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)     

Change in coordination across phases of psychotherapy and outcome: Two mechanisms for the role played by patients' contribution to the alliance.

Investigated the mechanisms underlying associations between patients' contribution to the alliance and outcome by examining relations between change in the alliance over the course of treatment and improvement in Short-Term Dynamic Psychotherapy (STDP) and Brief Adaptive Psychotherapy (BAP). Findings for STDP were consistent with 1 model about the role played by the alliance, according to which change in the alliance over the course of therapy is the vehicle for overall improvement. Results for BAP were consistent with the other main position proposed in the literature, which argues that a positive alliance provides the foundation for successful treatment. Discussion includes suggesting that it might prove useful in future research to group therapy approaches in terms of these 2 models and that this idea may explain 2 apparently contradictory sets of findings from previous studies on relations between change in the alliance and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pattern of alliance and outcome in short-term individual psychotherapy.

Pattern of change in the therapeutic alliance across time-limited, 20-session individual psychotherapy was investigated with the procedure of hierarchical linear modeling (HLM) in 2 samples of 32 psychiatric outpatients each (aged 21–53 yrs), those with low and those with high quality of object relations (QOR). Significant variation in the pattern of change in the therapeutic alliance was found within each sample. For low-QOR patients, a direct relationship was found between increasing therapist-rated alliance and favorable outcome. Pattern of change was more important than average level. For high-QOR patients, there was no evidence of a direct relationship between pattern of change and outcome. However, there was considerable evidence of a direct relationship between average level and favorable outcome. The use of HLM provided a new perspective to understanding alliance–outcome relationships. (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)     

Patient coordination: Contrasts with other conceptualizations of patients' contribution to the alliance and validity in insight-oriented psychotherapy.

Describes how the patient coordination construct contrasts with the bond and collaboration conceptualizations of the alliance and reports on an initial investigation of the validity of patient coordination in the context of insight-oriented psychotherapy. In contrast with other approaches, the coordination construct focuses on the kinds of complex defensive patterns that appear prominently in clinical discussions of problematic patient behavior. Data consisted of audiotaped therapy sessions with 16 male college students and 9 psychiatric inpatients. As predicted, the group of relatively higher functioning outpatients was significantly more coordinating in interpersonal behavior in therapy than the more seriously disturbed hospitalized patients. In another comparison, patients in therapy with experienced therapists were significantly more coordinating than patients treated by untrained therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The alliance in child and adolescent psychotherapy.

The therapeutic alliance has a long history in the child and adolescent psychotherapy literature. This article examines prominent views on the alliance with youth and considers a number of issues that distinguish youth alliance from its adult counterpart. A meta-analysis of alliance–outcome associations in individual youth therapy is presented. In order to provide a direct comparison with the adult literature, the review included only prospective studies of individual youth therapy that used an explicit measure of alliance. Results from 16 studies revealed consistency with the adult literature with a weighted mean correlation of .22 (k = 16, n = 1306, p     

The role of the therapeutic alliance in psychotherapy.

Traces the development of the concept of the therapeutic working alliance from its psychodynamic origins to current pantheoretical formulations. Research on the alliance is reviewed under 4 headings: the relation between a positive alliance and success in therapy, the path of the alliance over time, the examination of variables that predispose individuals to develop a strong alliance, and the exploration of the in-therapy factors that influence the development of a positive alliance. Important areas for further research are also noted. (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.     

Patient's and therapist's views of early alliance building in dynamic psychotherapy: Patterns and relation to outcome.

Patients and therapists have somewhat divergent perspectives of alliance. Usually in psychotherapy research, the focus is on the patient's view of alliance, predicting parts of outcome. This study questions this hypothesis by applying the shape-of-change procedure to patient's and therapist's view of alliance-building processes in dynamic psychotherapy. The results of this naturalistic study indicate that none of the 3 patient patterns is related to outcome at the end of psychotherapy, but a specific therapist's pattern--out of 2--is linked to positive symptom change. These results are discussed in the context of present research on therapeutic alliance, especially in terms of level and process, its measurement, and potential in predicting outcome in dynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome.

The purpose of this study was to understand how the real relationship (RR) relates to important process and outcome variables from both the clients’ and therapists’ perspectives. Using a sample of 31 therapist/client dyads at a university counseling center, the authors examined the RR at the 3rd session of therapy and at termination. The results revealed that client adult attachment avoidance was negatively correlated with client RR, while client adult attachment anxiety was uncorrelated. Therapists’ ratings of negative transference were negatively correlated with therapist-rated RR and were uncorrelated with client-rated RR. Hierarchical linear modeling analyses were conducted to predict postintervention outcome from client and therapist perceptions of the RR. Therapists’ ratings of the RR accounted for a significant amount of variance in client posttreatment symptoms while controlling pretreatment symptoms. Client-rated RR total scores and client and therapist 3rd-session alliance scores were not significant predictors of postsymptom ratings. Implications of the usefulness of measuring the RR in psychotherapy are discussed, as are recommendations for future study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled outcome research in psychotherapy: The group comparison approach reassessed.

Contends that the group comparison approach to treatment outcome research is sometimes rejected on the grounds that it ignores individual differences. The present author argues that this rejection is based on a misunderstanding of the research strategy involved and that the group comparison approach, in the framework of a multifactorial design, can reveal those individual differences that are important (i.e., the factors that affect outcome). (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic alliance: Its place as a process and outcome variable in dynamic psychotherapy research.

Argues that conceptual unclarity has surrounded psychotherapy research efforts to define and measure the therapeutic alliance. A precisely defined conception of the therapeutic alliance is offered that focuses on the patient's active collaboration in the tasks appropriate to the treatment process. The therapeutic alliance is thus distinguished from patient characteristics and attitudes as well as from therapist contributions to the formation of the alliance. The importance of the therapeutic alliance as a change measure in process research is underscored, and its place as a primary indicator of outcome is described. Empirical studies are reviewed, with particular reference to the Menninger Treatment Interventions Project, and the use of single-case methodology is considered. The special relevance of the therapeutic alliance to the investigation of the therapeutic change process with borderline patients is outlined. (52 ref) (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.     

The therapeutic alliance and its relationship to alcoholism treatment participation and outcome.

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The application of separation-individuation theory to analytic group psychotherapy.

Argues that analytic group psychotherapy can be a highly effective modality in the treatment of patients with deficits in psychic structure. It is important to develop treatment approaches that integrate theory and technique and can be therapeutically directed toward developmental lesions in phase-appropriate ways. The application of separation-individuation theory is discussed as one useful model to facilitate change in patients with developmental arrests. This conceptual framework is also valuable in understanding how individuals may use the group to enhance personal growth and/or to perpetuate symbiosis. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weakenings and repairs of the working alliance in short-term psychotherapy.

Investigated how the weakening and repair of the working alliance in short-term psychotherapies relates to change in therapy. In 6 short-term, time-limited therapies involving 4 therapists and 6 patients, weakenings and repairs were identified with a unitized process ratings scale. Though the data must be considered preliminary, interesting relations emerged. Patients with greater ego strength had a higher initial quality of alliance with their therapist and were better able to work to repair any weakenings. These patients also exhibited a growing use of observing ego in their increasing ability to initiate talk about weakenings. Highest levels of patient alliance were preceded by high levels of therapist repair action. The success with which weakenings and repairs were handled was predictive of the general outcome of therapy. Surprisingly, more frequent interpretations of transference allusions were associated with poor outcome. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The outcome of psychotherapy with children.

Examined 75 studies, published between 1952 and 1983, in which children who received psychotherapy were compared with controls or children receiving another form of treatment. Only those studies using Ss younger than a mean age of 13 yrs at the time of treatment were included. Exceptions to the age limitation were made only if separate analyses for younger children were reported or if individual data from older Ss could be eliminated. Results show that therapy with children was similar in effectiveness to therapy with adults; treated children achieved outcomes about two-thirds of a standard deviation better than untreated children. Although behavioral treatments appeared to be more effective than nonbehavioral treatments, this apparent superiority was due largely to the types of outcome and target problems included in behavioral studies. No differences in outcome were found to result from other treatment characteristics such as the use of play in therapy or the administration of treatment individually or in groups. The evidence suggests that previous doubts about the overall efficacy of psychotherapy with children can be laid to rest. A bibliography of the studies examined is appended. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' view of the alliance in psychotherapy: Exploratory factor analysis of three alliance measures.

Extending a previous study (R. L. Hatcher, A. Barends, J. Hansell, & M. J. Gutfreund; see record 1995-44524-001), factor analysis of 3 alliance measures completed by 231 patients explored patients' views of the alliance. Two of 6 factors, Confident Collaboration and Idealized Relationship (with the substantial general factor removed), correlated with patients' estimate of improvement (rs?=?.37 and –.23, respectively; p?     

Treatment delay, outcome, and satisfaction in time-limited group and individual psychotherapy.

As part of a randomized clinical trial in which we compared outcome in time-limited individual and time-limited group psychotherapy, patients were interviewed and completed a battery of assessment measures. All participants in the study were then randomly assigned to one or the other treatment modality. There were inevitable delays before patients began their assigned therapies. Group treatment patients waited an appreciably longer period of time, on average, than did individual treatment patients (48 days vs. 31 days). Nonetheless, it was only for individual therapy patients that we found a highly significant relationship between this delay and treatment satisfaction at the completion of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)