.505). After 6 weeks, FB patients (ES 0.31) actually improved less than TAU patients (0.56) (p = 0.019). CONCLUSIONS Patients with psychiatric problems and severe distress seeking emergency psychiatric help did not benefit from direct feedback. TRIAL REGISTRATION Dutch Trial Register, NTR3168 , date of registration 1-9-2009.
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Affiliation(s)
- Flip Jan van Oenen
- Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. .,, Baarsjesweg 224, 1058 AA, Amsterdam, The Netherlands.
| | - Suzy Schipper
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Rien Van
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Robert Schoevers
- Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Irene Visch
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,Klinische Psychologie Vrije Universiteit van Amsterdam, de Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
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Janse PD, De Jong K, Van Dijk MK, Hutschemaekers GJM, Verbraak MJPM. Improving the efficiency of cognitive-behavioural therapy by using formal client feedback. Psychother Res 2016; 27:525-538. [PMID: 27013204 DOI: 10.1080/10503307.2016.1152408] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Feedback from clients on their view of progress and the therapeutic relationship can improve effectiveness and efficiency of psychological treatments in general. However, what the added value is of client feedback specifically within cognitive-behavioural therapy (CBT), is not known. Therefore, the extent to which the outcome of CBT can be improved is investigated by providing feedback from clients to therapists using the Outcome Rating Scale (ORS) and Session Rating Scale (SRS). METHOD Outpatients (n = 1006) of a Dutch mental health organization either participated in the "treatment as usual" (TAU) condition, or in Feedback condition of the study. Clients were invited to fill in the ORS and SRS and in the Feedback condition therapists were asked to frequently discuss client feedback. RESULTS Outcome on the SCL-90 was only improved specifically with mood disorders in the Feedback condition. Also, in the Feedback condition, in terms of process, the total number of required treatment sessions was on average two sessions fewer. CONCLUSION Frequently asking feedback from clients using the ORS/SRS does not necessarily result in a better treatment outcome in CBT. However, for an equal treatment outcome significantly fewer sessions are needed within the Feedback condition, thus improving efficiency of CBT.
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Affiliation(s)
| | - Kim De Jong
- b Department of Clinical Psychology , Leiden University , Leiden , The Netherlands
| | | | | | - Marc J P M Verbraak
- d Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
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Perinelli E, Gremigni P. Use of Social Desirability Scales in Clinical Psychology: A Systematic Review. J Clin Psychol 2016; 72:534-51. [PMID: 26970350 DOI: 10.1002/jclp.22284] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There is still an open debate about the utility of social desirability indicators. This report systematically reviewed the use of social desirability scales in studies addressing social desirability in clinical psychology. METHOD A systematic review (January 2010-March 2015) was conducted, including 35 studies meeting the inclusion criteria of being published in peer-reviewed journals and describing quantitative findings about an association of social desirability with clinical psychology variables using a cross-sectional or longitudinal design. RESULTS Social desirability was associated with self-reports of various clinical-psychological dimensions. Most of the included studies treated social desirability as a 1-dimensional variable and only 10 of 35 disentangled the impression management and self-deception components. Although theoretical literature does not consider social desirability a mere response bias, only 4 of the reviewed articles controlled for the possible suppressor effect of personality variables on social desirability, while the majority focused upon the stylistic (response bias) rather than the substantive (personality) nature of this construct. CONCLUSION The present review highlighted some limitations in the use of social desirability scales in recent clinical psychology research and tried to offer a few suggestions for handling this issue.
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Knekt P, Heinonen E, Härkäpää K, Järvikoski A, Virtala E, Rissanen J, Lindfors O, Helsinki Psychotherapy Study Group. Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up. Psychiatry Res 2015; 229:381-8. [PMID: 26162657 DOI: 10.1016/j.psychres.2015.05.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 05/09/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.
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Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland.
| | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Esa Virtala
- National Institute for Health and Welfare, Helsinki, Finland
| | - Julius Rissanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | - Helsinki Psychotherapy Study Group
- National Institute for Health and Welfare, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland; University of Lapland, Rovaniemi, Finland; Rehabilitation Foundation, Helsinki, Finland; Social Insurance Institution, Finland
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The working alliance in a randomized controlled trial comparing Internet-based self-help and face-to-face cognitive behavior therapy for chronic tinnitus. Internet Interv 2014. [DOI: 10.1016/j.invent.2014.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Owen J, Duncan B, Reese RJ, Anker M, Sparks J. Accounting for therapist variability in couple therapy outcomes: what really matters? JOURNAL OF SEX & MARITAL THERAPY 2014; 40:488-502. [PMID: 24965052 DOI: 10.1080/0092623x.2013.772552] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study examined whether therapist gender, professional discipline, experience conducting couple therapy, and average second-session alliance score would account for the variance in outcomes attributed to the therapist. The authors investigated therapist variability in couple therapy with 158 couples randomly assigned to and treated by 18 therapists in a naturalistic setting. Consistent with previous studies in individual therapy, in this study therapists accounted for 8.0% of the variance in client outcomes and 10% of the variance in client alliance scores. Therapist average alliance score and experience conducting couple therapy were salient predictors of client outcomes attributed to therapist. In contrast, therapist gender and discipline did not significantly account for the variance in client outcomes attributed to therapists. Tests of incremental validity demonstrated that therapist average alliance score and therapist experience uniquely accounted for the variance in outcomes attributed to the therapist. Emphasis on improving therapist alliance quality and specificity of therapist experience in couple therapy are discussed.
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Affiliation(s)
- Jesse Owen
- a Department of Educational and Counseling Psychology, Counseling, and College Student Personnel, College of Education , University of Louisville , Louisville , Kentucky , USA
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