Sources accounting for alliance and cohesion at three stages in group psychotherapy: Variance component analyses.

This study examined patient, therapist, and group variability accounting for alliance and cohesion over three stages in a sample of 145 patients attending short- and long-term psychodynamic group therapy. G-study variance components were estimated for the 14 sources of variation identifiable by the research design. Results indicated that patient variability represented the strongest clinically relevant contribution to both alliance and cohesion. Therapists were important for alliance at all stages, but for cohesion only in the middle stage. The therapist × group interaction was important to the alliance in early therapy and for cohesion within the two first stages, but this contribution then decreased. Group length did not account for any variability in the process measures. Theoretical implications were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive validity of therapeutic alliance in group marital therapy.

The relation between marital distress, therapeutic alliance formation, and treatment outcome was investigated in a group marital skills training program in which 63 couples met for 9 weekly 3-hr sessions. Treatment outcome was assessed before and after completion of treatment through a series of self-report measures. The quality of the therapeutic alliance as viewed by the couples and the therapists was monitored at the 3rd session. Results indicate that levels of marital distress neither impaired nor facilitated alliance formation. In addition, it was demonstrated that patients' and therapists' ratings of the strength of the therapeutic alliance constitute a determinant of successful treatment. It appears, however, that the strength of the alliance is a more powerful predictor of therapeutic success among men than among women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group therapy.

Cohesion is the most popular of several relationship constructs in the clinical and empirical group therapy literature. This article reviews the most frequently cited definitions and studied measures of group cohesion. We briefly introduce a new measure, the Group Questionnaire, which elucidates group relationships by suggesting two latent factors of cohesion—relationship quality (positive bond, positive work, and negative relationship) and structure factors (member-leader and member-member). To further understand the literature, we conducted a meta-analysis examining the relationship between cohesion and treatment outcome in 40 studies. Results indicate cohesion that the weighted aggregate correlation was statistically significant with outcome r = .25, k (40), N (3,323), z = 6.54 (p     

Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men.

This study used multilevel modeling to examine process and treatment adherence factors as predictors of collateral partner reports of abuse following participation in a cognitive-behavioral group treatment program for partner violent men (N = 107). Therapist working alliance ratings predicted lower levels of physical and psychological abuse at the 6-month follow-up and were the strongest predictors of outcome. Homework compliance partially mediated associations between early alliance ratings and psychological abuse at follow-up. Greater group cohesion during treatment, assessed by client report, also predicted lower physical and psychological abuse at follow-up. The findings support the promotion of a collaborative therapeutic environment to induce change among partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic alliance: Predicting continuance and success in group treatment for spouse abuse.

This study examined the role of the therapeutic alliance between client and therapist on group treatment outcome in 70 husband-to-wife violent couples. Strength of husbands' alliance assessed at Session 1 was positively associated with treatment outcome, as measured by decreased husband-to-wife mild and severe psychological and physical aggression. Strength of wives' alliance was unrelated to treatment outcome. Finally, although alliance was related to treatment, outcome, it was unrelated to treatment completion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early process and dropping out from short-term group therapy for complicated grief.

Early group process variables were investigated as predictors of dropping out for patients who participated in short-term group psychotherapy for complicated grief. Constructs assessed included affect, cohesion, group climate, and therapeutic alliance. Using logistic regression analyses, the authors investigated differences between dropouts and remainers at Sessions 1 and 4. Results indicated that after the lst therapy session, imminent dropouts reported experiencing less positive feelings than remainers. In addition, therapists' ratings of cohesion to the patients were significantly lower for the dropouts than for remainers. Clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Potential Mediators of Cognitive-Behavioral Therapy for Adolescents With Comorbid Major Depression and Conduct Disorder.

Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire (S. D. Hollon & P. C. Kendall, 1980) appeared to mediate treatment effects on depressive symptoms. Therapeutic alliance by the 3rd session was higher among the CWD-A participants but did not predict reductions in depressive symptoms. Findings suggest that reducing negative thinking may be the primary mechanism through which the CWD-A intervention reduces depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group psychotherapy.

Insight into the therapeutic relationship in group psychotherapy requires an understanding of the treatment context. Cohesion is defined as the therapeutic relationship in group psychotherapy emerging from the aggregate of member leader, member-member, and member-group relationships. Using this definition, evidence for the relationship between cohesion, patient outcome, an treatment processes is reviewed. Six empirically supported principles that undergird the development and maintenance of cohesion are presented touching on pregroup preparation, ear group structure, leader interaction, feedback, leader modeling, and member emotional expression. The limitations the present research are discussed; leading to opportunities for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working alliance as a mediator of client attachment dimensions and psychotherapy outcome.

Studies that employ multidimensional attachment measures to explore the impact of attachment style on psychotherapy process and outcome are virtually absent in the literature. Further, the role of the working (therapeutic) alliance as a mediator of the influence of attachment on treatment outcome has not been formally investigated. In order to address these gaps in the research, archival data from 66 psychotherapy clients treated at a university graduate program training clinic were used to examine the influence of three adult attachment dimensions (Comfort with Closeness, Comfort Depending on Others, and Rejection Anxiety) on the therapeutic alliance and outcome, as well as to assess whether the alliance mediates the relationship between attachment and therapy outcome. Both Comfort with Closeness and Comfort Depending on Others were significantly related to alliance and outcome, whereas Rejection Anxiety was not significantly related to either variable. Alliance was a significant partial mediator of the effect of Comfort with Closeness on outcome. The results suggest that multidimensional measures of attachment capture important influences on alliance and psychotherapy and that Comfort with Closeness promotes successful outcome by virtue of its influence on alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of initial and delayed structure in facilitating group development.

Notes that recent theoretical and empirical developments indicate that the use of structure in initiating group work facilitates group development and client outcome. Three levels of structured learning exercises (initial structure, delayed structure, and no structure) were presented to 43 undergraduates meeting in interpersonal growth groups. The effects of structure on member anxiety, group cohesion, and quality of interpersonal interaction were assessed at 2 points during the life of the groups. Initial structure was associated with increased levels of self-disclosure in early meetings and higher levels of anxiety among members. The effects of levels of structure dissipated over time. Structure did not differentially influence group cohesion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of specific cognitive and behavioral structure on early group behavior and atmosphere.

Prior theoretical formulations have suggested that client exposure to levels of personal risk and responsibility most conducive to optimal group development can be regulated with group structure. The current study of 64 undergraduates employed a randomized, between-Ss design with a 2 by 4 factorial arrangement of treatments to determine the effects of (a) 2 levels of risk-taking disposition and (b) 4 types of pregroup preparation on early group development. ANOVA revealed a consistent Behavioral Structure by Risk-Taking Disposition interaction effect on all 6 dependent measures. The primary source of this interaction was the differential response of high and low risk takers to behavioral structure. High risk takers exposed to the behavioral structure condition were more involved in self-disclosure and interpersonal feedback, reported higher levels of group cohesion, and reported greater perceived depth of communications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using and misusing factor analysis to explore group cohesion

Group cohesion is an important construct in understanding the behavior of different types of groups. However, controversy exists about how to conceptualize and measure cohesion, and a central issue is its dimensionality. Consequently, researchers have used factor analysis to examine the structure of the construct of cohesion and measures of it. Our goals in writing this article were to review critically how factor analysis has been used to understand group cohesion, make some recommendations for future factor analytic work, and point out some weaknesses and strengths in using factor analysis to explore cohesion.     

Cohesion and Performance in Groups: A Meta-Analytic Clarification of Construct Relations.

Previous meta-analytic examinations of group cohesion and performance have focused primarily on contextual factors. This study examined issues relevant to applied researchers by providing a more detailed analysis of the criterion domain. In addition, the authors reinvestigated the role of components of cohesion using more modern meta-analytic methods and in light of different types of performance criteria. The results of the authors' meta-analyses revealed stronger correlations between cohesion and performance when performance was defined as behavior (as opposed to outcome), when it was assessed with efficiency measures (as opposed to effectiveness measures), and as patterns of team workflow became more intensive. In addition, and in contrast to B. Mullen and C. Copper's (1994) meta-analysis, the 3 main components of cohesion were independently related to the various performance domains. Implications for organizations and future research on cohesion and performance are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p     

Modeling longitudinal data from a rolling therapy group program with membership turnover: Does group culture affect individual alliance?

Many community- and hospital-based group treatment programs have an open enrolment, that is, a rolling admissions structure, in which a group member who drops out or successfully completes therapy is replaced by another individual. Although practically efficient and perhaps clinically useful, the interdependence of these group participants' data may result in incorrect inferences drawn from the data analyses if this interdependence is not accounted for. We present an analytic strategy that uses time varying covariates in multilevel models to illustrate a methodology to address these data analysis problems. Participants were adults with eating disorders (N = 229) who attended an average of 12 weeks of a rolling admissions group-based day hospital program during an 8-year period, and who completed a group therapy alliance measure weekly. Individual alliance to the group increased from week to week, and this growth remained significant even after controlling for the time varying level of other group members' alliance to the group. Further, the level of an individual's alliance score during any given week was positively related to the group's alliance during that week. The multilevel time varying covariate models presented here add to a very small but emerging set of analytic strategies available for researchers to address some of the hurdles to correctly analyze data from rolling admissions group-based treatment programs. Results from this study provide evidence that a group's culture is passed on and affects an individual's alliance to the group despite changes in group membership. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance as a Mediator of Expectancy Effects in Short-Term Group Psychotherapy.

This study investigated whether the therapeutic alliance mediates between patient expectancy of improvement and the outcome of time-limited, short-term group psychotherapy. Data were drawn from a comparative trial of 2 forms (interpretive and supportive) of time-limited group therapy for complicated grief (W. E. Piper, M. McCallum, A. S. Joyce, J. S. Rosie, & J. S. Ogrodniczuk, 2001). Patients' outcome expectancy was based on individualized target objectives for treatment, and alliance was assessed from patient and therapist perspectives. The data were analyzed through the use of hierarchical linear modeling. Patient-rated alliance played a mediating role in the relationship between outcome expectancy and group benefit, suggesting that the expectancy-outcome association is expressed through the development of a collaborative relationship between the individual members and the group therapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in two telephone-administered treatments: Relationship with depression and health outcomes.

The present study examined the relationship between therapeutic alliance and both depression and health outcomes in a randomized clinical trial of 2 telephone-administered treatments with 97 clients with multiple sclerosis (MS). The 16-week, manualized treatments compared were telephone-administered cognitive-behavioral therapy (T-CBT) and telephone-administered supportive emotion focused therapy (T-SEFT), an experiential treatment. Alliance scores were significantly higher in T-CBT compared with T-SEFT, and treatment moderated the relationship between alliance and outcome on some of the measures. Specifically, alliance predicted subsequent improvements in depression within the T-CBT condition, but not in T-SEFT, controlling for early symptom change. The authors found a similar trend for alliance and MS-related disability in T-CBT only. This is one of the first studies to examine the role of alliance in outcome for the emerging modality of telephone therapy and one of the few to relate alliance to health outcomes. The findings suggest that the therapist-client relationship is important to improvement in telephone therapy and that the role of alliance in outcome may vary by treatment approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations of the alliance with psychotherapy outcome: findings in the Second Sheffield Psychotherapy Project

Clients (n = 79) and therapists (n = 5) rated their alliance using parallel forms of the Agnew Relationship Measure (ARM) after every session of their time-limited psychodynamic-interpersonal or cognitive-behavioral treatments for depression. The ARM assesses 5 dimensions of the alliance: Bond, Partnership, Confidence, Openness, and Client Initiative. Treatment outcome was assessed as residual gain from pretreatment assessment to end of treatment, 3-month follow-up, and 1-year follow-up on 6 standard measures. Some aspects of the alliance as measured by the ARM were correlated with clients' gains in treatment. The strength of the association varied across assessment measures, occasions of outcome assessment, ARM scales, and the session number when the alliance was measured.     

Where is the relationship in research on the alliance? Two methods for analyzing dyadic data.

Researchers examining the therapy relationship are encouraged "to study both patients' and therapists' contribution to the relationship and the ways in which these contributions combine to impact treatment outcome" (Steering Committee, 2002, p. 443). Research on the therapeutic alliance, however, is dominated by studies that examine the individual contributions of the counselor and client. Relationship researchers have developed alternative ways to analyze dyadic data that do take into account the relationship. One alternative paradigm is to model the interdependence in dyadic alliance data with the Actor-Partner Interdependence Model (APIM; D. A. Kashy & D. A. Kenny, 2000). The APIM examines interdependence by modeling the impact of 1 dyad member's alliance ratings on the other member's session impact rating. APIM can also examine how alliance agreement interacts with alliance ratings to predict session impact. The other alternative paradigm is to use the latent group model (R. Gonzalez & D. Griffin, 2002) to examine the individual-level and dyad-level covariance in alliance and session impact ratings. The APIM and latent group models are illustrated with alliance and session impact measures from 53 client-counselor dyads. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session and intersession experience related to treatment outcome in bulimia nervosa.

Treatment in bulimia nervosa is challenging, with rates of successful treatments for only about 50% of all patients. This study aimed to identify predictors of outcome through secondary analysis of data from a randomized clinical trial that compared inpatient and day hospital treatment for bulimia. Process measures included assessments of patients' in-session experiences, therapeutic alliance, and therapy-related intersession experiences (ISE). ISE measures were better predictors of outcome than pretreatment variables (e.g., social adjustment) or global therapeutic alliance. Outcome at 3 month follow-up was strongly related to the ISE dimension Recreating Therapeutic Dialogue with Negative Emotions, indicating a heightened risk of failure. Prediction of outcome by these variables showed a sensitivity of 0.86 and a specificity of 0.78, and 83% of patients could be correctly classified. These results show that certain aspects of ISE may serve as early and reliable indicators of long term treatment failure, prompting alternate treatment approaches and opening new directions of research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)