The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review.

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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)     

Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy.

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in psychodynamic psychotherapy: Theoretical conceptualizations and research findings.

The construct of the therapeutic alliance is approached from the psychoanalytic tradition by reference to the ideas of Freud, R. Sterba, E. R. Zetzel, R. R. Greenson, and L. Luborsky. The transtheoretical approaches posited by E. S. Bordin and L. Gaston are also presented and the relation of alliance to the transference is discussed. The empirical evidence as to the role of the alliance in psychodynamically oriented psychotherapy is presented, and the construct is operationally defined by means of the major psychometric instruments. Factors that foster the development of strong alliances (patient and therapist factors), as well as those that hinder or result in its rupture are discussed in detail. The differential association of alliance to outcome depending on who measures the alliance (patient, therapist, or independent observer) and the timing of the measurement of the alliance (first, third, fifth, or later session) are considered. Last, there is a discussion of the criticisms of how research in this area is conducted, and suggestions for future researchers are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studying psychotherapy using the one-with-many design: The therapeutic alliance as an exemplar.

Most psychotherapy research uses a one-with-many design, in which each therapist (the one) treats multiple clients (the many), which raises the challenge of nonindependent data. We present a statistical model for analyzing data from studies that use a one-with-many design. This model addresses the problems associated with nonindependence and can address theoretically relevant questions. To illustrate this model, we analyzed data in which 65 therapists and their 227 clients rated their therapeutic alliance. The primary finding was that both therapist and client alliance ratings were largely relational (i.e., specific to the unique therapist–client combination). There was little consensus among clients treated by the same therapist about the quality of the therapeutic alliance, although some therapists reported forming stronger alliances than other therapists. There was substantial dyadic reciprocity, indicating that if a therapist reported an especially good alliance with a particular client (better than with his or her other clients), then that client was also likely to report an especially good alliance (better than those reported by the therapist’s other clients). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal complementarity and individual differences.

Interpersonal circumplex theory has predicted complementarity in interpersonal interactions to be expressed in the form of correspondence along the affiliation dimension (e.g., friendly behavior evokes friendliness) and reciprocity along the control dimension (e.g., dominance evokes submission). Prior research has supported the first prediction but not the second. It was hypothesized in this study that the inconsistent findings were due in part to the neglect of the importance of individual differences (personality) variables. Interpersonal process and individual differences variables were assessed jointly in this study, and it was found that affiliative behavior was due largely to situational (complementarity) effects and control behavior was due largely to individual differences. The results are discussed with respect to an integration of group–interpersonal process and individual differences research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research summary on the therapeutic relationship and psychotherapy outcome.

Factors that influence client outcome can be divided into four areas: extratherapeutic factors, expectancy effects, specific therapy techniques, and common factors. Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome than specialized treatment interventions. The common factors most frequently studied have been the person-centered facilitative conditions (empathy, warmth, congruence) and the therapeutic alliance. Decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is the nature of the therapeutic relationship. Clinicians must remember that this is the foundation of our efforts to help others. The improvement of psychotherapy may best be accomplished by learning to improve one's ability to relate to clients and tailoring that relationship to individual clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A therapeutic index: Measuring therapeutic actions in psychotherapy.

This article describes a research method that measures a therapist's effectiveness by assigning a composite value to each therapeutic verbal statement during a session. The intrasubject averaging of these values is called the mean therapeutic index (Σ). In this study, whether the mean therapeutic index could be used to predict treatment outcome was investigated. A successful case and an unsuccessful case were selected for 15 therapists, and an early session for each case was coded using the mean therapeutic index. The results show that the magnitude of the effect of the mean therapeutic index, as indicated by the correlation coefficient r, was .92. Thus, the mean therapeutic index accounted for 85% of the variance in the classification of treatment outcome as successful or unsuccessful. The findings point to the method's potential use for clinical practice and supervision of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder.

This study investigated the quality and development of the therapeutic alliance as a mediator of change in schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder. Seventy-eight patients were randomly allocated to 3 years of biweekly SFT or TFP. Scores of both therapists and patients for the therapeutic alliance were higher in SFT than in TFP. Negative ratings of therapists and patients at early treatment were predictive of dropout, whereas increasingly positive ratings of patients in the 1st half of treatment predicted subsequent clinical improvement. Dissimilarity between therapist and patients in pathological personality characteristics had a direct effect on growth of the therapeutic alliance but showed no relationship with clinical improvement. The authors conclude that the therapeutic alliance and specific techniques interact with and influence one another and may serve to facilitate change processes underlying clinical improvement in patients with borderline personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship among patient contemplation, early alliance, and continuation in psychotherapy.

The present study examined the relationship among contemplation stage of readiness to change, formation of an early therapeutic alliance, and psychological distress following the first session of psychotherapy. Significant correlations between the contemplation scores and the therapeutic alliance were found for patients in the contemplation stage. Although contemplation scores were not a factor in return for a second session of psychotherapy, the bond subscale of the alliance inventory did significantly contribute to whether patients returned for therapy. Patient psychological distress was not a significant factor in predicting the early alliance. Results indicate a need for further focus on contemplation with its inherent ambivalence, its relationship to alliance, and continuation in early psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contextual therapeutic relationship: Ecological considerations in psychotherapy research and practice.

While the psychotherapeutic relationship has been assumed to be relatively free from external influence, we suggest that the therapeutic alliance develops within a larger environment, much of which is beyond the control of client and therapist. The reticence of practitioners and researchers to recognize and explore ecological issues is likely related to therapeutic tasks that are necessary for insight-oriented treatments (e.g., developing a therapeutic setting that protects clients from the intrusion of outside influences). Two sources of ecological disruption are discussed, managed care and psychotherapy research, and an illustrative case example of ecological disruption within a psychotherapy research setting is presented. We suggest that addressing ecological disruptions in the context of the therapeutic relationship may facilitate the establishment and maintenance of a positive therapeutic alliance. By doing so, the therapist can integrate the demands of the external world into the therapeutic relationship, thereby increasing the meaningfulness of interpersonal interventions and easing discussions about therapeutic alliance ruptures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal self-confirmation and challenge in psychotherapy.

Six therapists and 45 university student clients participated in a study that tested predictions from interpersonal self-confirmation theory (e.g., J. Andrews; see record 1980-21500-001) and applied the predictions to psychotherapy. The prediction that higher levels of interpersonal challenge vs complementary relationships are experienced as more positively and negatively emotionally stimulating was confirmed. These findings support the application of the discrepancy hypothesis of D. Fiske and S. Maddi (1961) and D. McClelland et al (1953) to the realm of interpersonal self-confirmation and challenge. Qualitative data from a case illustration are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting patient change from therapist competence and patient-therapist complementarity in short-term anxiety-provoking psychotherapy: A pilot study.

Examined therapist competence and patient–therapist complementarity, measured by the Structural Analysis of Social Behavior system (L. S. Benjamin, 1974), as to their interrelation and their unique, collective, and interactive contributions to patient change in 20 sessions of short-term anxiety-provoking psychotherapy (STAPP; P. E. Sifneos, 1979). Patients were 15 highly educated outpatients (mean age 30 yrs) with mainly anxiety diagnoses. Therapists were in postgraduate manual-guided STAPP training. Results show that competence in an early session did not relate to patient change. In contrast, patient–therapist complementarity ratings predicted patient change both alone and over and above competence. Predictions were strongest for changes in general distress and dysfunctional attitudes and for shorter term change rather than for longer term change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The 1982 Interpersonal Circle: A taxonomy for complementarity in human transactions.

Integrates previous theory and research addressing interpersonal complementarity, a construct that is central to refined and extended research and clinical applications of interpersonal theory. The 1982 Interpersonal Circle is presented, which the present author constructed as a comprehensive taxonomy of the domain of 2-dimensional interpersonal behavior. The 1982 Circle integrates and expands the content of 4 major adult interpersonal measures (the Interpersonal Check List, the Interpersonal Adjective Scales, the Interpersonal Behavioral Inventory, and the Impact Message Inventory) to provide a circle taxonomy consisting of 16 segments 128 subclasses, 2 levels, and 350 bipolar items. Previous conceptions of interpersonal complementarity are reviewed and, using the 1982 Circle as a theoretical and operational guide, 11 propositions of complementarity as they apply in personality, psychopathology, and psychotherapy are derived. (108 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?     

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     

Early identification of treatment failures in short-term psychotherapy. An assessment of therapeutic alliance and interpersonal behavior

Gender awareness and sensitivity in disaster research and management remains uncommon and tends to focus on the developing rather than the developed world. This paper uses a feminist oral geography to present some findings about women's experiences in two floods in Scotland. It is conceptualised around public and private (masculinised and feminised) space, problematising the private domain and presenting it, in the feminist research tradition, as a legitimate object of research. It shows the ordinary and everyday to be more opaque and complex than usually imagined and makes recommendations for their recognition and incorporation into disaster management. While there is a specific focus on the private domain of the home, this is not intended to reinforce gender stereotypes but simply to recognise the reality of many of the women interviewed. It concludes that disaster research generally has yet to advance much beyond the earliest stages of feminist studies which merely sought to make women visible in society.     

Interpersonal problems and the psychotherapy context: The construct validity of the Inventory of Interpersonal Problems.

This research investigated the construct validity of the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, S. E. Rosenberg, B. A. Baer, G. Ure?o, & V. S. Villase?or, 1988) in the context of psychodynamic psychotherapy. The interpersonal circumplex was used to categorize patients reporting interpersonal distress into 1 of 4 problem quadrants: Friendly Dominant, Hostile Dominant, Hostile Submissive, and Friendly Submissive. At several points in treatment, therapists assessed their patients' personality disturbances, global functioning, and assets and liabilities for therapy. Patients described their in-session experiences using the Therapy Session Report (D. E. Orlinsky & K. I. Howard, 1975). The 4 problem types each had a coherent and distinctive set of correlates. Patients' interpersonal problems were articulated in therapists' perceptions and evaluations, and in the kinds of interpersonal and intrapsychic themes (wants, hopes, feelings, behaviors, etc.) that characterized patients' retrospective accounts of the therapy sessions. The results add to knowledge about the IIP, interpersonal problems, and the psychotherapy context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)