Session impact, working alliance, and treatment outcome in brief counseling.

Examined associations among working alliance, session evaluations over the course of brief counseling, and counseling outcome. At a training clinic, 61 clients and student counselors from 41 dyads completed ratings of session depth, smoothness, positivity, and arousal after their 1st 12 sessions. Alliance ratings were completed after the 4th session and at termination. Clients and counselors also provided 5 measures of counseling outcome. Results indicated that session evaluations were significantly related to later alliance ratings, and positive alliance ratings predicted subsequent session evaluations. Both linear and curvilinear session effects were suggested. Associations for client ratings were generally stronger than for counselor ratings. Both alliance and session evaluations were significant unique predictors of client-related outcome, but only alliance predicted counselor-rated outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of working alliance development: A typology of client's working alliance ratings.

Patterns of working alliance development were detected by clustering working alliance ratings across 4 sessions of counseling. Results from an initial sample of recruited participants working with novice counselors (N?=?38) revealed 3 patterns of alliance development labeled stable alliance, linear alliance growth, and quadratic alliance growth. Results from a replication sample (N?=?41) of recruited participants also working with novice counselors, revealed 3 identical patterns of alliance development, which offered strong support for the validity of these growth patterns. As predicted by Gelso and Carter (1994), a pattern of quadratic alliance development was associated with greater improvement on measures of counseling benefit when compared to other patterns of alliance development. The discussion underscores the importance of examining both the strength (level) and pattern of development when examining the effects of the working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thromboelastography--an instrument for the researcher or clinician?

Thromboelastography is a method which is used experimentally since 1948. Since the end of the eighties it is experiencing a certain revival also in clinical medicine. The submitted case-record presents this technique as a very useful aid in the differential diagnosis of postoperative haemorrhagic conditions in cardiosurgery. Its application can facilitate aimed treatment of some typical disorders of haemocoagulation.     

The working alliance within time-limited therapy: A case analysis.

The working alliance across stages of time-limited psychodynamic treatment was investigated using an intensive case-analysis approach. Two White, male clients in their 20s were treated by the same therapist with process data obtained from the perspectives of client, therapist, and independent judge. As predicted, clients' perceptions of the working alliance increased, dropped, and then increased over the course of treatment. The implications of these results for a stage-process model of time-limited treatment and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Therapeutic alliance and outcome: Impact of treatment length and pretreatment symptomatology.

Studied data collected in 1978–1982 in a research project at a university psychological clinic that provides low-cost services to families in the community. Data consisted of pre- and posttherapy written measures and audiotapes from selected sessions with 40 patients (aged 20–57 yrs). Findings indicate that (1) strength of therapeutic alliance was established within the 1st 3 sessions of therapy with little change over the course of therapy, (2) short length therapy cases had lower levels of therapist positive alliance, (3) therapeutic alliance was predictive of outcome, and (4) therapeutic alliance was adversely affected by pretreatment symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward an integration of macro and micro measurement systems for the researcher and the clinician.

Comments on previous discussions (e.g., H. D. Grotevant; see record 1990-12120-001) on the development of strategies for developing key constructs of family functioning at both the macro and micro levels. The most generalizable models of family process should include data from both insiders and outsiders who make ratings at both the macro and micro levels. This position is based on the assumption that each measurement strategy and reporting agent brings with it a certain reliable bias or error that detracts from the core construct being examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference, attachment, and the working alliance: The therapist's contribution.

This study examined the relationship among therapist attachment styles, countertransference behaviors, and working alliance. Fifty therapists in training and their supervisors participated in the study. Therapists completed a self-rated measure of attachment style and a measure of working alliance with 1 of their clients. Supervisors completed measures of working alliance and countertransference behaviors about their supervisee's relationship with the same client. Results indicate that therapist attachment style did not correlate with either countertransference behaviors or working alliance. However, negative countertransference was associated with poorer working alliances, and positive countertransference was related to a weak bond within the working alliance. Additional analyses indicate that disagreement among supervisors and therapists about the bond component was predictive of countertransference behaviors. (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)     

The magnitude of client and therapist working alliance ratings.

Researchers studying the working alliance frequently comment that clients and therapists tend to rate the alliance highly. The authors conducted this study to determine the accuracy of these comments by examining of the magnitude of adult client and therapist working alliance ratings in 63 refereed articles published between 1990 and 2007. The authors wondered if clients and therapists generally tend to use just the higher points of rating scales for measures of working alliance. The 63 articles used 9 different measures of the working alliance and provided working alliance ratings by 6,441 clients and 6,359 therapists. Results indicate that clients tend to use only the top 20% of rating points and therapists tend to use only the top 30% of rating points on alliance measures. Implications of the findings include the possibility that clients and therapists do not differentiate among lower rating points on the scales, tend to rate the alliance according to a social desirability or dissonance-reducing response set, or provide ratings that accurately reflect the alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reminiscence of an addictionologist: thoughts of a researcher and clinician

The changes in the field of addiction are discussed from the prospective of twenty-two years of work as a researcher and clinician. The growing importance and relevance of twelve step programs to clinical practice is explored as is the changing experiences of working with early stage alcoholics. This is followed by a discussion of the interaction the research and clinical aspects of chemical dependency. Behavioral and learning theory in relationship to chemical dependency, the disease concept and the importance of the incubation period, withdrawal syndromes, and hereditary aspects of chemical dependency are all discussed.     

The generalizability of the psychoanalytic concept of the working alliance.

Reviews and elaborates the psychoanalytic concept of the working alliance. It is argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances (WA) embedded in them. Moreover, the strength, rather than the kind of WA, will prove to be the major factor in change achieved through psychotherapy. Strength of alliance will be a function of the goodness of fit of the respective personalities of patient and therapist to the demands of the WA. The WA includes 3 features: agreement on goals, assignment of tasks, and the development of bonds. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of six measures of working alliance.

Compared 6 measures of working alliance: the California Psychotherapy Alliance Scales (CALPAS), the Penn Helping Alliance Scales (PHAS), the Vanderbilt Therapeutic Alliance Scale (VTAS), Working Alliance Inventory—Observer Form (WAI—O), Working Alliance Inventory—Client Form, and Working Alliance Inventory—Therapist Form. All measures had high internal consistency. Observers were able to reach high levels of interrater reliability on all the observer-rated measures (CALPAS, PHAS, VTAS, WAI—O). Evidence of construct validity was found for the CALPAS, VTAS, and WAI—O, given that they were all highly correlated with each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using evidence-based treatments: The experiences of youth providers working under a mandate.

Whether as clinicians, administrators, or evaluators, psychologists are increasingly involved in efforts to implement evidence-based treatments (EBTs) within clinical practice settings. The state of Texas has undertaken what may be the largest EBT implementation effort to-date. A survey was conducted to understand the experiences of 197 children’s service providers working within this effort. Providers’ own attitudes toward the EBTs and their perceptions of their colleagues’ support for the EBTs were somewhat negative, although they gave positive ratings of the quality of their EBT training and of their agencies’ support for the EBTs. Significant, independent predictors of providers’ attitudes toward the EBTs included provider views of their colleagues’ and their agencies’ support for the EBTs, their opinions of the quality of their training in the EBTs, and their perceptions of institutional barriers to EBT use (all ps     

Measuring the working alliance in counselor supervision.

We developed the Supervisory Working Alliance Inventory (SWAI) to measure the relationship in counselor supervision. SWAI was based conceptually on the work of R. R. Greenson (1967), H. B. Pepinsky and M. J. Patton (1971), and others. Three supervisor factors (Client Focus, Rapport, and Identification) and two trainee factors (Rapport and Client Focus) were extracted by factor analysis. The scores on the SWAI were found to possess adequate scale reliability, and evidence of convergent and divergent validity for the SWAI was established by examining its relation to selected scales from the Supervisory Styles Inventory (M. L. Friedlander and L. G. Ward; see record 1985-05618-001). Trainee scores on the Rapport and Client Focus scales of the SWAI were significant predictors of scores on the Self-Efficacy Inventory (Friedlander and J. Snyder; see record 1984-04972-001). Implications for counselor training are discussed in the context of additional research on the psychometric properties of the SWAI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does the alliance cause good outcome? Recommendations for future research on the alliance.

Research has consistently documented that the quality of the therapeutic alliance is related to the outcome of diverse psychotherapies. Insufficient attention, however, has been directed at identifying the nature and magnitude of the causal relationship between the alliance and outcome. In this commentary, we discuss the major threats to causal interpretation of alliance-outcome correlations and provide suggestions for future research that would help clarify the extent to which the alliance causes positive outcomes. Assuming the alliance is a causal factor in relation to outcome, we provide recommendations for research on the alliance that would attempt to improve patient care by enhancing the alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of leaders' working alliance in premarital education.

Premarital (and general relationship) education programs, as a prevention method, have been shown to have a positive effect on marital quality and can prevent divorce. However, it is unclear whether these positive effects are consistent across leaders who conduct premarital education programs. Examining the variability in relationship outcomes attributed to the leaders of premarital education programs, and the role of general therapeutic factors such as working alliance in explaining relationship outcomes, may help increase the effectiveness of these programs. Accordingly, this study examined 31 leaders who trained 118 couples (236 attendees) in a randomized clinical trial of the Prevention and Relationship Enhancement Program (PREP), a research-based and empirically supported premarital education program being compared with a treatment as usual track. The results demonstrated that couples' relationship outcomes from pre- to post-training varied on the basis of the leader who provided the premarital education training. Both training in PREP and aggregated leader working alliance quality (as rated by attendees) explained variability between leaders in change in attendees' observed negative and positive communication. Leaders' aggregated working alliance quality also explained change in relationship satisfaction. In addition, attendees' ratings of their leaders' working alliance predicted change in their relationship satisfaction and confidence, and attendees had higher positive communication when they reported better working alliance with their leader. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review.

To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)