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Lee GC, Platow MJ, Cruwys T. Listening quality leads to greater working alliance and well-being: Testing a social identity model of working alliance. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:573-588. [PMID: 38946045 DOI: 10.1111/bjc.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Characterization of psychotherapy as the "talking cure" de-emphasizes the importance of an active listener on the curative effect of talking. We test whether the working alliance and its benefits emerge from expression of voice, per se, or whether active listening is needed. We examine the role of listening in a social identity model of working alliance. METHODS University student participants in a laboratory experiment spoke about stress management to another person (a confederate student) who either did or did not engage in active listening. Participants reported their perceptions of alliance, key social-psychological variables, and well-being. RESULTS Active listening led to significantly higher ratings of alliance, procedural justice, social identification, and identity leadership, compared to no active listening. Active listening also led to greater positive affect and satisfaction. Ultimately, an explanatory path model was supported in which active listening predicted working alliance through social identification, identity leadership, and procedural justice. CONCLUSIONS Listening quality enhances alliance and well-being in a manner consistent with a social identity model of working alliance, and is a strategy for facilitating alliance in therapy.
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Affiliation(s)
- Georgina C Lee
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael J Platow
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tegan Cruwys
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
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Sherlow-Levin A, Shahar B, Goldman R, Bar-Kalifa E. Applying the Rupture Resolution Rating System to emotion-focused couple therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:801-820. [PMID: 38887106 DOI: 10.1111/jmft.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
Alliance ruptures and their repair are robustly associated with outcomes in individual therapy. Little is known about these processes in couple therapy, despite the acknowledged challenges of nurturing the alliance when working with two parties in conflict. One factor contributing to this gap in the literature is the lack of an instrument to capture ruptures and repair in couple therapy. We adapted the Rupture Resolution Rating System (3RS) to identify ruptures and repairs in couple therapy at the within-system (between the two partners) and the between-system (between each partner and the therapist) levels. Sessions from one couple with good outcome and one couple with poor outcome were coded. Couples were in therapy to deal with emotional injury. Rupture-repair events in both the within-system and between-system were common. The couple with the poor outcome showed greater levels of rupture with the therapist. The injured partners (vs. injurer partners) demonstrated higher frequencies of ruptures.
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Affiliation(s)
| | - Ben Shahar
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rhonda Goldman
- Clinical Psychology, The Chicago School of Professional Psychology, Chicago, Illinois, USA
| | - Eran Bar-Kalifa
- Psychology Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Magill M, Martino S, Wampold BE. Defining the therapeutic relationship in the context of alcohol use, other drug use, and behavior change: Principles and practices. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209398. [PMID: 38754554 PMCID: PMC11180559 DOI: 10.1016/j.josat.2024.209398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
OVERVIEW This article contributes to knowledge and practice of core processes that are shared by evidence-based alcohol or other drug (AOD) therapies. It is the fourth in a series with this aim, and here we discuss perhaps the most universally acknowledged ingredient of effective therapy - the therapeutic relationship. We consider various related terms and definitions in the literature, but in the present review, we offer a definition that underscores the context of behavior change. METHOD This study conducted a literature review and qualitative content analysis to derive a set of principles and practices for facilitating and maintaining the therapeutic relationship. The sources for this review included government-issued practice guidelines, therapy manuals or books, demonstration videos, and peer-reviewed articles (61 sources). The content analysis was performed in NVIVO, and reliability analysis showed moderate agreement between raters (kappa = 0.60). RESULTS Six principles and 16 practices were identified. The distribution of principles and practices could be broken into three categories: 1) the facilitation of client behavior change mechanisms (i.e., self-determination, motivation, self-efficacy), 2) partnership considerations (e.g., goal and task alignment), and 3) therapist interpersonal skills (e.g., empathy). CONCLUSIONS The therapeutic relationship is foundational to the behavior change process. We frame it as a combination of broader interpersonal considerations and attention to key mechanisms of client behavior change. The present work provides a novel resource for trainees, clinicians, and clinical supervisors interested in fostering therapy relationships with clients in AOD or other behavior change settings.
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Affiliation(s)
- Molly Magill
- Brown University, Providence, RI, United States of America.
| | - Steve Martino
- Yale University, New Haven, CT, United States of America
| | - Bruce E Wampold
- University of Wisconsin, Madison, WI, United States of America
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Saxler E, Schindler T, Philipsen A, Schulze M, Lux S. Therapeutic alliance in individual adult psychotherapy: a systematic review of conceptualizations and measures for face-to-face- and online-psychotherapy. Front Psychol 2024; 15:1293851. [PMID: 38993343 PMCID: PMC11238262 DOI: 10.3389/fpsyg.2024.1293851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
Background The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. Methods We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. Results A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments (n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures (n = 14), based on literature searches (n = 3) or on an empirical survey (n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. Discussion The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.
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Affiliation(s)
- Eva Saxler
- Deutsches Zentrum für Neurodegnerative Erkrankungen, University Clinic of Bonn, Bonn, Germany
| | - Theresa Schindler
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Aafjes-van Doorn K, Spina DS, Horne SJ, Békés V. The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clin Psychol Rev 2024; 110:102430. [PMID: 38636207 DOI: 10.1016/j.cpr.2024.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/28/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The strength of the therapeutic alliance is widely understood to impact treatment outcomes, however, the alliance-outcome relationship in teletherapy has remained relatively unexamined. The aim of this meta-analysis is to systematically summarize the relationship between therapeutic alliance and treatment outcomes in teletherapy with adult patients conducted via videoconferencing or telephone. METHODS We conducted a systematic search of the databases PsycINFO, PsycARTICLES, ProQuest Dissertation Databases, EMBASE, The Cochrane Library, MEDLINE, Google Scholar, and PubMed for studies published before June 26, 2023. We identified 31 studies with 34 independent samples (4862 participants). RESULTS The average weighted effect size was 0.15, p = .001, 95% CI [0.07, 0.24], k = 34. reflecting a small effect of therapeutic alliance on mental health outcomes. There was significant heterogeneity in the effect sizes, which was driven by between-study differences in the alliance-outcome correlation. The alliance-outcome effect was larger when the alliance was measured late in treatment and when the outcome was measured from the patient's perspective. CONCLUSION Very few teletherapy treatment studies were identified that initially reported on alliance-outcome associations, underlining that this is an under-researched area. The association between alliance-teletherapy outcomes in this meta-analysis was small but significant, and somewhat weaker than the alliance-outcome associations reported for in-person treatments and other online interventions. This might indicate that there are other processes at play in teletherapy that explain variance of treatment outcomes, or that the therapist (and the relationship) has less influence on the treatment outcomes than in in-person therapy.
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Affiliation(s)
| | - Daniel S Spina
- Pennsylvania State University, Psychology Department, PA, USA
| | - Sarah J Horne
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
| | - Vera Békés
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
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Moon DJ, Nichols CB, Zhang Y, Cruce A, Haran H, Sgourakis A, Lee H, Johnson-Motoyama M. Engagement Measures in Maltreatment Prevention Studies: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1551-1567. [PMID: 37626470 DOI: 10.1177/15248380231188070] [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: 08/27/2023]
Abstract
Prevention services can promote public health by building protective factors and reducing maltreatment risk. Yet, engaging caregivers in prevention services presents a unique set of challenges. Measurement studies are important first steps to increase the knowledge of caregiver engagement in prevention services. The purpose of this scoping review was to investigate how family engagement has been measured and operationalized in the studies of maltreatment prevention/positive parenting programs. The review examined quantitative and mixed methods studies conducted in the U.S., which measured multiple dimensions of client engagement, including behavioral, attitudinal, and relational domains. A total of 88 studies selected from PubMed, CINAHL, ERIC, PsycINFO, Social Work Abstracts, Academic Search Premier, and Web of Science were included in this review. Results indicated that studies examine engagement constructs in all three domains of engagement with a primary focus on behavioral engagement. The attitudinal and relational engagement was mostly assessed through general satisfaction surveys, and a limited number of studies utilized validated measures to assess those constructs. While most studies reported acceptable internal reliabilities, only two studies reported other dimensions of psychometric qualities. Only one validated measure was found, which assessed client perceptions of provider cultural competence. More measurement studies are needed to further incorporate multiple dimensions of engagement into the studies of maltreatment prevention programs, which can inform the effort to develop tailored implementation strategies to fully engage various groups of parents in maltreatment prevention programs.
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Litt MD. Do you need a therapist to have a therapeutic alliance? Comment on Benitez et al., "The connection still matters: Therapeutic alliance with digital treatment for alcohol use disorder". ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:459-461. [PMID: 38195112 DOI: 10.1111/acer.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Affiliation(s)
- Mark D Litt
- Division of Behavioral Sciences and Community Health - MC3910, UConn Health, Farmington, Connecticut, USA
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Cruwys T, Lee GC, Robertson AM, Haslam C, Sterling N, Platow MJ, Williams E, Haslam SA, Walter ZC. Therapists who foster social identification build stronger therapeutic working alliance and have better client outcomes. Compr Psychiatry 2023; 124:152394. [PMID: 37216806 DOI: 10.1016/j.comppsych.2023.152394] [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] [Received: 12/13/2022] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND For decades we have known that therapeutic working alliance is a key contributor to client engagement and positive outcomes in therapy. However, we have made little progress in narrowing down its determinants, which is critical in supporting trainees to optimize such alliance. We make a case for the value of incorporating social psychological frameworks into models of alliance and explore the role of social identity processes in the development of therapeutic alliance. METHOD Across two studies, over 500 psychotherapy clients completed validated measures of alliance, social identification with their therapist, positive therapy outcomes, and a range of client and therapist characteristics. FINDINGS Social identification strongly predicted alliance in both samples, whereas client and therapist characteristics showed few such associations. Alliance mediated the relationship between social identification and positive therapy outcomes. In addition, we found evidence that (a) personal control is a key psychological resource in therapy that arises from social identification, and (b) therapists who engage in identity leadership (i.e., who represent and build a social identity that they share with clients) are more likely to foster social identification and its downstream benefits. INTERPRETATION These data show that social identity processes are key to the emergence of working alliance. We conclude with a discussion of how recent social identity and identity leadership interventions might be adapted to train therapists in relevant identity-building skills.
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Affiliation(s)
- Tegan Cruwys
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia.
| | - Georgina C Lee
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Alysia M Robertson
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Catherine Haslam
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Nikola Sterling
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Michael J Platow
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Elyse Williams
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - S Alexander Haslam
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Zoe C Walter
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
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Carmel MA, Mishali M. Patient-physician alliance and patient's sense of self-efficacy are negatively associated with resistance to treatment among patients with type 2 diabetes. Prim Care Diabetes 2023; 17:185-189. [PMID: 36775726 DOI: 10.1016/j.pcd.2023.01.015] [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] [Received: 11/14/2021] [Revised: 10/19/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
AIMS Resistance to treatment is prevalent among patients diagnosed with chronic conditions, including type 2 diabetes (T2DM). The current study aimed to examine the relationship between patient characteristics, patient-physician relationship, and resistance to treatment in T2DM. METHODS A sample of 120 T2DM patients were recruited by means of non-randomized sampling and through a public post on Facebook. Participants were asked to fill-in several questionnaires online: Rotter's Locus of Control questionnaire (short version); the General Self-efficacy (GSE) questionnaire; the Working Alliance Inventory - Short Revised (WAI-SR) - evaluating patient-physician relationship; and, finally, the Resistance to Treatment Questionnaire (RTQ) - which meant to capture the intensity of resistance to treatment and served as the dependent variable in this study. RESULTS Interestingly, better patient-physician relationship and higher sense of self-efficacy among patients were found to negatively associate with patient's resistance to treatment (r = -.53, p < .001, and, r = -.26, p < .01, respectively). Patient-physician relationship explained 22% of the variance of resistance to treatment, and self-efficacy explained 6% of the variance. CONCLUSIONS Stronger patient-doctor relationship and higher sense of self-efficacy are shown to robustly associate with lower resistance to treatment among patients with T2DM. Current findings may instructor educate physicians as to the importance of the alliance with these chronic patients.
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Affiliation(s)
- Moran Accos Carmel
- The School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838 Haifa, Israel.
| | - Moshe Mishali
- The School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838 Haifa, Israel.
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Wheaton MG, Mcingvale E, Van Meter AR, Björgvinsson T. Quality of the therapeutic working alliance as a factor in intensive residential treatment of obsessive-compulsive disorder. Psychother Res 2023; 33:442-454. [PMID: 36314194 DOI: 10.1080/10503307.2022.2138618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Intensive residential treatment (IRT) for obsessive-compulsive disorder (OCD) includes frequent meetings with a cognitive-behavioral therapist. We examined whether this therapeutic working alliance relates to IRT outcomes. METHOD Data came from a naturalistic sample of patients with OCD (n = 124) who received IRT at a specialty OCD clinic. Patients completed measures of OCD severity and well-being at admission and discharge. Both the patient and treating psychologist completed the Working Alliance Inventory-Short Form (WAI-SF). Alliance ratings were tested as predictors in models predicting outcomes (discharge scores adjusting for baseline and treatment duration) as well as logistic regression predicting treatment response (≥35% symptom reduction in OCD symptoms). RESULTS Patient and clinician ratings of the quality of the alliance were weakly yet significantly correlated. Patient ratings of the alliance predicted outcomes, while therapist ratings did not. Moreover, greater discrepancy between patient and client ratings predicted worse outcomes. Patient ratings of the task dimension of the alliance uniquely related to responder status. CONCLUSIONS Patient perceptions of the working alliance, particularly as pertaining to agreement on therapeutic tasks, related to success with IRT for OCD. Further study is needed test interventions to improve task alliance as a strategy to enhance treatment.
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Roest JJ, Welmers-Van de Poll MJ, Peer Van der Helm GH, Stams GJJM, Hoeve M. A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy. Res Child Adolesc Psychopathol 2023; 51:275-293. [PMID: 36394705 DOI: 10.1007/s10802-022-00986-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/18/2022]
Abstract
Previous meta-analyses have found small to moderate associations between child-therapist alliance and treatment outcomes. However, these meta-analyses have not taken into account changes in alliance (i.e., alliance shifts), alliance agreement (i.e., congruence or discrepancies between child-therapist ratings), and the role of alliance as a moderator in relation to treatment outcomes (i.e., an interaction effect of alliance and treatment condition on treatment outcomes). A series of multilevel meta-analyses of 99 studies was conducted to investigate several types of alliance-outcome associations in child and adolescent psychotherapy. Associations between child-therapist alliance and child outcomes (r = 0.17), changes in child-therapist alliance and child outcomes (r = 0.19), child-therapist alliance as a moderator of outcomes (r = 0.09), and parent-therapist alliance and child outcomes (r = 0.13) were small. Associations between child-therapist alliance agreement and outcomes (r = 0.21) and between parent-therapist alliance and parent outcomes (r = 0.24) were small to moderate. This meta-analysis provides the most updated and comprehensive overview of the alliance-outcome association in child and adolescent psychotherapy, showing that the alliance continues to show impact on treatment outcomes. Alliance research in youth psychotherapy has increasingly focused on several complex aspects of the alliance-outcome association, such as the role of changes in alliance, alliance discrepancies, client and therapist variability, and the reciprocal association between alliance and prior symptom change in relation to treatment outcomes. Implications for future research and clinical practice are discussed.
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Affiliation(s)
- Jesse J Roest
- University of Applied Sciences Leiden, Zernikedreef 11, 2300 AJ, Leiden, The Netherlands.
| | | | - G H Peer Van der Helm
- University of Applied Sciences Leiden, Zernikedreef 11, 2300 AJ, Leiden, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
| | - Geert Jan J M Stams
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
| | - Machteld Hoeve
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15780, 1001 NG, Amsterdam, The Netherlands
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Roest JJ, Welmers-Van de Poll MJ, Van der Helm GHP, Stams GJJM, Hoeve M. A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:55-73. [PMID: 35862768 DOI: 10.1080/15374416.2022.2093210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The alliance in child and adolescent psychotherapy is widely recognized as an important factor in therapy. Studies on the alliance have increasingly focused on assessment of the alliance as a dyadic construct, measuring both client and therapist alliance ratings. However, cross-informant reports of the alliance in child psychotherapy have not yet been subjected to meta-analysis. Therefore, the present meta-analysis aims to increase knowledge on the degree of convergence and divergence between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. METHODS A series of three-level meta-analyses of 78 studies was conducted to investigate differences and associations between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. RESULTS Findings indicated that children and parents in general rated the alliance more positively than their therapists (d = 0.35, d = 0.72, respectively), and that child-therapist and parent-therapist alliance ratings were moderately correlated (r = .32, r = .23, respectively). Associations between child and therapist ratings and observer ratings were moderate to large (r = .43, r = .53, respectively). CONCLUSIONS It can be concluded that children and parents generally report more positively on the alliance compared to their therapists, which is consistent with research on the alliance in adult populations. The small to moderate associations between alliance ratings indicate that individuals to some extent have a shared perspective on their alliance, and that the various perspectives on alliance should be acknowledged when dealing with children and parents in therapy. Implications for future research are discussed.
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Affiliation(s)
- Jesse J Roest
- Department of Social Work and Applied Psychology, University of Applied Sciences Leiden
| | | | - G H Peer Van der Helm
- Department of Social Work and Applied Psychology, University of Applied Sciences Leiden.,Research Institute Child Development and Education, University of Amsterdam
| | | | - Machteld Hoeve
- Research Institute Child Development and Education, University of Amsterdam
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Munch Nielsen C, Hjorthøj C, Arnfred BT, Nordentoft M. Patient Outcomes of Flexible Assertive Community Treatment Compared With Assertive Community Treatment. Psychiatr Serv 2022:appips20220235. [PMID: 36475824 DOI: 10.1176/appi.ps.20220235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In many European countries, flexible assertive community treatment (FACT) has replaced assertive community treatment (ACT) despite limited evidence for FACT's effectiveness in improving functional and patient-reported outcomes. This study evaluated the effectiveness of FACT relative to ACT in improving functioning, client satisfaction, and the working alliance. METHODS The authors used a nonblinded, quasi-experimental controlled study design to compare outcomes of patients treated by ACT teams that were reconfigured to FACT teams with those of patients treated by a remaining ACT team. Patients from nine ACT teams in the Capital Region of Denmark were included. Six of the nine ACT teams were reconfigured to FACT in 2018 and 2019 by integrating them with community mental health teams. The remaining three ACT teams were used as control groups. Assignment to treatment was based solely on administrative considerations. RESULTS The study included 131 patients (FACT, N=74; ACT, N=57). Patients treated by FACT teams had poorer personal and social functioning than patients assigned to ACT teams (adjusted difference in means=-2.9, 95% CI=-5.8 to -0.1). No between-group differences were found in client satisfaction or working alliance. CONCLUSIONS Patients treated by FACT teams had significantly lower functioning than patients treated by ACT teams, but the clinical relevance or causality of this finding remains unclear. Given the reconfiguration of the FACT teams during follow-up, along with substantial drop-out rates and baseline differences between the two groups, these results must be interpreted with caution. The findings require further examination in a randomized controlled trial that includes fidelity measures of the treatment models.
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Affiliation(s)
- Camilla Munch Nielsen
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Benjamin Thorup Arnfred
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (all authors); Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen (Hjorthøj)
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Vermeiden M, Reijnders J, van Duin E, Simons M, Janssens M, Peeters S, Jacobs N, Lataster J. Prospective associations between working alliance, basic psychological need satisfaction, and coaching outcome indicators: a two-wave survey study among 181 Dutch coaching clients. BMC Psychol 2022; 10:269. [PMID: 36380365 PMCID: PMC9664732 DOI: 10.1186/s40359-022-00980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The coach-coachee working alliance and coachee motivation seem important factors for achieving positive coaching results. Self-determination theory, specifically basic psychological need theory, has been proposed as a relevant framework for understanding these relationships. The current longitudinal survey study therefore investigates prospective associations between coachees' appraisal of the working alliance, basic psychological need satisfaction, and the coaching outcome indicators goal attainment, wellbeing, absence of psychopathology, and personal growth initiative. METHODS The sample (N = 181) consisted of Dutch coachees that were recruited across a range of coaching settings and contexts. Online self-report questionnaires were administered twice (T0 and T1), with an intervening time of 3 weeks, assessing working alliance, basic psychological need satisfaction, goal attainment, wellbeing, absence of psychopathology, and personal growth initiative. Parallel analysis with Monte Carlo simulations and confirmatory factor analyses were performed to assess the dimensionality of working alliance and basic psychological need satisfaction scores. Multiple regression analyses (stepwise) were used to examine prospective (T0 to T1) associations between working alliance and basic psychological need satisfaction, and their association with outcome indicators. RESULTS The coachees' perception of the working alliance was positively and reciprocally, although modestly, associated with basic psychological need satisfaction. In addition, both working alliance and basic psychological need satisfaction were prospectively associated with goal attainment, but not with other outcome indicators. CONCLUSIONS Results provide tentative support for a role of basic psychological need satisfaction in facilitating the establishment of a good working alliance. Additionally, the perception of a good quality, need supportive relationship with the coach appears to be associated with better goal achievement, but not with other outcome indicators. Associations were generally modest, and more research is needed to better measure and comprehend the unique contributions of specific relational and motivational factors to outcomes in coaching and assess the robustness of the current study findings.
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Affiliation(s)
- Margriet Vermeiden
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Jennifer Reijnders
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Eva van Duin
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Marianne Simons
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Mayke Janssens
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sanne Peeters
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nele Jacobs
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Johan Lataster
- Faculty of Psychology, Department of Lifespan Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
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15
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Sened H, Zilcha-Mano S, Shamay-Tsoory S. Inter-brain plasticity as a biological mechanism of change in psychotherapy: A review and integrative model. Front Hum Neurosci 2022; 16:955238. [PMID: 36092652 PMCID: PMC9458846 DOI: 10.3389/fnhum.2022.955238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Recent models of psychopathology and psychotherapy highlight the importance of interpersonal factors. The current review offers a biological perspective on these interpersonal processes by examining inter-brain synchrony-the coupling of brain activity between people interacting with one another. High inter-brain synchrony is associated with better relationships in therapy and in daily life, while deficits in the ability to achieve inter-brain synchrony are associated with a variety of psychological and developmental disorders. The review suggests that therapy improves patients' ability to achieve such synchrony through inter-brain plasticity-a process by which recurring exposure to high inter-brain synchrony leads to lasting change in a person's overall ability to synchronize. Therapeutic sessions provide repeated situations with high inter-brain synchrony. This can lead to a long-term increase in the ability to synchronize, first with the therapist, then generalized to other interpersonal relationships, ultimately leading to symptom reduction. The proposed inter-brain plasticity model offers a novel biological framework for understanding relational change in psychotherapy and its links to various forms of psychopathology and provides testable hypotheses for future research. Understanding this mechanism may help improve existing psychotherapy methods and develop new ones.
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Affiliation(s)
- Haran Sened
- Department of Psychology, University of Haifa, Haifa, Israel
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16
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Paap D, Karel YHJM, Verhagen AP, Dijkstra PU, Geertzen JHB, Pool G. The Working Alliance Inventory's Measurement Properties: A Systematic Review. Front Psychol 2022; 13:945294. [PMID: 35910993 PMCID: PMC9337219 DOI: 10.3389/fpsyg.2022.945294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Measurement properties of the Working Alliance Inventory (WAI) and its various translations and adaptations for specific target groups have been investigated for over 30 years. No systematic review analyzing studies on measurement properties of the WAI has been conducted to date. COnsensus-based Standards for the selection of health Measurements INstruments (COSMIN) were developed for conducting high-quality systematic reviews on measurement properties in a transparent and standardized way. Aim of this study was to systematically review studies on measurement properties of the WAI, and its adapted versions, within psychotherapy, and other healthcare contexts using COSMIN criteria. PsycINFO, Medline, and EMBASE were searched (1989–2021). In all phases of the review procedure, study selection, data extraction, risk of bias assessment, rating of the quality of measurement properties, and rating of the quality of evidence for measurement properties, disagreement between reviewers was resolved by discussion. Results on validity, internal structure, reliability, construct validity, and responsiveness were analyzed. In total 66 studies were included. In most studies, evidence for measurement properties was according to COSMIN criteria, insufficient, lacking, or conflicting. Content validity was rated insufficient because neither patients nor healthcare professionals were involved in the development and validation process. Hence evidence for content validity of the WAI is unknown. Conflicting evidence was found for structural validity. Evidence for internal consistency could not be established. Limited evidence was found for inter-rater reliability and convergent validity. Conflicting evidence was also found for test-retest reliability and divergent validity. COSMIN criteria exposed persistent problems in validation studies of the WAI. These findings may indicate that measurement properties of the WAI are not up to current standards, or that COSMIN criteria may be less appropriate for assessing measurement properties of the WAI, or it could indicate both. The results of this systematic review suggest that WAI outcomes should be interpreted with caution and further research is needed regarding the content validity and hypotheses development. For the future, the theoretical framework underlying the measurement of the working alliance needs to be studied in psychotherapy and other health contexts, and tested in methodologically sound studies.
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Affiliation(s)
- Davy Paap
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Physical Therapy, Saxion University of Applied Science, Enschede, Netherlands
- *Correspondence: Davy Paap
| | - Yasmaine H. J. M. Karel
- Center of Expertise Caring Society 3.0, Avans University of Applied Science, Breda, Netherlands
- Department General Practice, Erasmus Medical Centre University, Rotterdam, Netherlands
| | - Arianne P. Verhagen
- Department General Practice, Erasmus Medical Centre University, Rotterdam, Netherlands
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Pieter U. Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Grieteke Pool
- Section Health Psychology, Faculty of Medical Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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17
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Schamong I, Bollmann S, Struck N, Kube T, D’Astolfo L, Brakemeier EL. Can we Modulate Therapeutic Interpersonal Style Experimentally to Address Alliance? A Proof-of-Concept Study. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
With a lack of experimental designs that explore which therapeutic style is helpful for which patient, the aim of this study was to test the feasibility of experimentally varying the therapeutic style under realistic conditions and to investigate how this affects alliance ratings by clients and counselors.
Methods
We defined two manualized therapeutic styles (neutral/distant relational style vs. high affiliation relational style) based on the interpersonal circumplex. In a randomized two-group design, 64 healthy university students (70% female, Mage = 23.78, SDage = 2.81) received a single psychological counseling session on interpersonal conflicts by one of four counselors and in one of the two styles. We checked the manipulation success using observer-rated degree of affiliation and ratings of counselors’ interpersonal behavior with the Interpersonal Message Inventory (IMI-R). A series of linear regression models analyzed whether the style predicted working alliance, assessed via the Working Alliance Inventory (WAI).
Results
In accordance with the hypotheses, significant differences in the rated degree of affiliation (p ≤ .001) and IMI-R ratings (p ≤ .001 in friendly, p = .003 in hostile dimension) were found between the two groups. Overall, alliance ratings were high across groups and raters (WAI overall scores ranging from 3.76 to 4.07). The style did not predict clients’ alliance ratings.
Conclusion
The experimental variation of the therapeutic style proved feasible under realistic conditions with high overall alliance ratings. The novel experimental design may provide a basis for further research.
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18
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Aafjes-van Doorn K, Bar-Sella A, Zilcha-Mano S, Luo X, Silberschatz G, Kealy D, McCollum J, Snyder J. Within-patient perceptions of alliance and attunement: Associations with progress in psychotherapy. Clin Psychol Psychother 2022; 29:1717-1727. [PMID: 35352860 DOI: 10.1002/cpp.2737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
The most frequently examined aspect of the therapeutic relationship is the working alliance, which reflects the conscious collaborative bond, and agreement on task and goal. In addition to the established importance of the working alliance, the therapists' attunement and responsiveness might reflect another important aspect of the therapeutic relationship that can be considered in relation to session-by-session progress over treatments. Emerging research suggests that the quality of the working alliance not only differs between patients but also within patients over time. However, little is known about the quality of the therapeutic relationship between and within patients in relation to progress in psychotherapy. We examined fluctuations of the working alliance measure (WAI) and the newly developed measure of the Patients' Experiences of Attunement and Responsiveness (PEAR) during treatment in a naturalistic sample of patients in an outpatient psychotherapy clinic. Multilevel modelling was used to examine the respective contribution of these measures to subsequent improvement in psychological functioning longitudinally. Results suggest that the within-patient effect, instead of between-patient effect, was significant for WAI (and did not reach significance for PEAR), indicating that the fluctuation of WAI was predictive of psychological functioning in the subsequent month. Based on these findings, therapists and their patients might benefit from regular tracking of the patient-reported working alliance. The findings underscore the importance of the alliance, specifically at the within-patient level. It also highlights the challenge for research to tap into other aspects of the therapeutic relationship that can help explain progress in therapy. Given the breadth and accessibility of the working alliance construct, more work is needed for researchers to examine the construct of attunement and responsiveness.
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Affiliation(s)
| | | | | | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | | | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - James McCollum
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
| | - John Snyder
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
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19
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Leangsuksant T, Taephant N. Development and validation of the working alliance inventory short form Thai client version. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2022. [DOI: 10.1080/21507686.2022.2036784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Argaman Ben David I, Bat Or M, Regev D, Snir S. Changes over time in therapeutic and art therapy working alliances in simulated art therapy sessions. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2021.101804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Sijercic I, Liebman RE, Stirman SW, Monson CM. The Effect of Therapeutic Alliance on Dropout in Cognitive Processing Therapy for Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:819-828. [PMID: 33772892 DOI: 10.1002/jts.22676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/23/2021] [Accepted: 02/21/2021] [Indexed: 01/10/2023]
Abstract
A substantial number of individuals who undergo cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) drop out before receiving a full course of treatment. Therapeutic alliance, defined as the working relationship between the therapist and client, is a dynamic process within therapy that may change over time. Research suggests that therapeutic alliance is associated with dropout in various treatments. However, no studies have yet examined the association between therapeutic alliance and dropout in CPT, and few studies have examined therapeutic alliance longitudinally over the course of treatment. Examining alliance in CPT through different methods may increase clinicians' understanding of how to tailor interventions to prevent treatment dropout. The present study examined the association between therapeutic alliance and treatment dropout among 169 participants in a randomized implementation effectiveness trial. In total, 33.1% of clients dropped out over the course of CPT, and nearly half of these individuals dropped out during the first six sessions. Continuous-time survival analysis results indicated that mean ratings of alliance significantly predicted treatment dropout, Wald χ2 (1, N = 167) = 4.08, Exp(β) = .64, p = .043, whereas initial alliance, late alliance, and change in alliance over treatment did not. These findings suggest that overall therapeutic alliance is an important predictor of dropout from CPT.
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Affiliation(s)
- Iris Sijercic
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Rachel E Liebman
- Department of Psychology, Ryerson University, Toronto, Canada.,Faculty of Health, York University, Toronto, Canada
| | - Shannon Wiltsey Stirman
- National Center for PTSD, Menlo Park, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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22
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Gazit I, Snir S, Regev D, Bat Or M. Relationships Between the Therapeutic Alliance and Reactions to Artistic Experience With Art Materials in an Art Therapy Simulation. Front Psychol 2021; 12:560957. [PMID: 34335345 PMCID: PMC8316854 DOI: 10.3389/fpsyg.2021.560957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
In art therapy, art-making plays an important role in the therapeutic relationship. To better understand the triangular relationship between the art therapist, the client and the artwork, this study investigated the association between the therapeutic alliance and reactions to artistic experiences with art materials in an art therapy simulation. The simulation consisted of a series of 6-8 sessions in which art therapy students were divided into teams composed of a permanent observer (art therapist) and creator (client). The client's role was to self-explore through art- making, and the art therapist's role was to accompany the client. Thirty-four students, all women, who played the art therapist role, and 37 students (one male) who played the client participated in the study. Of these participants, there were 24 pairs where both participants filled out all the questionnaires. A short version of the Working Alliance Inventory (WAI) was completed by the clients and the art therapists on the second session (T1) and on the penultimate session (T2). The clients also completed the Art-Based Intervention Questionnaire (ABI) at T2. Significant positive correlations were found between indices of the WAI for the art therapist and the client and the clients' reactions to the artistic experience with art materials on the ABI. The evaluation of the emotional bond between the art therapist and the client at the start of the simulation significantly predicted the client's reactions to the artistic experience with art materials at the end of the simulation and explained 45.4% of the variance for this variable. These findings highlight factors related to the development and influence of the therapeutic alliance, as well as the role of the artistic experience in art therapy and lay the groundwork for further research.
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Affiliation(s)
- Inbal Gazit
- The School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Sharon Snir
- Department of Art Therapy, Tel Hai College, Upper Galilee, Israel
| | - Dafna Regev
- The School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Michal Bat Or
- The School of Creative Arts Therapies, University of Haifa, Haifa, Israel
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23
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Alvarez I, Herrero M, Martínez-Pampliega A, Escudero V. Measuring Perceptions of the Therapeutic Alliance in Individual, Family, and Group Therapy from a Systemic Perspective: Structural Validity of the SOFTA-s. FAMILY PROCESS 2021; 60:302-315. [PMID: 32588915 DOI: 10.1111/famp.12565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study examined the multidimensional structure of the client and therapist versions of the self-report measure, System for Observing Family Therapy Alliances (SOFTA-s; Friedlander, Escudero, & Heatherington, Therapeutic alliances in couple and family therapy: An empirically informed guide to practice. Washington, DC: American Psychological Association, 2006) across three distinct therapeutic modalities (individual, family, group). Specifically, we investigated whether the originally theorized model of four first-order factors (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family) would be reflected in a second-order factor (Therapeutic Alliance). The sample included 105 therapists who worked with 858 clients (165 individuals, 233 families, and 43 groups) in several Spanish community agencies. To control for dependent data, we used multilevel modeling. Results of the multilevel confirmatory factor analyses showed adequate reliabilities, fit indices, and factor loadings across the three therapy contexts for both versions of the measure (client and therapist). Adequate measurement invariance was also found across respondents and therapy modalities. Taken together, these results support the structural validity of the SOFTA-s, a brief and flexible self-report alliance measure that can be used reliably in clinical practice as well as in studies of individual, family, and group therapy.
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Affiliation(s)
- Irati Alvarez
- Departamento de Psicología Social y del Desarrollo, Universidad de Deusto, Biscay, Spain
| | - Marta Herrero
- Departamento de Psicología Social y del Desarrollo, Universidad de Deusto, Biscay, Spain
| | - Ana Martínez-Pampliega
- Departamento de Psicología Social y del Desarrollo, Universidad de Deusto, Biscay, Spain
| | - Valentín Escudero
- Departamento de Psicología, Universidad de A Coruña, A Coruña, Spain
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24
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Gómez Penedo JM, Schwartz B, Giesemann J, Rubel JA, Deisenhofer AK, Lutz W. For whom should psychotherapy focus on problem coping? A machine learning algorithm for treatment personalization. Psychother Res 2021; 32:151-164. [PMID: 34034627 DOI: 10.1080/10503307.2021.1930242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE We aimed to develop and test an algorithm for individual patient predictions of problem coping experiences (PCE) (i.e., patients' understanding and ability to deal with their problems) effects in cognitive-behavioral therapy. Method: In an outpatient sample with a variety of diagnoses (n=1010), we conducted Dynamic Structural Equation Modelling to estimate within-patient cross-lagged PCE effects on outcome during the first ten sessions. In a randomly selected training sample (2/3 of the cases), we tried different machine learning algorithms (i.e., ridge regression, LASSO, elastic net, and random forest) to predict PCE effects (i.e., the degree to which PCE was a time-lagged predictor of symptoms), using baseline demographic, diagnostic, and clinically-relevant patient features. Then, we validated the best algorithm on a test sample (1/3 of the cases). RESULTS The random forest algorithm performed best, explaining 14.7% of PCE effects variance in the training set. The results remained stable in the test set, explaining 15.4% of PCE effects variance. CONCLUSIONS The results show the suitability to perform individual predictions of process effects, based on patients' initial information. If the results are replicated, the algorithm might have the potential to be implemented in clinical practice by integrating it into monitoring and therapist feedback systems.
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Affiliation(s)
- Juan Martin Gómez Penedo
- Facultad de Psicología, Universidad de Buenos Aires (Conicet), Buenos Aires, Argentina.,Department of Psychology, University of Trier, Trier, Germany
| | - Brian Schwartz
- Department of Psychology, University of Trier, Trier, Germany
| | - Julia Giesemann
- Department of Psychology, University of Trier, Trier, Germany
| | - Julian A Rubel
- Department of Psychology, Justus-Liebig University Giessen, Giessen, Germany
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
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25
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Rutan JS. Rupture and Repair: Using Leader Errors in Psychodynamic Group Psychotherapy. Int J Group Psychother 2021; 71:310-331. [PMID: 38449167 DOI: 10.1080/00207284.2020.1808471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The therapeutic alliance is the bedrock upon which psychotherapy rests. Therapists need be aware of ruptures in the alliance, especially those caused by the therapist. Much important therapeutic work occurs in repairing alliance ruptures.
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Earle MJ, Freddolino PP. Meeting the Practice Challenges of COVID-19: MSW Students' Perceptions of E-Therapy and the Therapeutic Alliance. CLINICAL SOCIAL WORK JOURNAL 2021; 50:76-85. [PMID: 33678922 PMCID: PMC7925139 DOI: 10.1007/s10615-021-00801-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic prompted a radical shift in social work practice. Overnight, social work intervention models provided in-person gave way to the utilization of Information and Communication Technologies to facilitate direct practice in virtual environments (e-therapy). Social work's slow acceptance of e-therapy prior to the pandemic resulted in a lack of training for many social work practitioners and MSW student interns, who were required to make rapid transitions to using and operating in online environments. It appears likely that e-therapy will continue after the COVID-19 pandemic subsides, so integrating education about effective e-therapy techniques into social work curricula seems like a logical next step. A social worker's ability to establish the therapeutic alliance, which is at the heart of all helping relationships, will be central to this curricula. Understanding social work students' perceptions of e-therapy and the therapeutic alliance can help shape the development of this new curriculum. Using internal student email, students at two Research I universities were invited to participate in a fully online anonymous survey dealing with attitudes towards e-therapy and the therapeutic alliance. Surveys were conducted in 2018 and April-May 2020. Survey questions were based on the only prior comprehensive study of student attitudes towards e-therapy (Finn in J Soc Work Educ 38(3), 403-419. 10.1080/10437797.2002.10779107, 2002). Study results indicate that students have e-therapy experience, believe that a practitioner can build a good therapeutic alliance, and think that some form of e-therapy will continue after the pandemic. These results confirm that further exploration about the inclusion of e-therapy education and its efficacy in social work curricula requires urgent attention.
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Affiliation(s)
- Melissa J. Earle
- School of Social Welfare, Stony Brook University, Stony Brook, NY USA
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27
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Interpreter-mediated psychotherapy – a qualitative analysis of the interprofessional collaboration between psychologists and interpreters. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Linares-Fernández MT, La Touche R, Pardo-Montero J. Development and validation of the therapeutic alliance in physiotherapy questionnaire for patients with chronic musculoskeletal pain. PATIENT EDUCATION AND COUNSELING 2021; 104:524-531. [PMID: 33004233 DOI: 10.1016/j.pec.2020.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study is to present the development and analysis of the factorial structure and psychometric properties of a new self-administered questionnaire (Therapeutic Alliance in Physiotherapy Questionnaire-Patients [CAF-P]) designed to measure therapeutic alliance in physiotherapy. METHODS The sample included 204 patients with chronic pain attending nine primary care centres. The CAF-P was developed and validated using standard methodology, which included developing items, cognitive debriefing and psychometric validation. RESULTS CAF-P has excellent internal consistency, with Cronbach's α of 0.91 and an intraclass correlation coefficient (ICC) of 0.87. We propose a structure of two factors that explain 55.80 % of the variance. The convergent validity showed a moderate positive correlation with the probability of recommending treatment and with the level of satisfaction. CONCLUSIONS The CAF-P appears to be a valid and reliable instrument for measuring the therapeutic alliance perceived by patients in physiotherapy. PRACTICE IMPLICATIONS The results of the present study leads to further research to identify the differences in the therapeutic alliance construct between different settings or professions.
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Affiliation(s)
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Institut of Neuroscience and Sciences of Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Institut of Neuroscience and Sciences of Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
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Ray DC, Lankford CT, Malacara AB, Woehler E, McCullough R. Exploring Counselor Experiences of Training in Relational Depth: An Interpretative Phenomenological Inquiry. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Dee C. Ray
- Department of Counseling and Higher Education University of North Texas
| | - Cody T. Lankford
- Department of Counseling and Higher Education University of North Texas
| | | | - Elliott Woehler
- Department of Counseling and Higher Education University of North Texas
- Now at Human Development and Organizational Studies in Education University of Florida
| | - Rachel McCullough
- Department of Counseling and Higher Education University of North Texas
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Keidar L, Snir S, Regev D, Orkibi H, Adoni-Kroyanker M. Relationship Between the Therapist-Client Bond and Outcomes of Art Therapy in the Israeli School System. ART THERAPY 2020. [DOI: 10.1080/07421656.2020.1827651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Affiliation(s)
- Gesa Solveig Duden
- Department of Psychology, University of Osnabrück, Osnabrück, Germany
- Departamento de Psicologia, Universidade Federal de Santa Catarina, Trindade, Florianópolis, Brazil
| | - Lucienne Martins-Borges
- École de travail social et de criminology, Faculté des sciences sociales, Université Laval, Québec, Canada
- Departamento de Psicologia, Universidade Federal de Santa Catarina, Trindade, Florianópolis, Brazil
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Thimm JC, Antonsen L, Malmedal W. Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction. Health Expect 2020; 23:1477-1484. [PMID: 32935451 PMCID: PMC7752195 DOI: 10.1111/hex.13132] [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: 03/23/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients' experiences of being involved in their treatment. OBJECTIVE To investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction. DESIGN Cross-sectional. SETTING AND PARTICIPANTS The sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection. MAIN VARIABLES STUDIED Perceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out-Patient Experiences Questionnaire. RESULTS About half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction. DISCUSSION AND CONCLUSION The findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention. PATIENT OR PUBLIC CONTRIBUTION The hospital's user panel was involved in the development of items assessing user involvement.
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Affiliation(s)
- Jens C Thimm
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway.,Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Liss Antonsen
- Psychiatric Centre, Helgeland Hospital Trust Mo i Rana, Mo i Rana, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Sandage SJ, Jankowski PJ, Paine DR, Exline JJ, Ruffing EG, Rupert D, Stavros GS, Bronstein M. Testing a relational spirituality model of psychotherapy clients’ preferences and functioning. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2020. [DOI: 10.1080/19349637.2020.1791781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Steven J. Sandage
- Albert & Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
- Department of Education, Religion, and Society, MF Norwegian School of Theology (Oslo), Oslo, Norway
- Boston University, Boston, Massachusetts, USA
- Department of Psychological and Brain Sciences, Boston University, USA
| | - Peter J. Jankowski
- Albert & Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
- Counseling Program, Bethel University, St Paul, Minnesota, USA
| | - David R. Paine
- Department of Psychological Sciences Vorpahl Psychological Associates, MA, USA
| | - Julie J. Exline
- Department of Psychological and Brain Sciences, Boston University, USA
| | - Elizabeth G. Ruffing
- Albert & Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
- Department of Psychological and Brain Sciences, Boston University, USA
| | - David Rupert
- Albert & Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
| | - George S. Stavros
- Albert & Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
| | - Miriam Bronstein
- Albert & Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
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Li X, Kivlighan DM. Examining therapy dynamics and session outcome using differential equations model and multilevel data disaggregation. Psychother Res 2020; 30:604-621. [PMID: 31382841 DOI: 10.1080/10503307.2019.1649730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/21/2019] [Indexed: 10/26/2022] Open
Abstract
Objective: This study used Ordinary Differential Equations (ODE) model in a multilevel framework to investigate how the dyadic dynamics between therapist and client in perceiving working alliance (WA) was associated with the clients' session evaluation. Method: Participants were 33 therapists and their 180 clients. Therapists' and clients' WA ratings after each session were entered into the ODE model to estimate four coefficients capturing their consistency of perceptions of WA, and the levels to which one's perception influenced and was influenced by the other's perception. These dynamic coefficients were disaggregated into between-therapist and within-therapist components and entered into the Hierarchical Linear Model to predict client's session evaluation. Results: First, when therapists were generally more stable/consistent in perceiving their WA with all clients, they tended to have higher client evaluations of session quality. Second, when therapists were generally not influential on clients or not receptive to clients' influence, therapists' higher influence or openness to being influenced with a particular client was related to better session outcome. Third, when a therapist was generally highly influential, the more that therapist was influential to a particular client, that client reported worse session outcome. Conclusion: Implications about therapy dynamics and the use of ODE models were discussed.
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Affiliation(s)
- Xu Li
- 1Department of Counseling, Higher Education, and Special Education, College of Education, University of Maryland, College Park, MD, USA
- 2Department of Educational Psychology, University of Wisconsin, Milwaukee, WI, USA
| | - Dennis M Kivlighan
- Department of Counseling, Higher Education, and Special Education, College of Education, University of Maryland, College Park, MD, USA
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Sturm A, Menger A, de Vogel V, Huibers MJH. Predictors of Change of Working Alliance Over the Course of Probation Supervision: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2020; 64:753-773. [PMID: 31578897 DOI: 10.1177/0306624x19878554] [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: 06/10/2023]
Abstract
The body of evidence that the working alliance is associated with positive outcomes for mandated clients is growing. The aim of this research was to investigate the influence of several characteristics of probation officers (POs) and offenders on the course of the working alliance during probation supervision. This study examined the patterns on the four alliance subscales: Trust, Bond, Goals-Restrictions, and Reactance of the Working Alliance With Mandated Clients Inventory (WAMCI) in 201 offenders and their 137 POs. Three patterns on each alliance subscale were found: deteriorating, improving, and stable. Multinomial logistic analysis revealed that change of POs and the preference of the PO to maintain rules were associated with a deteriorating Trust pattern. From the perspective of the offenders, being motivated to take part in supervision was associated with a stable pattern on every alliance subscale, but having problems with substance use increased the likelihood of a deteriorating pattern on every alliance subscale.
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Affiliation(s)
- Annelies Sturm
- HU University of Applied Sciences Utrecht, The Netherlands
| | - Anneke Menger
- HU University of Applied Sciences Utrecht, The Netherlands
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36
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Holter MTS, Ness O, Johansen AB, Brendryen H. Making Come-Alive and Keeping Un-Alive: How People Relate to Self-Guided Web-Based Health Interventions. QUALITATIVE HEALTH RESEARCH 2020; 30:927-941. [PMID: 32046613 PMCID: PMC7322942 DOI: 10.1177/1049732320902456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Health interventions delivered online (self-guided web-based interventions) may become more helpful through a person-to-program "working alliance." In psychotherapy, the working alliance signifies a therapeutically useful client-therapist relationship and includes an emotional bond. However, there exist no theories of how program users relate to online programs, or that explain a person-to-program bond theoretically. Addressing this gap, we conducted qualitative interviews with and collected program data from users of a self-guided web-based intervention. Taking a grounded theory approach, the analysis arrived at a model of relating based on two relational modes-making come-alive and keeping un-alive. Different combinations of these modes could describe a range of ways of relating to the program, including a nonsocial interaction, a semi-social interaction, and a semi-social relationship. A person-to-program bond is explained by the model as an experienced supportive social presence, enabled by making come-alive and a positive program interaction.
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Affiliation(s)
- Marianne T. S. Holter
- The Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ottar Ness
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ayna B. Johansen
- The Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håvar Brendryen
- The Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, University of Oslo, Oslo, Norway
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37
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Sørensen KD, Wilberg T, Berthelsen E, Råbu M. Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be. Front Psychol 2020; 10:2879. [PMID: 31920894 PMCID: PMC6928111 DOI: 10.3389/fpsyg.2019.02879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (n = 15) were interviewed twice, using semi-structured in-depth interviews, and the responses subject to interpretative-phenomenological analysis. Persons with first-hand experience of avoidant personality disorder were included in the research process. Results: The super ordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, the findings highlight the importance of being met inter-subjectively as a person with intentionality and agency, even when one does not feel like one. The importance of establishing an emotional bond and emergent trust for open therapeutic collaboration, learning, and becoming able to build courage to begin to approach that which one fears is emphasized.
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Affiliation(s)
- Kristine Dahl Sørensen
- Group Therapy Team, Aust-Agder County Outpatient Psychiatric Unit, Sorlandet Hospital, Arendal, Norway
| | - Theresa Wilberg
- Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eivind Berthelsen
- Aust-Agder County Outpatiet Psychiatric Unit, Sorlandet Hospital, Arendal, Norway
| | - Marit Råbu
- Department of Psychology, University of Oslo, Oslo, Norway
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Andrade-González N, Hernández-Gómez A, Álvarez-Sesmero S, Gutiérrez-Rojas L, Vieta E, Reinares M, Lahera G. The influence of the working alliance on the treatment and outcomes of patients with bipolar disorder: A systematic review. J Affect Disord 2020; 260:263-271. [PMID: 31521862 DOI: 10.1016/j.jad.2019.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/22/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The working alliance plays an essential role in the treatment of patients with different diseases. However, this variable has received little attention in patients with bipolar disorder. Therefore, this systematic review aimed to examine the working alliance's influence on these patients' treatment outcomes, analyze its role in the adherence to pharmacotherapy, and identify the variables that are related to a good working alliance. METHODS PubMed, PsycINFO, and Web of Science databases were searched until January 5, 2018 using a predetermined search strategy. Then, a formal process of study selection and data extraction was conducted. RESULTS Seven articles fulfilled the inclusion criteria and they included a total of 3,985 patients with bipolar disorder type I and II. Although the working alliance's ability to predict the duration and presence of manic and depressive symptoms is unclear, a good working alliance facilitates the adherence to pharmacological treatment. In addition, good social support for patients is associated with a strong working alliance. LIMITATIONS The selected studies used different definitions and measures of the working alliance and adherence, and most used self-reports to assess the working alliance. Furthermore, the relationships found among the variables were correlational. CONCLUSIONS The working alliance can play an important role in adjunctive psychological therapies and in pharmacological and somatic treatments for patients with bipolar disorder. However, the number of studies on working alliance in bipolar disorder is rather limited and there is methodological heterogeneity between the studies.
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Affiliation(s)
- Nelson Andrade-González
- Relational Processes and Psychotherapy Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | | | | | | | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; IRyCIS, CIBERSAM, Madrid, Spain.
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Schenk N, Zimmermann R, Fürer L, Krause M, Weise S, Kaess M, Schlüter-Müller S, Schmeck K. Trajectories of alliance ruptures in the psychotherapy of adolescents with borderline personality pathology: timing, typology and significance. ACTA ACUST UNITED AC 2019; 22:348. [PMID: 32913792 PMCID: PMC7451373 DOI: 10.4081/ripppo.2019.348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
Jeremy Safran and his research group suggest that rupture-repair processes are important for the therapeutic change in patients with personality disorders. In this exploratory study, we describe alliance ruptures and resolutions on a session-by-session basis in a clinical sample of adolescents with Borderline Personality Pathology (BPP). Three research questions are addressed: i) Is there a typical trajectory of alliance ruptures over treatment time? ii) Which rupture and resolution markers occur frequently? iii) Which rupture markers are most significant for the therapeutic alliance? Ten patients who presented with identity diffusion and at least three Borderline Personality Disorder criteria were studied and treated with Adolescent Identity Treatment. Alliance ruptures and resolutions were coded in 187 therapy sessions according to the Rupture Resolution Rating System. Mixed-effect models were used for statistical analyses. Findings supported an inverted U-shaped trajectory of alliance ruptures across treatment time. The inspection of individual trajectories displayed that alliance ruptures emerge non-linearly with particular significant alliance ruptures appearing in phases or single peak sessions. Withdrawal rupture markers emerged more often compared to confrontation markers. However, confrontation markers inflicted a higher impact or strain on the immediate collaboration between patient and therapist compared to withdrawal markers. Clinicians should expect alliance ruptures to occur frequently in the treatment of adolescents with BPP. The findings support the theory of a dynamic therapeutic alliance characterised by a continuous negotiation between patients and therapists.
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Affiliation(s)
- Nathalie Schenk
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Mariane Krause
- Psychology School, Catholic University of Chile, Santiago, Chile.,Millennium Institute for Research in Depression and Personality, Santiago, Chile
| | - Sindy Weise
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Susanne Schlüter-Müller
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
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Gómez Penedo JM, Berger T, grosse Holtforth M, Krieger T, Schröder J, Hohagen F, Meyer B, Moritz S, Klein JP. The Working Alliance Inventory for guided Internet interventions (WAI‐I). J Clin Psychol 2019; 76:973-986. [DOI: 10.1002/jclp.22823] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Thomas Berger
- Department of Clinical Psychology and PsychotherapyUniversity of Bern Switzerland
| | - Martin grosse Holtforth
- Department of Clinical Psychology and PsychotherapyUniversity of Bern Switzerland
- Psychosomatic Competence CenterUniversity Hospital InselspitalBern Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and PsychotherapyUniversity of Bern Switzerland
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, Institute for Sex Research and Forensic PsychiatryUniversity Medical Center Hamburg‐EppendorfHamburg Germany
| | - Fritz Hohagen
- Department of Psychiatry and PsychotherapyLübeck UniversityLübeck Germany
| | - Björn Meyer
- GAIA AGHamburg Germany
- Department of PsychologyUniversity of LondonLondon United Kingdom
| | - Steffen Moritz
- Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburg Germany
| | - Jan Philipp Klein
- Department of Psychiatry and PsychotherapyLübeck UniversityLübeck Germany
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41
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Gonçalves MM, Sousa I, Rosa C. Correlation structure in hierarchical linear modelling: An illustration with the therapeutic alliance. Clin Psychol Psychother 2019; 26:626-635. [PMID: 31111531 DOI: 10.1002/cpp.2374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/12/2019] [Accepted: 05/13/2019] [Indexed: 11/08/2022]
Abstract
Previous studies have found an association between therapeutic alliance and treatment outcome, but only recently have researchers begun to analyse time-lagged relationships between session-to-session measures of alliance and outcomes with hierarchical linear modelling (HLM). HLM assumes simple correlation structures between any two measurements from the same client. In this paper, we suggest that this assumption might be problematic. Session-to-session measurements of outcomes (Outcome Questionnaire-10.2) and alliance (Working Alliance Inventory) in a sample (N = 63) were used to perform HLM analyses to test time-lagged (lag +1) relations between outcomes and alliance in both directions. A first set of analyses replicated the models consistently used in the literature, whereas a second set of models considered a correlation structure as a function of time. A correlation independent of time distance resulted in a bidirectional influence between alliance and outcomes (the model commonly used in the literature), but when considering a correlation structure as a function of time, only the outcomes were predictive of alliance. Considering a more complex correlation structure as a function of time seems to be an important analytical strategy for addressing the issue of variability in within-client measurements over time. This study highlights how the misspecification of a statistical model, namely, not considering a time-dependent correlation structure of the response variable, may lead to misleading findings in HLM studies. This is particularly relevant in process-outcome research, such as studies analysing the impact of therapeutic alliance on clinical outcomes.
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Affiliation(s)
- Miguel M Gonçalves
- School of Psychology, Psychology Research Center, University of Minho, Braga, Portugal
| | - Inês Sousa
- School of Sciences, Department of Mathematics and Applications, University of Minho, Braga, Portugal
| | - Catarina Rosa
- Department of Education and Psychology, CINTESIS.UA-Centre for Health Technology and Services Research, University of Aveiro, Aveiro, Portugal
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Liebmann EP, Preacher KJ, Richter KP, Cupertino AP, Catley D. Identifying pathways to quitting smoking via telemedicine-delivered care. Health Psychol 2019; 38:638-647. [PMID: 31021123 DOI: 10.1037/hea0000740] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A randomized controlled trial of quitline-like phone counseling (QL) versus telemedicine integrated into primary care (ITM) compared the effectiveness of these modalities for smoking cessation. Study design and components were based on self-determination theory (SDT). The purpose of this study was to test our SDT-based model in which perceived health care provider autonomy support, working alliance, autonomous motivation, and perceived competence were hypothesized to mediate the effects of ITM on smoking cessation. METHOD Rural smokers (n = 560) were randomized to receive 4 sessions over a 3-month period of either QL or ITM. Follow-up assessments were conducted at Months 3, 6, and 12. The primary outcome was biochemically verified 7-day point prevalence at 12 -months. Structural equation modeling with latent change scores was used for the analysis. RESULTS Participants in the ITM condition reported greater increases in perceived health care provider autonomy support (PAS) at end of treatment, which in turn was associated with enhanced perceived competence to quit smoking (PC). Increased PC was associated with a higher likelihood of cessation at 12-months. Mediation analysis demonstrated significant indirect effects, including a path from ITM to increases in PAS to increases in PC to cessation at 12-months (indirect effect = 0.0183, 95% confidence interval [.003, .0434]). CONCLUSIONS When integrated into primary care, ITM may influence smoking cessation by enhancing the extent to which smokers feel supported by their providers and thereby increase their perceived ability to quit. Findings suggest that locating tobacco treatment services in health care provider offices imparts a motivational benefit for cessation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Coco GL, Tasca GA, Hewitt PL, Mikail SF, Kivlighan DM. Ruptures and repairs of group therapy alliance. An untold story in psychotherapy research. RESEARCH IN PSYCHOTHERAPY (MILANO) 2019; 22:352. [PMID: 32913782 PMCID: PMC7451388 DOI: 10.4081/ripppo.2019.352] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/02/2019] [Indexed: 11/23/2022]
Abstract
Although previous studies investigated the characteristics of therapeutic alliance in group treatments, there is still a dearth of research on group alliance ruptures and repairs. The model by Safran and Muran was originally developed to address therapeutic alliance in individual therapies, and the usefulness of this approach to group intervention needs to be demonstrated. Alliance ruptures are possible at member to therapist, member to member, member to group levels. Moreover, repairs of ruptures in group are quite complex, i.e., because other group members have to process the rupture even if not directly involved. The aim of the current study is to review the empirical research on group alliance, and to examine whether the rupture repair model can be a suitable framework for clinical understanding and research of the complexity of therapeutic alliance in group treatments. We provide clinical vignettes and commentary to illustrate theoretical and research aspects of therapeutic alliance rupture and repair in groups. Our colleague Jeremy Safran made a substantial contribution to research on therapeutic alliance, and the current paper illustrates the enduring legacy of this work and its potential application to the group therapy context.
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Affiliation(s)
- Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy
| | | | - Paul L. Hewitt
- Department of Psychology, University of British Columbia, Canada
| | | | - Dennis M. Kivlighan
- Department of Counseling, Higher Education and Special Education, University of Maryland, USA
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Brockmann J, Kirsch H, Dembler K, König D, de Vries I, Zabolitzki M, Silberschatz G. Effects of interventions promoting mentalization and interventions disconfirming pathogenic beliefs: A comparative single case study of three patients. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1470482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Josef Brockmann
- Free Praxis, Berlin, Ludwigshafen, Hamburg, Frankfurt, Germany
| | | | - Katja Dembler
- Free Praxis, Berlin, Ludwigshafen, Hamburg, Frankfurt, Germany
| | - Dorothe König
- Free Praxis, Berlin, Ludwigshafen, Hamburg, Frankfurt, Germany
| | - Isolde de Vries
- Free Praxis, Berlin, Ludwigshafen, Hamburg, Frankfurt, Germany
| | | | - George Silberschatz
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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45
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Grant AM, Green RM. Developing clarity on the coaching-counselling conundrum: Implications for counsellors and psychotherapists. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018. [DOI: 10.1002/capr.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anthony M. Grant
- Coaching Psychology Unit; University of Sydney; Sydney New South Wales Australia
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46
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da Silva ACN, Vasco AB, Watson JC. Alexithymia and therapeutic alliance: a multiple case study comparing good and poor outcome cases. RESEARCH IN PSYCHOTHERAPY (MILANO) 2018; 21:313. [PMID: 32913763 PMCID: PMC7451330 DOI: 10.4081/ripppo.2018.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/10/2018] [Indexed: 11/23/2022]
Abstract
Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients expressing emotions, engaging in emotional tasks and also poor therapeutic alliances. This study aims to better understand alexithymic patients in psychotherapy. A multiple case study design was used. Cases were selected from a larger research project considering their alexithymia level and outcome status, based on the reliable change index and the client perspective on change. Four cases are presented: with and without alexithymia with good and poor outcome. The therapeutic alliance was included as a process measure, evaluated from both client and therapist. At the end a semi structured interview was conducted with both participants, individually. The analysis concerned the integration and triangulation of the therapist and client experience for each case. Each patient was briefly presented and then a focus was made regarding the perception of both participants on the therapeutic alliance and the emotional processing and change process of the client. Both alexithymic cases and the non-alexithymic poor outcome case showed difficulties in the therapeutic alliance, especially from the perspective of the therapist. In these cases, emotional impairments may have contributed to a poor therapeutic alliance, impacting on the outcome. We suggest that a great focus on the therapeutic alliance with alexithymic patients may increase the quality of treatment and it may be more useful for case conceptualization to consider each feature of the alexithymia construct individual.
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Affiliation(s)
- Ana Catarina Nunes da Silva
- Department of Cognitive, Behavioral and Integrative Psychotherapy, Faculty of Psychology, University of Lisbon, Portugal
| | - Antonio Branco Vasco
- Department of Cognitive, Behavioral and Integrative Psychotherapy, Faculty of Psychology, University of Lisbon, Portugal
| | - Jeanne C. Watson
- Ontario Institute for Studies in Education, University of Toronto, Canada
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Calhoun S. The clinician-patient working alliance: Is it a significant predictor of psychiatric medication adherence in a sample of recently released parolees? THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 2018; 29:782-793. [PMID: 30524208 PMCID: PMC6277031 DOI: 10.1080/14789949.2018.1477976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Persistent psychiatric symptoms can serve as a major barrier to the successful reintegration of parolees with mental illness. Thus, it is important to identify factors that might impact their mental health recovery, such as low adherence to their treatment regimen. Although many studies have examined the issue of psychiatric medication nonadherence, very few studies have focused specifically on justice-involved individuals. The strength of the clinician/patient working alliance has been found to be significantly associated with psychiatric medication adherence in prior research, but this relationship has not been assessed in a parolee population. Logistic regression analysis was used to determine if patient-rated working alliance was a significant predictor of low psychiatric medication adherence while taking into account alcohol/illegal drug use, age, and ethnicity in a sample of recently released parolees with mental illness (N=49). Patient-rated working alliance, age, and ethnicity were not significant predictors of low adherence. Alcohol/illegal drug use during the follow-up period was associated with a significantly increased likelihood of meeting the criteria for low medication adherence (OR=8.36; 95% CI=1.60, 43.66). The findings from this study highlight the importance of addressing alcohol and illegal drug use issues as part of the psychiatric treatment plan for returning prisoners with mental illness.
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Affiliation(s)
- Stacy Calhoun
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025
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Doran JM, Gómez-Penedo JM, Safran JD, Roussos A. A therapist version of the Alliance Negotiation Scale. Clin Psychol Psychother 2018; 25:745-753. [PMID: 29722105 DOI: 10.1002/cpp.2197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 11/06/2022]
Abstract
The aim of the current study was to design and evaluate a therapist version of the Alliance Negotiation Scale (ANS). The ANS was created in order to operationalize the construct of dyadic negotiation in psychotherapy and to augment existing conceptualizations of the working alliance. The ANS has existed only as a client self-report form since its inception and has demonstrated promise as a psychotherapy process measure. This research intended to develop a complementary therapist self-report version of the measure. The scale creation process is discussed in detail, and the results of a preliminary psychometric investigation are reported. The ANS-Therapist version (ANS-T) was developed using a sample of therapists (n = 114) through a principal components analysis procedure. The ANS-T contains 9 unidimensional items and was moderately correlated with therapist-reported working alliance (r = .468). The results of the study support the composition of the ANS-T and provide initial support for the reliability and validity of the measure.
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Affiliation(s)
- Jennifer M Doran
- VA Connecticut Healthcare System, CT, USA.,Department of Psychiatry, Yale School of Medicine, CT, USA
| | | | | | - Andrés Roussos
- CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
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Orkibi H, Azoulay B, Regev D, Snir S. Adolescents’ dramatic engagement predicts their in-session productive behaviors: A psychodrama change process study. ARTS IN PSYCHOTHERAPY 2017. [DOI: 10.1016/j.aip.2017.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Andrade-González N, Lahera G, Fernández-Liria A. Patient-Therapist Perspective of the Working Alliance in Psychotherapy. Psychiatr Q 2017; 88:623-633. [PMID: 27848105 DOI: 10.1007/s11126-016-9477-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to examine perceptions of the working alliance in a sample of Spanish patients and therapists. The alliance was measured after the third and tenth psychotherapy sessions using patient and therapist versions of the Spanish adaptation of the Working Alliance Inventory (WAI). After both sessions, correlations between the patients' and therapists' ratings, both of total alliance and of the various dimensions of the alliance, were moderate at best. Moreover, after the third psychotherapy session, patients' scores for the total alliance and the Goal and Task subscales were significantly higher than the scores from their therapists in these dimensions. Following the tenth session, patient ratings exceeded those of their therapists only on the Task subscale. Finally, in contrast to the ratings of patients, therapists' alliance ratings increased significantly between the third and tenth sessions of psychotherapy. Certain recommendations are presented to improve the study of patient and therapist perceptions of the working alliance and to increase the convergence between them with regard to this central treatment variable.
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Affiliation(s)
- Nelson Andrade-González
- Relational Processes and Psychotherapy Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Campus Universitario, Carretera Madrid-Barcelona Km. 33,600, 28871, Alcalá de Henares, Madrid, Spain.
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
- IRyCIS, CIBERSAM, Madrid, Spain
| | - Alberto Fernández-Liria
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
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