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Fusar-Poli L, Panariello F, Berry K, Rocchetti M, Casiraghi L, Malvezzi M, Starace F, Zamparini M, Zarbo C, de Girolamo G. Working alliance in treating staff and patients with Schizophrenia Spectrum Disorder living in Residential Facilities. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:156-177. [PMID: 38115200 DOI: 10.1111/bjc.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies. METHODS Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI-P) and staff members (WAI-T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning. RESULTS Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI-P and WAI-T ratings. Linear regression showed that patients with higher education reported lower WAI-P ratings (β = -.50, p = .044), while not being engaged in work or study was associated with lower WAI-T scores (β = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI-P ratings (β = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI-T (β = -.10, p = .002) and WAI-P ratings (β = -.19, p < .001). Better functioning level positively foresaw WAI-T (β = .14, p < .001) and WAI-P ratings (β = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy. CONCLUSIONS This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Fabio Panariello
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Katherine Berry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Department of Research and Innovation, Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matteo Rocchetti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Letizia Casiraghi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Matteo Malvezzi
- Department of Biostatistics, University of Parma, Parma, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Li X, Wu M, Li F. Examining therapist estimation of client working alliance and client symptom outcome using truth and bias model and response surface analysis. Psychother Res 2024; 34:503-517. [PMID: 37014789 DOI: 10.1080/10503307.2023.2193671] [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: 09/29/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE The aims of this study were to investigate the congruence and discrepancy between Chinese therapist trainees' estimated client working alliance (WA) and their clients' actual WA rating, and how the congruence and discrepancy predicted client symptom outcome. METHODS Participants were 211 beginning therapist trainees and 1216 clients. Data from their 6888 sessions were analyzed using Truth and Bias Model and Response Surface Model. RESULTS AND CONCLUSIONS (i) Chinese trainees' estimation of client WA was on average significantly lower than actual client WA. (ii) At the between-person level, whether the trainee generally over- or underestimated client WA was not related to the client's initial symptom level or symptom improvement rate. (iii) At the within-person between-session level, a session where a trainee accurately perceived high client WA, compared to a session where the trainee accurately perceived low client WA, was followed by greater client symptom relief before the next session. In the case of estimation bias, a session where the trainee underestimated client WA was followed by greater client symptom reduction in the next session, rather than the other way around when the trainee overestimated client WA. Implications on therapist training were discussed.
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Affiliation(s)
- Xu Li
- Department of Educational Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Manxuan Wu
- Department of Educational Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Feihan Li
- Faculty of Psychology, Beijing Normal University, Beijing, People's Republic of China
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Elran-Barak R, Grundman-Shem Tov R, Zubery E, Lewis YD. Therapeutic alliance with psychotherapist versus dietician: a pilot study of eating disorder treatment in a multidisciplinary team during the COVID-19 pandemic. Front Psychiatry 2024; 14:1267676. [PMID: 38348361 PMCID: PMC10860050 DOI: 10.3389/fpsyt.2023.1267676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
Little is known about the therapeutic alliance (TA) formed with different professionals in multidisciplinary eating disorder (ED) treatment, particularly in the context of online treatment during the COVID-19 pandemic. We aimed to conduct a pilot study during the COVID-19 pandemic examining characteristics of patients' TA with their dieticians and psychotherapists, associations between patients' and therapists' views of the TA, and relationships between psychological characteristics and TAs. Sixty-three patients with EDs and their treating psychotherapists and dieticians were surveyed during the COVID-19 pandemic using the Working Alliance Inventory (WAI-S). Spearman correlation tests were used to examine associations between variables. Positive associations were found between the TAs examined. Concordance was stronger in patient-dietician dyads than in patient-psychotherapist dyads. Severe ED psychopathology was associated with weaker TA (bond subscale). General psychopathology was associated with weaker TA with the dietician (task subscale). Given that several differences were found between the TAs of treatment dyads, further longitudinal studies are needed to validate our pilot findings and to investigate multidisciplinary TAs and their impact on treatment outcomes in online ED treatment settings during the COVID-19 pandemic, as well as in other treatment settings (e.g., in-person settings). This study will contribute to a deeper understanding of the dynamics of TAs in multidisciplinary ED treatment and inform the development of more effective interventions.
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Affiliation(s)
| | - Rinat Grundman-Shem Tov
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Eynat Zubery
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael D. Lewis
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Moshe-Cohen R, Kivity Y, Huppert JD, Barlow DH, Gorman JM, Shear K, Woods SW. Agreement in patient-therapist alliance ratings and its relation to dropout and outcome in a large sample of cognitive behavioral therapy for panic disorder. Psychother Res 2024; 34:28-40. [PMID: 36169615 PMCID: PMC10043046 DOI: 10.1080/10503307.2022.2124131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/23/2022] [Indexed: 10/14/2022] Open
Abstract
Objective: The therapeutic alliance is related to treatment outcome but less is known about the agreement on alliance between patients and therapists and its relationship to outcomes. We examined the association of patient-therapist congruence of alliance perceptions, early and late in cognitive behavioral therapy for panic disorder in relation to symptom reduction and dropout. Method: Patients (n = 181) and their therapists provided alliance ratings early and late during 11-session treatment. Independent evaluators rated patients' symptomatic levels post-treatment. Polynomial regression and response surface analysis were used to examine congruence as a predictor of outcome. Results: Early in therapy, stronger combined patient-therapist alliances, regardless of agreement, predicted lower symptom severity at the end of therapy and a lower likelihood of dropout. Late in treatment, the outcome was worse when therapist ratings of the alliance were higher than those of the patient. Conclusions: Therapist-patient agreement on the strength of the alliance is important for symptom improvement and dropout. The study highlights the importance of understanding the dyadic nature of the alliance and its impact on therapeutic change.
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Affiliation(s)
- Rotem Moshe-Cohen
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem
| | - Yogev Kivity
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Jonathan D. Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem
| | - David H. Barlow
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, USA
| | - Jack M. Gorman
- Franklin Behavioral Health Care Consultants and Critica LLC, Bronx, NY, USA
| | | | - Scott W. Woods
- Connecticut Mental Health Center, Department of Psychiatry, Yale University, New Haven, CT
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5
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Lavi-Rotenberg A, Kivity Y, Igra L, Atzil-Slonim D, Hasson-Ohayon I. A dyadic session-by-session assessment of therapeutic alliance and short-term outcome among clients with schizophrenia in comparison with clients with emotional disorders. Psychol Psychother 2023; 96:1029-1043. [PMID: 37665174 DOI: 10.1111/papt.12494] [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: 12/22/2022] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Although the clinical significance of the therapeutic alliance (TA) is well documented, the literature regarding the establishment of TA and the relation between client-therapist agreement on it to short-term outcome among various diagnostic groups-and specifically among clients diagnosed with serious mental illness (SMI)-is sparse. The aim of the present study was to examine the effect of client diagnosis on the abovementioned TA characteristics. METHOD Dyadic analyses of session-by-session (SBS) data were used to compare clients diagnosed with schizophrenia and clients diagnosed with emotional disorders (based on a clinical interview) in their TA characteristics. RESULTS TA as initially rated by clients was stronger in the emotional disorders group than in the schizophrenia group. Higher TA ratings, regardless of whether these were provided by the therapist or the client, predicted better subsequent functioning in the emotional disorders group, whereas in the schizophrenia group, this association was observed only among good-outcome cases. CONCLUSIONS Establishing TA, having client-therapist agreement on it, and having clients derive therapeutic benefit from it might be more challenging with clients with schizophrenia than with clients with emotional disorders. Special attention should be given to specific challenges and needs regarding clients' diagnosis in order to enhance favourable therapy outcomes.
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Affiliation(s)
| | - Yogev Kivity
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Libby Igra
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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Cunningham PB, Gilmore J, Naar S, Preston SD, Eubanks CF, Hubig NC, McClendon J, Ghosh S, Ryan-Pettes S. Opening the Black Box of Family-Based Treatments: An Artificial Intelligence Framework to Examine Therapeutic Alliance and Therapist Empathy. Clin Child Fam Psychol Rev 2023; 26:975-993. [PMID: 37676364 PMCID: PMC10845126 DOI: 10.1007/s10567-023-00451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
The evidence-based treatment (EBT) movement has primarily focused on core intervention content or treatment fidelity and has largely ignored practitioner skills to manage interpersonal process issues that emerge during treatment, especially with difficult-to-treat adolescents (delinquent, substance-using, medical non-adherence) and those of color. A chief complaint of "real world" practitioners about manualized treatments is the lack of correspondence between following a manual and managing microsocial interpersonal processes (e.g. negative affect) that arise in treating "real world clients." Although family-based EBTs share core similarities (e.g. focus on family interactions, emphasis on practitioner engagement, family involvement), most of these treatments do not have an evidence base regarding common implementation and treatment process problems that practitioners experience in delivering particular models, especially in mid-treatment when demands on families to change their behavior is greatest in treatment - a lack that characterizes the field as a whole. Failure to effectively address common interpersonal processes with difficult-to-treat families likely undermines treatment fidelity and sustained use of EBTs, treatment outcome, and contributes to treatment dropout and treatment nonadherence. Recent advancements in wearables, sensing technologies, multivariate time-series analyses, and machine learning allow scientists to make significant advancements in the study of psychotherapy processes by looking "under the skin" of the provider-client interpersonal interactions that define therapeutic alliance, empathy, and empathic accuracy, along with the predictive validity of these therapy processes (therapeutic alliance, therapist empathy) to treatment outcome. Moreover, assessment of these processes can be extended to develop procedures for training providers to manage difficult interpersonal processes while maintaining a physiological profile that is consistent with astute skills in psychotherapeutic processes. This paper argues for opening the "black box" of therapy to advance the science of evidence-based psychotherapy by examining the clinical interior of evidence-based treatments to develop the next generation of audit- and feedback- (i.e., systemic review of professional performance) supervision systems.
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Affiliation(s)
- Phillippe B Cunningham
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Rd. Ste. 104, Charleston, SC, 29407, USA.
| | - Jordon Gilmore
- Department of Bioengineering, Clemson University, 401-3 Rhodes Research Center, Clemson, SC, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL, USA
| | - Stephanie D Preston
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
| | - Catherine F Eubanks
- Gordon F. Derner School of Psychology, Adelphi University, One South Avenue, Garden City, NY, USA
| | - Nina Christina Hubig
- School of Computing, Clemson University, 1240 Supply Street, Charleston, SC, 29405, USA
| | - Jerome McClendon
- Department of Automotive Engineering, Clemson University, 4 Research Drive, Greenville, SC, USA
| | - Samiran Ghosh
- Department of Biostatistics and Data Science & Coordinating Center for Clinical Trials (CCCT), University of Texas School of Public Health, University Texas Health Sciences , RAS W-928, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Stacy Ryan-Pettes
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798, USA
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Grossman-Giron A, Fisher H, Atzil-Slonim D, Maoz H, Nitzan U, Tzur Bitan D. The effect of Oxytocin administration on patient-therapist alliance congruence: Results from a randomized controlled trial. Psychother Res 2023:1-11. [PMID: 37856680 DOI: 10.1080/10503307.2023.2269300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES The effects of oxytocin (OT) administration on psychotherapeutic processes have thus far been elusive. This study explored the effect of OT administration on patient-therapist congruence of the working alliance. METHOD Inpatients with mental disorders (N = 87) participating in a randomized controlled trial received OT (n = 44) or placebo (n = 43) intranasally twice a day, for four weeks. Patients and therapists rated the alliance after each session. RESULTS Oxytocin significantly moderated the level of agreement (b = -0.56, SE = 0.25, t = -2.30, p = 0.02), such that patients receiving OT demonstrated lower discrepancy (b = -0.73, p < 0.001) than did those receiving placebo (b = -1.30, p < 0.001). On the other hand, the mutual covariance of patient-therapist ratings across sessions was positive and significant for patients receiving placebo (b = 0.26, p = 0.01) but not for patients in the OT group (b = -0.06, p = .56). CONCLUSION Oxytocin can reduce discrepancies of patient-therapist perceptions of the alliance, although additional studies are needed to explore OT's effect on alliance development over time. As alliance congruence is associated with therapy outcomes, such intervention may lead to enhancement of therapeutic gains.
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Affiliation(s)
- Ariella Grossman-Giron
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Fisher
- Department of Psychology, Haifa University, Haifa, Israel
| | | | - Hagai Maoz
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Nitzan
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Tzur Bitan
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Whelen ML, Ezawa ID, Strunk DR. Congruence in patient and therapist-rated alliance predicts subsequent depressive symptoms in cognitive behavioral therapy for depression. Psychother Res 2023; 33:719-728. [PMID: 36525598 PMCID: PMC10272287 DOI: 10.1080/10503307.2022.2156304] [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: 12/17/2021] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The therapeutic alliance is a dyadic process involving both patient and therapist perspectives. We investigated the effect of patient and therapist agreement on the alliance in cognitive behavioral therapy for depression. METHOD Patients (N = 191) were drawn from two studies of cognitive behavioral therapy for depression provided over 16 weeks. Alliance data were collected from patients and therapists at the first four sessions. Patients provided symptom data at each session. We used multilevel polynomial regression with response surface analysis to investigate the effect of alliance agreement and disagreement on symptoms. RESULTS The within-person strength of patient and therapist-rated alliance (given agreement) predicted lower within-person symptoms. The nature and degree of the discrepancy in patient and therapist alliance scores was not a significant predictor. CONCLUSION Patients and therapist alliance strength in early sessions (given agreement) predicted greater symptom change. Future research is needed to examine whether specific patient characteristics can be used to identify for whom the alliance plays a more or less important role.
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Tanzilli A, Boldrini T, Carone N, Gualco I, Lingiardi V, Williams R. Patient personality dimensions, relational patterns and therapeutic alliance in clinical practice: An empirical investigation. Clin Psychol Psychother 2023; 30:97-111. [PMID: 35981709 DOI: 10.1002/cpp.2779] [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: 04/10/2022] [Revised: 07/03/2022] [Accepted: 08/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. METHODS A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler-Westen Assessment Procedure-200 (SWAP-200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI-T) to evaluate quality of therapeutic alliance. RESULTS Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician-patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. CONCLUSIONS Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes.
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Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ivan Gualco
- Center for Individual and Couple Therapy, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Sergerie-Richard S, Dupuis F, Cassivi C. For a better understanding of the relationship between caregivers and young adults living with a concomitant substance-related mental health and substance use disorder: an integrative review. Rech Soins Infirm 2023; 153:24-39. [PMID: 37709664 DOI: 10.3917/rsi.153.0024] [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] [Indexed: 09/16/2023]
Abstract
Introduction The importance of a quality relationship between young adults living with dual diagnosis and their health care providers is well documented. Context Although this complex phenomenon was mostly studied from an individual perspective, the results indicated the systemic nature of this relationship. Objective This study aims to better understand the relationship between young adults living with dual diagnosis and their health care providers, with a systemic perspective. Method Six data bases were consulted; manual research in gray literature and references screening enhanced the process. Results Of a total of 532 studies and reports identified, 44 were included in the review. Thematic data analysis was carried out, and two themes were identified: the health care system as a constraining environment; and the relationship at the heart of care. Discussion This study confirms the joint role played by the young adult in question and their health care provider in developing and maintaining the relationship, by acknowledging the importance of the care, of mutual confidence, and of a hierarchic relationship. Conclusion This integrative review provides a basis for future nursing interventions that foreground the relationship and take a systemic approach.
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Affiliation(s)
- Sophie Sergerie-Richard
- Infirmière, M.Sc, Faculté des sciences infirmières de l’Université de Montréal, Montréal, Québec, Canada
| | - France Dupuis
- Infirmière, Ph.D, professeure agrégée, Faculté des sciences infirmières de l’Université de Montréal, Montréal, Québec, Canada
| | - Christine Cassivi
- Infirmière, M.Sc, Faculté des sciences infirmières de l’Université de Montréal, Montréal, Québec, Canada
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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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Alfi-Yogev T, Kivity Y, Hasson-Ohayon I, Ziv-Beiman S, Yehezkel I, Atzil-Slonim D. Client-therapist temporal congruence in perceiving immediate therapist self-disclosure and its association with treatment outcome. Psychother Res 2022:1-15. [DOI: 10.1080/10503307.2022.2151947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tal Alfi-Yogev
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Yogev Kivity
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Sharon Ziv-Beiman
- Faculty School of Behavioral Sciences, The Academic College Tel-Aviv Yaffo, Tel Aviv-Yaffo, Israel
| | - Ido Yehezkel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
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Factors promoting alliance quality: Differentiation of therapeutic alliance according to the formal aspects of the psychotherapeutic process and demographic variables. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022. [DOI: 10.1016/j.ejpsy.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Heinze PE, Weck F, Hahn D, Kühne F. Differences in psychotherapy preferences between psychotherapy trainees and laypeople. Psychother Res 2022; 33:374-386. [PMID: 35847994 DOI: 10.1080/10503307.2022.2098076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists. We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive-behavioural therapy (CBT) and psychodynamic trainees. We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy. Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.
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Affiliation(s)
- Peter Eric Heinze
- University of Potsdam, Clinical Psychology and Psychotherapy, Potsdam, Germany
| | - Florian Weck
- University of Potsdam, Clinical Psychology and Psychotherapy, Potsdam, Germany
| | - Daniela Hahn
- Johannes Gutenberg-University Mainz, Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Franziska Kühne
- University of Potsdam, Clinical Psychology and Psychotherapy, Potsdam, Germany
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15
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Cersosimo BH, Hilsenroth MJ, Bornstein RF, Gold JR, Blais MA. Personality assessment inventory items in relation to patient- and therapist-rated alliance. Clin Psychol Psychother 2022; 29:1905-1917. [PMID: 35701013 DOI: 10.1002/cpp.2759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022]
Abstract
Based on the results of prior research, we examined relationships between Personality Assessment Inventory (PAI) items on clinical scales of antisocial features (ANT) and anxiety-related disorders (ARD) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also explored the relationship between the PAI treatment rejection scale (RXR) and early session therapist-rated alliance, despite null findings in previous work. We used PAI protocols from a clinical outpatient sample (N = 80). Data were analysed using backwards linear regressions. Results indicated that a group of ANT items from different ANT subscales predicted patient-rated therapeutic alliance, F(8,59) = 5.182, p = .000, R2 of .413, f2 = 0.70. Additionally, a group of ARD items from different ARD subscales significantly predicted therapist-rated alliance, F(6,62) = 3.007, p = .012, R2 of .225, f2 = 0.29. No significant relationships were found for RXR items and therapist-rated alliance, consistent with prior findings. Clinical implications are discussed.
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Affiliation(s)
- Bianca H Cersosimo
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Mark J Hilsenroth
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Robert F Bornstein
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Jerold R Gold
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Yan Z, Meng F, He M, Li Z. The efficacy of a transdiagnostic group cognitive behavioral intervention for Chinese elderly with emotional disorders: A one-year follow-up randomized clinical trial. Front Psychiatry 2022; 13:1027994. [PMID: 36506431 PMCID: PMC9732091 DOI: 10.3389/fpsyt.2022.1027994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND With the global aging, geriatric emotional disorders have received more and more attention. Psychotherapy is an effective approach for alleviating the symptoms associated with emotional disorder, but the number of experienced therapists is low. Studies should be conducted to explore a low-cost and efficient treatment method. Previous findings indicate that transdiagnostic cognitive behavior therapy is an effective approach for treatment of emotional disorders. Group therapy is appropriate for the elderly as they are characterized by high levels of loneliness. In this study, we compared and explored the effects of a transdiagnostic group cognitive behavioral intervention (TD-GCBT), a transdiagnostic individual cognitive behavioral intervention (TD-CBT), and treatment as usual (TAU) on treatment of emotional disorders among the elderly. METHOD A total of 120 elderly patients diagnosed with emotional disorders were randomly assigned to the TD-GCBT group (40), TD-CBT group (40), and TAU group (40). Changes in symptoms were assessed using HAMD, PHQ-9, HAMA, and GAD-7 scales at baseline, post-treatment (three months), six-month and twelve-months follow-up. The efficacies of the three intervention strategies were compared using linear mixed-effects models. Post-hoc and simple effect analyses were conducted to determine the differences among the three groups. RESULTS The HAMD, PHQ-9, HAMA, and GAD-7 scores revealed a significant effect from baseline to 12 months for time (p < 0.001), group (p < 0.001) and time × group interaction (p < 0.001) in TD-GCBT group compared with the TD-CBT group and TAU group. The effect of TD-GCBT (HAMD: Cohen's d (3th month, 6th month, 12th month) = 2.69, 3.98, 4.51; HAMA: Cohen's d = 2.84, 4.13, 5.20) and TD-CBT (HAMD: Cohen's d = 2.55, 2.87, 2.63; HAMA: Cohen's d = 2.43, 2.83, 2.78) group was better relative to that of the TAU group (HAMD: Cohen's d = 0.41, 1.13, 1.46; HAMA: Cohen's d = 0.64, 1.22, 1.57) (p < 0.001). The scores of the TD-GCBT group showed the most significant decrease compared with the other two groups. CONCLUSION The findings indicate that TD-GCBT method is effective for treatment of emotional disorders among the elderly. TD-GCBT is effective for alleviating depression and anxiety symptoms up to at least nine months after treatment. The results indicate that TD-GCBT is a cost-effective and resource-effective strategy and can be used an alternative therapy for treatment of mental disorders. CLINICAL TRIAL REGISTRATION [https://www.chictr.org.cn], identifier [ChiCTR1900021806].
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Affiliation(s)
- Zijun Yan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fanqiang Meng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meiling He
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhanjiang Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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17
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Urmanche AA, Lipner LM, Bloch-Elkouby S, Hunter E, Kaufmann J, Warren JT, Weil GT, Eubanks CF, Muran JC. The beginning of the end: A comparison of treatment completers and early dropouts in trainee-provided time-limited Cognitive Behavioral Therapy. COUNSELLING PSYCHOLOGY QUARTERLY 2022; 35:763-788. [PMID: 36684503 PMCID: PMC9856216 DOI: 10.1080/09515070.2021.1997916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.
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Affiliation(s)
- Adelya A. Urmanche
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Lauren M. Lipner
- Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Sarah Bloch-Elkouby
- Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Elaine Hunter
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Jerzy Kaufmann
- The New School for Social Research, 80 Fifth Avenue, New York, NY 10011,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Jonathan T. Warren
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Gregory T. Weil
- The New School for Social Research, 80 Fifth Avenue, New York, NY 10011,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Catherine F. Eubanks
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - J. Christopher Muran
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
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18
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Ovenstad KS, Jensen TK, Ormhaug SM. Four perspectives on traumatized youths' therapeutic alliance: Correspondence and outcome predictions. Psychother Res 2021; 32:820-832. [PMID: 34893017 DOI: 10.1080/10503307.2021.2011983] [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: 10/19/2022] Open
Abstract
OBJECTIVE Does the rater-perspective of youths' therapeutic alliance matter? To answer this, we evaluated the relationships between four perspectives of youths' alliance, then, we examined whether each perspective and potential discordance between the perspectives predicted outcomes. METHOD Participants were 65 youth (M age = 15.11, SD = 2.14; 76.9% girls) undergoing trauma-focused cognitive behavioral therapy (TF-CBT) and their therapists (n = 24). Youths' alliance was rated by youth, therapists and parents using the Therapeutic Alliance Scale for Children-revised and by observers using the Therapy Process Observational Coding System-Alliance scale. Posttraumatic stress symptoms (PTSS) were assessed with the Child PTSD Symptom Scale (CPSS) and the Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA). RESULTS The alliance ratings by youth-parent, parent-therapist, and therapist-observer significantly correlated. Only a higher youth-rated alliance significantly predicted fewer PTSS. Furthermore, a higher therapist-rated than youth-rated alliance significantly predicted higher scores on CPSS and CAPS-CA, and a higher parent-rated than youth-rated alliance predicted significantly higher CPSS score. CONCLUSION Therapists should explicitly check in with youth clients about the alliance; because only youths' evaluation of their alliance predicted the outcome and an overestimation of their alliance by therapists and parents predicted more PTSS.Trial registration: ClinicalTrials.gov identifier: NCT00635752..
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Affiliation(s)
- Kristianne S Ovenstad
- Department of Psychology, University of Oslo, Oslo, Norway.,Oslo University Hospital, Oslo, Norway
| | - Tine K Jensen
- Department of Psychology, University of Oslo, Oslo, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, Oslo, Norway
| | - Silje M Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, Oslo, Norway
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19
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de Jong S, Hasson-Ohayon I, Lavi-Rotenberg A, Carter SA, Castelein S, Lysaker PH. Longitudinal assessments of therapeutic alliance predict work performance in vocational rehabilitation for persons with schizophrenia. Psychol Psychother 2021; 94:915-928. [PMID: 33904233 DOI: 10.1111/papt.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To promote functional recovery in persons diagnosed with a psychotic disorder, vocational interventions have emerged over the last few decades which range from sheltered employment to supported employment in the community. DESIGN Using data from a 6-month vocational rehabilitation programme, we examined whether assessments of the therapeutic alliance were related to the quality of work performed in this work placement. Our first hypothesis was that stronger alliances would be related to better work performance. Second, we expected that client assessments of the TA would better predict outcomes than therapist assessments. Third, we expected that the discrepancy between assessment scores from the client and therapist (client rating minus therapist rating) would be a better predictor for outcome than individual assessments by the therapists or clients. RESULTS Clients systematically rated the alliance higher than therapists. Modelling the data longitudinally, we found both therapist and client ratings predictive of outcome, though client assessments over time were inversely related to work performance. CONCLUSIONS Discrepancy in scores was also shown to be predictive of work performance during the program. Clinicians are advised to routinely assess the therapeutic alliance from both client and therapist perspectives and calculate the discrepancy between them as they may indicate ruptures are occurring and thus hamper the intervention. PRACTITIONER POINTS Clinicians are advised to regularly assess the therapeutic alliance from both their own and the client's perspective. Growing discrepancy in scores may impede intervention effectiveness. Therapeutic alliance may help buffer against work stresses experienced by participants in a vocational programme. Be aware that therapists tend to rate the alliance lower than their clients.
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Affiliation(s)
- Steven de Jong
- Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands
| | | | | | - Sarah A Carter
- University College Roosevelt, Utrecht University, Middelburg, The Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral Sciences, University of Groningen, Groningen, the Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center and the Indiana University School of Medicine, Indiana, USA
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20
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Chen R, Bar-Kalifa E, Sade A, Ziv-Beiman S. Client-therapist congruence in session-helpfulness ratings and its association with therapy outcomes. Psychother Res 2021; 32:484-496. [PMID: 34542020 DOI: 10.1080/10503307.2021.1974598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective: The present study aimed to explore client-therapist congruence in helpfulness evaluations session-by-session and its association with therapy outcomes. As suggested by West and Kenny's truth and bias model, we constructed congruence as both temporal congruence (i.e., the correlation between therapists' and clients' helpfulness judgments over time) and directional discrepancy (i.e., the average difference between therapists' and clients' helpfulness judgments).Method: Seventy-eight clients were treated by 22 experienced therapists within a 12-session course of integrative psychotherapy. At the end of each session, clients and therapists rated their perceptions of session helpfulness and, at the beginning of the next session, clients rated their own psychological functioning.Results: Therapists' and clients' helpfulness judgments were temporally congruent across treatment, and therapists' judgments were lower than those of their clients. Moreover, we found that therapists' negative directional discrepancy, but not temporal congruence, was associated with improvement in clients' psychological functioning as well as with clients' global treatment evaluations.Conclusion: Our results highlight the importance of therapists' vigilant assessment of session helpfulness in a course of brief integrative psychotherapy. As such, they strengthen the importance of further research regarding client-therapist congruence (in different aspects of the therapeutic process) and its association with therapy outcomes.Clinical or methodological significance of this article In this study, we found that therapists' tendency to provide lower session-helpfulness assessments than did their clients was associated with better therapeutic outcomes. These results may highlight the importance of therapists' cautious and humble stance when assessing their perception of session helpfulness across treatment.
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Affiliation(s)
- Roei Chen
- Mifrasim Institute for Psychotherapy Research and Training, School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Eran Bar-Kalifa
- Department of Psychology, Ben-Gurion University, Be'er-Sheva, Israel
| | - Astar Sade
- Mifrasim Institute for Psychotherapy Research and Training, School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Sharon Ziv-Beiman
- Mifrasim Institute for Psychotherapy Research and Training, School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
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21
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Prior K. Comorbid mental and substance use disorders: A common and complex treatment consideration. Bull Menninger Clin 2021; 85:89-99. [PMID: 34032462 DOI: 10.1521/bumc.2021.85.2.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Katrina Prior
- Postdoctoral research fellow at the Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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22
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Bar M, Saad A, Slonim-Atzil D, Tuval-Mashiach R, Gour T, Baron N, Mendlovic S. Patient-therapist congruent exchanges engaged with the potential-to-experience is associated with better outcome of psychotherapy. Psychol Psychother 2021; 94 Suppl 2:304-320. [PMID: 32319219 DOI: 10.1111/papt.12274] [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] [Received: 12/03/2019] [Revised: 03/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. However, as this assumption has never been empirically tested, the relationship between such interventions and treatment outcome is unclear. The aim of this pilot study is to explore the relationship between patient-therapist congruence of potential-to-experience engaged statements and the outcome of psychodynamic treatments. METHODS Transcripts of 90 sessions from good- and poor-outcome treatments (N = 18) were encoded using the MATRIX - a novel content analysis tool of psychodynamic psychotherapy. Based on fixed algorithms, this observer-coding system is designed to identify different types of clinical interventions, including those which focus on the potential-to-experience. Total number of MATRIX codes analysed was 11,125. We compared the total congruence/incongruence ratio of such statements in good and poor treatments. The importance of the congruence/incongruence ratio of the potential-to-experience statements was measured by applying general linear models to classify treatment outcome. RESULTS The congruence/incongruence ratio of the potential-to-experience engaged statements was significantly higher in good treatments. In the best model for classifying treatment outcome based on the congruence/incongruence ratios of several parameters, the congruence/incongruence ratio of the potential-to-experience engaged statements was the single most important predictor. DISCUSSION Maintaining the congruence of potential-to-experience engaged statements within the therapeutic session is associated with better clinical outcome. This provides an initial empirical indication to the importance of the potential-to-experience discourse in psychotherapy praxis. PRACTITIONER POINTS The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. The current results suggest that the ability of both patient and therapist to maintain the congruence of potential-to-experience statements within the session may improve clinical outcomes. These findings suggest a practical approach for a better management of the therapeutic process. Mainly, it recommends therapists to implement a very careful, active listening to potential-to-experience-related content throughout the session, while highlighting the patient's associations for their potential to become new modus operandi. Moreover, the current study presents an integrative, micro-level tool that enables the translation of complex theoretical concepts in psychotherapy into measurable constructs, aiming at the creation of a bridge between clinical theory and evidence-based practice.
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Affiliation(s)
- Mor Bar
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Amit Saad
- Sackler School of Medicine, Tel Aviv University, Israel.,Shalvata Mental Health Center, Hod Hasharon, Israel
| | | | | | - Tamir Gour
- The School of Psychological Sciences, Tel Aviv University, Israel
| | - Noga Baron
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Shlomo Mendlovic
- Sackler School of Medicine, Tel Aviv University, Israel.,Shalvata Mental Health Center, Hod Hasharon, Israel.,Psychotherapy Program, Sackler School of Medicine, Tel Aviv University, Israel
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23
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Nakash O, Cruz-Gonzalez M, Lincoln AK, Banerjee S, Alegría M. Similarities in client-clinician perceptions of subjective social status and its association to similarities in the quality of working alliance and client anxiety symptoms. Psychother Res 2021; 31:1079-1091. [PMID: 33752581 DOI: 10.1080/10503307.2021.1900618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Subjective social status (SSS) has largely been ignored within psychotherapy literature. We investigated the association between similarities in client-clinician perceptions of SSS, similarities in their report of the quality of working alliance, and resultant anxiety symptoms. Participants represented a primarily low-income, culturally diverse sample of 312 clients receiving care from 68 clinicians at 13 outpatient mental health clinics in the Northeastern United States between September 2013 and August 2016. As part of a larger randomized controlled trial, clients and clinicians completed the MacArthur Scale of subjective social status and the Working Alliance Inventory (WAI), and clients completed the Generalized Anxiety Disorder 7-item Scale (GAD-7). At the within-clinician level, client-clinician dyads with less similar perceptions of the client's SSS were characterized by less similar perceptions of their alliance, which in turn resulted in worsening anxiety symptoms. Clinicians' correct perception of their clients' social status might be important for sharing a similar view of the client-clinician level of alliance, which can, in turn, contribute to lowering the client's anxiety symptoms.
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Affiliation(s)
- Ora Nakash
- School for Social Work, Smith College, Northampton, MA, USA.,Baruch Ivcher School of Psychology Interdisciplinary Center (IDC), Herzliya, Israel
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alisa K Lincoln
- College of Social Sciences and Humanities and Bouvé College of Health Sciences; Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Souvik Banerjee
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA, USA
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24
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Hasson‐Ohayon I, Jong S, Igra L, Carter SA, Faith LA, Lysaker P. Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments. Clin Psychol Psychother 2021; 28:1243-1253. [DOI: 10.1002/cpp.2572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Libby Igra
- Department of Psychology Bar‐Ilan University Ramat‐Gan Israel
| | - Sarah A. Carter
- Utrecht University: University College Roosevelt Middelburg The Netherlands
| | - Laura A. Faith
- Department of Psychology University of Missouri‐Kansas City Kansas City Missouri USA
| | - Paul Lysaker
- Department of Psychiatry Roudebush VA Medical Center and the Indiana University School of Medicine Indianapolis Indiana USA
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25
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Eubanks CF, Sergi J, Samstag LW, Muran JC. Commentary: Rupture repair as a transtheoretical corrective experience. J Clin Psychol 2021; 77:457-466. [PMID: 33547813 DOI: 10.1002/jclp.23117] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This commentary highlights common principles shared across the diverse clinical case examples featured in this In Session issue on Rupture Repair in Practice. We discuss the importance of therapists recognizing subtle signs of rupture and responding to ruptures with curiosity and compassion. We also consider how therapists can use repair strategies responsively to facilitate a corrective experience for the patient. We explore the ways in which the specific resolution strategy of linking a rupture to larger interpersonal patterns can benefit the therapeutic process, and the ways in which it can constitute a form of avoidance. We conclude by noting promising future directions and celebrating the generosity evidenced by these insightful authors' willingness to share and explore challenging moments in therapy.
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Affiliation(s)
- Catherine F Eubanks
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joey Sergi
- Therapists of New York, New York, New York, USA
| | - Lisa Wallner Samstag
- Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychology, Long Island University, Brooklyn, New York, USA
| | - J Christopher Muran
- Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
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26
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Egozi S, Tishby O, Wiseman H. Therapeutic distance in client-therapist narratives: client attachment, therapist attachment, and dyadic effects. Psychother Res 2021; 31:963-976. [PMID: 33471634 DOI: 10.1080/10503307.2021.1874069] [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: 10/22/2022] Open
Abstract
Based on the attachment framework, therapeutic distance conceptualization focuses on closeness-distance dynamics in the therapeutic relationship. We aimed to evaluate the psychometric properties of the Therapeutic-Distance-Scale, Observer-version (TDS-O) and apply a dyadic approach to examine associations between attachment characteristics and therapeutic distance experiences of clients, therapists, and mutual effects. Sixty-six clients and their 29 therapists completed the ECR and relational narratives collected in RAP interviews at early, mid, and late psychodynamic-therapy were rated on TDS-O scales: too close, too distant, autonomy, and engagement. The TDS-O showed good IRR, internal reliability and content validity. Client anxiety was not associated with therapeutic distance but associated with autonomy. Client avoidance associated with clients' experiencing therapist as too close, and lower engagement only at early therapy, but was not associated with therapists' experience. Therapist anxiety was not related to closeness-distance at early therapy but related to gaps between client and therapist experiences at mid and late therapy. Therapist avoidance related to clients experiencing therapists as too close and granting less autonomy at early and mid-therapy, and to therapist experience of distance at late therapy. The findings underscore the importance of therapists' regulating therapeutic distance through attunement to client's interpersonal needs and therapy phase.
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Egozi S, Tishby O, Wiseman H. Changes in clients and therapists experiences of therapeutic distance during psychodynamic therapy. J Clin Psychol 2020; 77:910-926. [PMID: 33094853 DOI: 10.1002/jclp.23077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/09/2020] [Accepted: 10/09/2020] [Indexed: 11/08/2022]
Abstract
Attachment theory provides a framework for examining closeness-distance experiences in the development of the therapeutic relationship. OBJECTIVE To examine changes in clients' and therapists' experiences of therapeutic distance along with psychodynamic therapy. HYPOTHESES Clients' and therapists' comfort with closeness and distance will increase, and the client's autonomy and engagement will increase with time. METHOD A total of 67 clients and their 27 therapists underwent Relationship Paradigm interviews in which they told narratives about their experience with each other, three times during therapy. The narratives were rated on the Therapeutic Distance Scale-Observer (TDS-O) version. RESULTS Growth curve analysis of the TDS-O ratings showed that clients decrease in perceiving therapists as too distant and increase in engagement. Therapists showed a decrease in perceiving clients as too close and an increase in granting autonomy and engagement. A clinical illustration depicts these experiences in a client-therapist dyad. CONCLUSIONS Therapists' awareness of clients' changing needs of closeness and autonomy may enhance attunement.
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Affiliation(s)
- Sharon Egozi
- Department of Social Work, Tel-hai College, Upper Galilee, Israel
| | - Orya Tishby
- Department of Psychology, Hebrew University, Jerusalem, Israel
| | - Hadas Wiseman
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
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Nissen-Lie HA, Solbakken OA, Falkenström F, Wampold BE, Holmqvist R, Ekeblad A, Monsen JT. Does it make a difference to be more "on the same page"? Investigating the role of alliance convergence for outcomes in two different samples. Psychother Res 2020; 31:573-588. [PMID: 32957850 DOI: 10.1080/10503307.2020.1823030] [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: 10/23/2022] Open
Abstract
Objective: To better understand the complexity of dyadic processes, such as the mechanisms of the working alliance, researchers recommend taking advantage of innovations in data analytic procedures when studying the interactions between therapists and patients that are associated with favorable therapeutic outcomes. Inspired by a recent line of alliance research using dyadic multilevel modeling, the present study investigated the hypothesis that convergence in the patient-therapist working alliance (i.e., increased similarity in ratings of the alliance across treatment) would be associated with better outcomes. Method: Data were retrieved from two samples: 1. A randomized controlled trial for treatment resistant depression (N = 96 dyads), and 2. An archival dataset of naturalistic psychotherapies from public health care (N = 139 dyads). Multilevel growth curve analysis was employed to investigate the degree of change in session-to-session agreement of global WAI ratings between therapists and patients (i.e., alliance convergence) as a predictor of symptom reduction in the BDI-II and the SCL-90R. Results: Contrary to our expectations, alliance convergence did not predict outcome in either sample, but was negatively associated with symptom severity in Study 2. Implications for understanding the complexity of dyadic processes and alliance work in psychotherapy are discussed.
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Affiliation(s)
| | | | - Fredrik Falkenström
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Bruce E Wampold
- University of Wisconsin-Madison, Madison, WI, USA.,Research Institute, Modum Bad Psychiatric Center, Vikersund, Norway
| | - Rolf Holmqvist
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Annika Ekeblad
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.,Sundsvall Hospital, Sundsvall, Sweden
| | - Jon T Monsen
- Department of Psychology, University of Oslo, Oslo, Norway
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Rossi FS, Javier SJ, Kimerling R. An Examination of the Association Between Patient Experience and Quality of Mental Health Care Among Women Veterans. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:61-69. [PMID: 32415345 DOI: 10.1007/s10488-020-01046-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Improving patient experience is one strategy that may increase the quality of mental health care if better experience is linked to the likelihood of a potentially therapeutic dose (PTD) of treatment. This study sought to examine: (1) the proportion of women veterans who obtained a PTD of mental health treatment; and (2) the association between women's experiences with Veterans Health Administration (VHA) mental health services and obtaining a PTD of mental health treatment. We assessed patient experience via a survey that measured experiences with gender-sensitive care, ease of getting care, perceived quality of care, and extent to which care met needs. We used VHA administrative data to determine mental health utilization across a national sample of 2109 women veterans with episodes of mental health care that included psychotherapy or pharmacotherapy. Results indicated that 71% of women received a PTD. Positive ratings regarding perceived quality of care and whether care met needs were associated with higher odds of receiving a PTD of treatment. Findings provide supporting evidence for the continued necessity of offering patient-centered mental health care to women veterans. Careful consideration of women veterans' mental health care experiences may be crucial in promoting high value mental health care for this population in VHA.
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Affiliation(s)
- Fernanda S Rossi
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA. .,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sarah J Javier
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Kimerling
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
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30
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Zilcha-Mano S, Shimshoni Y, Silverman WK, Lebowitz ER. Parent-Child Agreement on Family Accommodation Differentially Predicts Outcomes of Child-Based and Parent-Based Child Anxiety Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:427-439. [PMID: 32401557 DOI: 10.1080/15374416.2020.1756300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: Family accommodation is linked to poor treatment outcomes for childhood anxiety. Progress in research on the role of accommodation in treatment has been hindered by the relatively weak association between child and parent reports on accommodation. In this study, we suggest that parent-child agreement on family accommodation may provide a dependable estimation of this construct, and investigated whether the level of parent-child agreement on family accommodation predicts subsequent treatment outcome. We further examined whether the effect was greater in Supportive Parenting for Anxious Childhood Emotions (SPACE), which directly targets family accommodation, than in individual child-focused cognitive behavioral therapy (CBT).Methods: Participants were 104 children (aged 6-15) with anxiety disorders, and their mothers, randomized to SPACE or CBT. Accommodation was rated by mothers and children before treatment, halfway through treatment, and at treatment end, using respective versions of Family Accommodation Scale-Anxiety. To accurately estimate agreement, we conducted multilevel response surface analysis by polynomial regression, with agreement on accommodation at each time point predicting subsequent child anxiety severity, over the course of treatment.Results: Parent-child agreement and disagreement on accommodation were significant predictors of subsequent anxiety symptom severity. Different results were obtained for SPACE and CBT, suggesting potentially distinct underlying mechanisms.Conclusions: The findings suggest treatment-specific roles of accommodation in SPACE vs. CBT. Multiple-informant assessment of accommodation provides important information, which may have important implications for optimal treatment personalization.
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Affiliation(s)
| | - Yaara Shimshoni
- Child Study Center, School of Medicine, Yale University, Child Study Center, School of Medicine
| | - Wendy K Silverman
- Child Study Center, School of Medicine, Yale University, Child Study Center, School of Medicine
| | - Eli R Lebowitz
- Child Study Center, School of Medicine, Yale University, Child Study Center, School of Medicine
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31
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Zilcha-Mano S, Eubanks CF, Bloch-Elkouby S, Muran JC. Can we agree we just had a rupture? Patient-therapist congruence on ruptures and its effects on outcome in brief relational therapy versus cognitive-behavioral therapy. J Couns Psychol 2020; 67:315-325. [PMID: 31855026 PMCID: PMC7125015 DOI: 10.1037/cou0000400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To draw clinically meaningful evidence-supported implications about the alliance-outcome association, recent studies have investigated patient-therapist congruence on ruptures in alliance. The present study investigated patient-therapist congruence on ruptures and its consequences on subsequent session outcome in 2 types of treatments that differ in the training therapists receive to identify ruptures: brief relational therapy (BRT), in which therapists receive alliance-focused training, and cognitive-behavioral therapy (CBT), in which no training specifically focused on the alliance is provided. We implemented polynomial regression and response surface analysis, and the truth and bias model on data of 162 dyads reporting weekly on their levels of ruptures, for 30 sessions, during either CBT or BRT. Therapists and patients exhibited substantial temporal congruence in their session-by-session rupture ratings. Therapists showed a tendency to detect more ruptures than did their patients. This tendency correlated with higher levels of congruence and was more evident in BRT than in CBT. Agreement and disagreement between patients and therapists on the question of whether a rupture had occurred was found to have a greater effect on subsequent session outcomes in BRT than in CBT. These findings may suggest that therapists who are more attuned to their patients may demonstrate greater vigilance in identifying ruptures than their patients do. This vigilant stance may be taught. Greater congruence may result in better subsequent session outcome throughout treatment in BRT than in CBT. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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32
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Kivity Y, Levy KN, Kolly S, Kramer U. The Therapeutic Alliance Over 10 Sessions of Therapy for Borderline Personality Disorder: Agreement and Congruence Analysis and Relation to Outcome. J Pers Disord 2020; 34:1-21. [PMID: 30689513 DOI: 10.1521/pedi_2019_33_376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors examined whether alliance dynamics are affected by tailoring the therapeutic relationship to the individual patient in brief psychotherapy of borderline personality disorder. Sixty patients were randomized to 10-session Good Psychiatric Management (GPM-BV) or GPM combined with Motive-Oriented Therapeutic Relationship techniques (MOTR+GPM-BV). Patient- and therapist-rated alliance was assessed weekly. Self-reported symptomatic distress was assessed pre-, mid-, and posttreatment. In MOTR+GPM-BV, stronger therapist-rated alliance predicted lower symptomatic distress in the same timepoint, but not in a lag, whereas symptomatic distress predicted therapist-rated alliance in a lag. Therapist-rated alliance was lower than patient-rated alliance in GPM-BV but not in MOTR+GPM-BV. In MOTR+GPM-BV, higher agreement on strong alliance tended to predict lower symptomatic distress. Patient- and therapist-rated alliances were temporally congruent, but congruence did not predict outcome. Addressing the relationship needs of patients may partly exert its salutary effect by increasing agreement between patients' and therapists' experience of the alliance.
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Affiliation(s)
- Yogev Kivity
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Kenneth N Levy
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- General Psychiatry Service and Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
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33
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Penix EA, Swift JK, Trusty WT. Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Joshua K. Swift
- Department of Psychology Idaho State University Pocatello Idaho
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34
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Fjermestad KW, Føreland Ø, Oppedal SB, Sørensen JS, Vognild YH, Gjestad R, Öst LG, Bjaastad JF, Shirk SS, Wergeland GJ. Therapist Alliance-Building Behaviors, Alliance, and Outcomes in Cognitive Behavioral Treatment for Youth Anxiety Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:229-242. [PMID: 31910051 DOI: 10.1080/15374416.2019.1683850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The alliance influences outcomes in CBT for youth anxiety disorders. Thus, knowledge about how therapists can enhance the alliance is needed. METHOD Seventy-three youth with anxiety diagnoses (M age = 11.5 years, SD = 2.2; range 8 to 15 years; 47.9% boys; 90.4% white-European) participated in 10-session cognitive behavioral therapy in community clinics. Therapist alliance-building behaviors in session 2 was reliably coded with the observer-rated Adolescent Alliance-Building Behavior Scale (Revised) (AABS(R)). Alliance was measured as youth- and therapist-rated alliance, and youth-therapist alliance discrepancy in session 3. Outcomes were diagnostic recovery and anxiety symptom reduction at post-treatment and one-year follow-up, and treatment dropout. We examined the direct effects of alliance-building on alliance, alliance on outcomes, and alliance-building on outcomes in multilevel mediation models, and between- versus within-therapist variance across these effects. RESULTS The alliance-building behaviors collaborate, present treatment model, and explore motivation positively predicted alliance, whereas actively structuring the session (i.e., dominating) negatively predicted alliance. The alliance-building behaviors attend to experience, collaborate, explore motivation, praise, and support positively predicted outcomes. The alliance-building behaviors present treatment model, express positive expectations, explore cognitions, and support negatively predicted outcomes. The effect of collaborate on symptom reduction was mediated by youth-therapist alliance discrepancy. There was almost zero between-therapist variance in alliance-building, and considerable within-therapist variance. CONCLUSION Therapist alliance-building behaviors were directly (positively and negatively) associated with alliance and/or outcomes, with only one effect mediated by alliance. Alliance-building behaviors varied far more within therapists (i.e., across clients) than between therapists.
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Affiliation(s)
| | - Øyvind Føreland
- Department of Psychology, University of Oslo.,Department for Addiction Medicine, Sørlandet Regional Hospital Trust
| | - Silje B Oppedal
- Department of Psychology, University of Oslo.,Oslo Educational and Psychological Counselling Service
| | - Julie S Sørensen
- Department of Psychology, University of Oslo.,Oslo Educational and Psychological Counselling Service
| | - Ylva H Vognild
- Department of Psychology, University of Oslo.,Vinderen Adult Mental Health Services, Diakonhjemmet Hospital
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital
| | | | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre
| | | | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen
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35
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Hatcher RL, Lindqvist K, Falkenström F. Psychometric evaluation of the Working Alliance Inventory-Therapist version: Current and new short forms. Psychother Res 2019; 30:706-717. [PMID: 31621525 DOI: 10.1080/10503307.2019.1677964] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: The Working Alliance Inventory (WAI) and its short forms are widely used, although the properties of the therapists' versions have been little studied. Method: We examined the psychometric properties of two short forms (WAI-S-T, WAI-SR-T), and explored the creation of a psychometrically stronger short form using contemporary measure development techniques. Well-fitting items from the full 36-item WAI were identified in a development sample (131 therapists, 688 patients) using multi-level Bayesian Structural Equation Modeling, accounting for therapist rated effects. Multi-level Item Response Theory (IRT) methods aided creation of a revised short form (WAI-S-T-IRT). Factor structures of the three forms were assessed using multi-level ML estimation with robust standard errors. Results: Collinearity problems for the Goal and Task dimensions led to testing a two-factor model (Goal-Task, Bond). All three measures showed satisfactory fit; the WAI-S-T-IRT fit slightly better but differences were minor. Testing the structures in an independent sample (N = 1117) yielded essentially the same results. No version showed strong measurement invariance. Discussion: Continued use of current therapist forms is supported; differentiation of theoretical dimensions is difficult with current measures, and may not be possible with self-report forms.
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Affiliation(s)
- Robert L Hatcher
- Wellness Center, Graduate Center-City University of New York, New York, NY, USA
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Ziem M, Hoyer J. Modest, yet progressive: Effective therapists tend to rate therapeutic change less positively than their patients. Psychother Res 2019; 30:433-446. [PMID: 31223074 DOI: 10.1080/10503307.2019.1631502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: Empirical findings on self-serving biases amongst psychotherapists are inconsistent. We tested in a large naturalistic data set, if therapists are prone to illusory superiority when estimating their patients' outcome and whether this effect is buffered by therapists' effectiveness. Method: A post-hoc analysis with N = 69 therapists, who treated N = 1080 patients, was conducted. Therapists' and patients' mean ratings for therapeutic improvement in the Clinical Global Impression Scale (CGI) were compared. Using a multilevel modelling approach, we further investigated the relation between the patient-therapist divergence in the CGI and actual therapeutic change in the Global Severity Index (GSI) of the Brief Symptom Inventory and in the Satisfaction With Life Scale (SWLS). Results: Ratings in the CGI did not show significant differences between patients' and therapists' assessment of therapeutic change. Lower estimations by therapists, compared to patients' self-report, were associated with greater therapeutic change in GSI and SWLS. Conclusions: Therapists, on a whole, did not seem to be prone to illusory superiority when assessing therapeutic outcome. Contrary, the more modest the therapists' estimation of therapeutic outcome was, the greater the actual therapeutic change.
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Affiliation(s)
- Max Ziem
- Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Saxonia, Germany
| | - Juergen Hoyer
- Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Saxonia, Germany
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Abstract
Heart rate variability (HRV) can be conceptualized as a marker of an individual's capability to adaptively respond to its environment and has been linked with mental health. Although conceptually and empirically linked to social behavior and thus relevant in the therapeutic setting, HRV is seldom investigated directly within therapy sessions. In the present examination, we aimed at addressing this research gap by assessing patients' and therapists' HRVs both ambulatory within therapy sessions and under resting conditions. Drawing on polyvagal theory, we hypothesized that higher in-session HRV is accompanied with higher therapeutic alliance ratings. Further, we expected baseline HRV to predict symptomatic outcome and to increase over the course of therapy. In a sample of 53 outpatients receiving 25 sessions of cognitive behavioral therapy, we measured HRV, therapeutic alliance and depressive symptoms on four occasions. Multilevel modeling analyses demonstrated that patients with higher in-session high-frequency HRV rated the therapeutic alliance higher. Baseline HRV predicted symptomatic outcome and increased over the course of therapy. Possible explanations involve a link between in-session HRV and in-session behavior and should be investigated in future studies. The results highlight the usefulness of in-session HRV as a promising process variable in psychotherapy research.
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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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Mendlovic S, Saad A, Roll U, Ben Yehuda A, Tuval-Mashiah R, Atzil-Slonim D. The association between patient–therapist MATRIX congruence and treatment outcome. Psychother Res 2018. [DOI: 10.1080/10503307.2018.1448479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Shlomo Mendlovic
- Be'er Ya'akov-Ness Ziona Mental Health Center, Be'er Ya'akov, Israel
- Tel Aviv University Program of Psychotherapy, Tel Aviv, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Amit Saad
- Tel Aviv University Program of Psychotherapy, Tel Aviv, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Uri Roll
- Mitrani Department of Desert Ecology, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Midreshet Ben-Gurion, Israel
| | - Ariel Ben Yehuda
- Tel Aviv University Program of Psychotherapy, Tel Aviv, Israel
- Department of Mental Health, Medical Corps, IDF, Ramat-Gan, Israel
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40
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Arnfred SM, Aharoni R, Hvenegaard M, Poulsen S, Bach B, Arendt M, Rosenberg NK, Reinholt N. Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder: Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial. BMC Psychiatry 2017; 17:37. [PMID: 28114915 PMCID: PMC5260024 DOI: 10.1186/s12888-016-1175-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/23/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the "The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders" (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. METHODS/DESIGN The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. DISCUSSION The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect. TRIAL REGISTRATION Clinicaltrials.gov NCT02954731 . Registered 25 October 2016.
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Affiliation(s)
- Sidse M. Arnfred
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Aharoni
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Hvenegaard
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
| | - Stig Poulsen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Bach
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
| | - Mikkel Arendt
- Unit for Anxiety and Compulsive Disorders, Psychiatric Hospital Risskov, Aarhus University Hospital, Aarhus, Denmark
| | - Nicole K. Rosenberg
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Reinholt
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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