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)     

A general framework for the statistical analysis of sequential dyadic interaction data.

Recent interest in sequential dyadic interactions has motivated researchers to develop methods appropriate for the analysis of such data. After briefly reviewing a series of methodological papers focusing on the analysis of discrete-valued observations, we present a general framework for studying many substantive effects, including dominance and autodependencies, in social interactions measured on dyads. We show how this framework allows a researcher to study dyadic interactions measured at two or more time points on one or more relations. The methods described here are general enough to permit the simultaneous analysis of the sequential relational variables and attribute variables (such as sex of actors or emotional status of the dyad) recorded on either the dyad or the actors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in behavior therapy.

It may be argued that behavior therapy has proceeded with minimal regard for the therapeutic alliance (TA) as a key mechanism of change. However, ignoring the role of TA in behavior therapy may not only be problematic on a practical level, but also may be inconsistent with basic principles that underlie behavior therapy. In beginning to address these issues, the authors consider the role of TA in behavior therapy with a focus on relevant basic principles. Keeping a focus on these basic principles, the authors then outline three contemporary behavior therapies that already incorporate a focus on the therapeutic relationship and conclude with a clinical case illustration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in adolescent substance abuse treatment: A one-with-many analysis.

Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398 adolescents treated for substance abuse by 14 therapists. Both the client and therapist alliance ratings yielded large relationship variances, with limited consensus among clients treated by the same therapist about the quality of the alliance. If a client reported an especially strong alliance with his or her therapist, the therapist was likely to also report an especially strong alliance with that client (dyadic reciprocity). The association between the components of the alliance and treatment outcome was complicated, with different levels of measurement and different components of the alliance (perceiver, partner, or relationship) derived from different informants (therapist or client) relating to different outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A sociological perspective on the therapeutic alliance: Ethnomethodology and conversation analysis.

Traditional perspectives consider the therapeutic alliance as tied to specific goals of positive patient change. Psychometric studies suggest that the therapeutic alliance is better conceptualized as linked to aspects of the patient–therapist dyad independent from therapeutic goals. A framework to capture the relational identity of the alliance, proposed by E. Bordin (see record 94-105022-001), centers on patient–therapist collaboration. Ethnomethodology, a sociological research paradigm, suggests that "collaboration" in psychotherapy consists of methods that establish an impression of common sense between patient and therapist. These methods involve verbal and para-verbal cues, often subtle and implicit, that compose a subtext to the more explicit dialogue about therapeutic goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response biases in the MMPI: A sequential analysis.

Conceptions of "response bias" have figured prominently in two dissimilar research areas, psychophysical tasks and assessment techniques. These areas share a common methodological problem—how to assess the contribution of non-content-determined sequential dependencies. A general technique is presented for assessing sequential dependencies in MMPI responses, and in responses to an instructional set to be random in a non-content guessing task. For MMPI responses, the effect of item content clearly overrides any tendency to develop sequential dependencies; response bias is limited to total number of True or False responses. In non-content guessing tasks, sequential dependencies play a major role. This general technique for measuring such biases provides a unifying conceptualization of non-content-determined response patterning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The alliance in couple therapy: Partner influence, early change, and alliance patterns in a naturalistic sample.

Objective: The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence and gender and sought to identify couple alliance patterns that predicted couple outcomes. Method: The authors examined the alliances and outcomes at posttreatment and follow-up of 250 couples seeking treatment for marital distress in a naturalistic setting. The Session Rating Scale was used to measure the alliance; the Outcome Rating Scale and Locke Wallace Marital Adjustment Scale were used to measure outcomes. Couples were White, Euro-Scandinavian, and heterosexual, with a mean age of 38.5 years and average number of years together of 11.8. On a subsample (n = 118) that included couples with 4 or more sessions, the authors investigated the relationship between the alliance and outcome controlling for early change, and patterns of alliance development were delineated. Results: In the full sample, first-session alliances were not predictive of outcomes, but last-session alliances were predictive for both individuals and their partners. In the subsample, third-session alliances predicted outcome significantly above early change (d = 0.25) that exceeded the reliable change index. Couple alliances that started over the mean and increased were associated with significantly more couples achieving reliable or clinically significant change. Gender influences were mixed. Conclusions: Given the current findings suggesting a potential alliance impact over and above symptom relief as well as the importance of ascending alliance scores, continuous assessment of the alliance appears warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workplace absenteeism and alcohol use: A sequential analysis.

This investigation examined the day-to-day relationship between alcohol use and workplace absenteeism among a sample of participants (N = 280) employed in 1 of 3 large companies located in the northeastern U.S. With a semistructured interview, information was collected from employees about specific days of drinking during a 1-month period and marked on a calendar. Data about employees' absences during the same target time period were collected from the companies' human resource departments and were also marked on a calendar. A significant relationship was found between alcohol use and workplace absences; workers were, roughly 2 times more likely to be absent from work the day after alcohol was consumed. (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?     

Cultural difference and the therapeutic alliance: An evidence-based analysis.

The research on positive psychotherapy outcome consistently indicates that the quality of the alliance is important across different models of psychotherapy (D. E. Orlinsky, M. H. Ronnestad, & U. Willutzki, 2004; B. E. Wampold, 2000). Social psychological research has documented how "unintentional bias" can produce barriers to university admissions, employment, and advancement of well-qualified members of ethnic minority groups (J. F. Dovidio, S. L. Gaertner, K. Kawakami, & G. Hodson, 2002). Neuroscience is further confirming social psychological responses associated with race (J. L. Eberhard, 2005). Unintentional bias identified in social psychological research may be part of the psychotherapist/client interaction, interfere with the therapeutic alliance, and partly account for the high dropout rates and underutilization of psychotherapeutic services by people of color. The purpose of this article is to provide an evidence-based analysis of how psychologists in practice may unintentionally interfere with development of quality alliances with culturally different clients or patients and thus contribute to the barriers to effective multicultural counseling and psychotherapy. Principles from the American Psychological Association's (2003) multicultural guidelines and a review of relevant research are applied in suggesting strategies to reduce bias and to develop culturally appropriate skills in psychological practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive change and the therapeutic alliance: The role of technical and nontechnical factors in cognitive therapy.

Tests whether there are reciprocal interactions between the technical and nontechnical aspects of cognitive therapy (CT). 47 outpatients (mean age 36.8 yrs) with a depressive and/or anxiety disorder were treated with a 20-week, manualized CT intervention. Measures included the Beck Depression Inventory, the Dysfunctional Attitude Scale, and the Working Alliance Inventory. Results indicate that pretreatment depressogenic cognitions impact on the ability to form an early therapeutic alliance, whereas pretreatment depression severity is unrelated to alliance formation. Second, the degree to which patients were in agreement with the goals and tasks of therapy was predictive of subsequent change in depressogenic cognitions. Third, the 2-way interaction between the therapeutic bond and cognitive-change scores was found to predict depression outcomes: patients who reported a better therapeutic bond and who experienced greater reduction in their depressogenic cognitions, experienced the most favorable clinical outcomes. Certain aspects of the therapeutic alliance (i.e., goals and tasks) may facilitate the implementation of the technical factors of CT, while other aspects of the alliance (i.e., bond) act in concert with technical factors to produce direct effects on depressed symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The alliance.

Two decades of empirical research have consistently linked the quality of the alliance between therapist and client with therapy outcome. The magnitude of this relation appears to be independent of the type of therapy and whether the outcome is assessed from the perspective of the therapist, client, or observer. Although the strength of the connection between alliance and therapy outcome appears to be relatively uniform throughout therapy, the client's report of the early alliance may be the most clinically useful indicator. In successful treatments, the therapist's and client's assessments of the alliance tend to converge over time. Recent research suggests that the therapist's skills and personal factors both influence the likelihood of developing a good therapeutic alliance with the client. Though the relation between the therapist's level of training and the quality of the alliance is inconsistent, it is likely that the more trained therapists are able to form better alliances with severely impaired clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy

This study was performed to determine the fluoride concentration of the various cementum surfaces in different tooth groups to find out the most proper teeth and tooth surfaces for different cementum studies. For this purpose, direct measurements of phosphorus and fluoride were carried out in an acid etch biopsy solution. The findings indicate that incisors with exposed cementum are the most inappropriate teeth in comparison with the other groups. According to the results obtained it may be recommended that the studies related to fluoride uptake for cementum should be performed on teeth with no gingival recession or on the unerupted teeth.     

Psychology and nursing: A natural alliance.

Argues that although the professions of psychology and nursing each possess their own tradition, clinical skills, and scientific knowledge base, there is much that they share in that both are evolving into autonomous disciplines. It is suggested that increased cooperative interdisciplinary efforts in the clinical, scientific, and public policy areas could contribute to each profession's autonomy. (64 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing sequential categorical data on dyadic interaction: A latent structure approach.

Demonstrates how a class of modeling techniques, commonly referred to as latent structure analysis, can be used in an informative way to study the character of sequential categorical data. Using this procedure, the authors show how to investigate (a) the lagged dependence between 2 actors, (b) dependency across populations, and (c) the issue of dominance and autodependence in reciprocal models of interaction sequences. Formal test statistics are utilized to select from an array of restricted and unrestricted latent class models fit to various sets of dyadic interaction data. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing sequential categorical data on dyadic interaction: A comment on Gottman.

Recent theoretical developments emphasize that social interactions are dynamic and reciprocal, and this has led to widespread use of time-series data on behavior in 2-person systems. In principle, such data allow one to separate the influences of 2 actors on each other. Statistical methods currently being used, however, are deficient in several respects. The present article shows that (1) a statistic proposed by G. P. Sackett (1979) and later "proved" by J. M. Gottman (see PA, Vol 62:5153; and 1980) is incorrect, and (2) the failure to control for autodependence can produce misleading results. New procedures are presented that are based on both traditional and more recently developed methods for the analysis of contingency tables. Using these procedures, methods are shown for testing dependency, measuring dependency, testing for differences in dependency across subgroups, and testing for dominance in reciprocal behavior sequences. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step toward disentangling the alliance/improvement cycle in family therapy.

The authors focused on 2 unique aspects of the alliance in conjoint therapy: feeling safe in the therapeutic context with other family members and the family's shared sense of purpose about treatment (i.e., productive within-family collaboration). Low-income, multiproblem families were seen in a community clinic by therapists with varying theoretical orientations and a wide range of experience. Alliance-related behavior was assessed using the System for Observing Family Therapy Alliances (M. L. Friedlander, V. Escudero, & L. Heatherington, 2006). The significant mediated model showed that parent safety contributed to productive family collaboration in the 1st session, which, in turn, predicted global improvement rated after Session 3. Given the heterogeneous sample of clients, therapists, and therapy approaches, findings support the ecological validity of the alliance in family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The alliance as mediator of expectancy effects in short-term individual therapy.

The authors investigated the hypothesis that the therapeutic alliance mediates the relationship between pretherapy expectancy of improvement and psychotherapy outcome. Data were drawn from a comparative trial of 2 forms of short-term, time-limited individual psychotherapy (W. E. Piper, A. S. Joyce. M. McCallum, & H. F. Azim, 1998). Measures of expectancy and outcome were based on an individualized assessment of target objectives; outcome was considered from 3 perspectives (patient, independent assessor, therapist). Using the R. M. Baron and D. A. Kenny (1986) procedure, the authors, found evidence in support of the hypothesized mediation effect. The effect was evident when the alliance was rated from the perspective of either patient or therapist, and it accounted for one third of the direct impact of expectancy on outcome. Clinical implications and limitations of the study are discussed. (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)