A relational perspective on the association between working alliance and treatment outcome (original) (raw)
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The Journal of Psychotherapy Practice and Research, 2001
Therapist characteristics were explored as possible predictors of working alliance, rated early and later in therapy both by therapists (n)95ס and patients (n)072ס in an ongoing multisite project on process and outcome of psychotherapy. Patients and therapists had divergent perspectives on the working alliance. Therapists' experience, training, skill, and progress as therapists did not have any significant impact on alliance as rated by patients. Training and skill were positively related to alliance as rated by therapists. Interpersonal relationships on the cold-warm dimension had a moderate impact for both patients' and therapists' alliance ratings. Some implications for therapist training are discussed.
Therapist characteristics influencing the quality of alliance in long-term psychotherapy
Clinical Psychology & Psychotherapy, 2009
This study explored therapist characteristics associated with the development of working alliance in long-term therapies, up to 120 sessions. The quality of working alliance was rated by both patients (n = 201) and therapists (n = 61) at sessions 3, 12, 20 and every 20th successive session. Therapists' self-reported scores on the 'cold/detached' dimension of Inventory of Interpersonal Problems-64 tapping therapists' interpersonal style, such as being distanced, disconnected or indifferent, had a negative impact on the working alliance as rated both by patients and therapists. More professional training was associated with poorer quality of working alliance, as rated by patients. A trend indicated that more experienced therapists rated the alliance lower at all sessions. Therapists' report of better maternal care up to their adolescence had a positive impact on patients' rating of alliance. Clinical implications are discussed.
Frontiers in Psychology, 2011
This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. A summary of how the concept of alliance has evolved over time and the more popular alliance measures used in literature to assess the level of alliance are presented. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. In our opinion, with regard to the relationship between the therapeutic alliance and outcome of psychotherapy, future research should pay special attention to the comparison between patients’ and therapists’ assessments of the therapeutic alliance. This topic, along with a detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects.
The Impact of Clients’ and Therapists’ Characteristics on Therapeutic Alliance and Outcome
Journal of Contemporary Psychotherapy
This article investigates distances between therapists and their clients in their experience of the therapeutic alliance across the duration of the psychotherapeutic treatments in a naturalistic study. We looked at the working alliances from different vantage points—rupture, repair of ruptures, distances in the alliance impressions of both clients and therapists—and their correlation with treatment outcome. The only predictive variable of alliance ruptures was the inability of therapists to bond sufficiently with their clients regarding a sustainable working atmosphere, which could be identified through a continuous distant alliance rating by the therapists. Alliance ruptures in turn significantly predicted premature termination of treatments, whereas alliance ruptures per se did not necessarily predict treatment outcome. The paper discusses the possible role of the quality of therapists’ attachment styles as a potentially crucial variable in an effective working alliance in psychot...
Development of working alliance over the course of psychotherapy
Psychology and Psychotherapy: Theory, Research and Practice, 2010
Objectives. The goal was to investigate patients' rating of working alliance in longerterm individual psychotherapy (N ¼ 201), in order to determine different patterns of development and predictors of positive versus negative development.
Pattern of alliance and outcome in short-term individual psychotherapy
Psychotherapy: Theory, Research, Practice, Training, 1995
Pattern of change in the therapeutic alliance across time-limited, 20-session individual psychotherapy was investigated with the procedure of hierarchical linear modeling (HIM) in two samples of 32 psychiatric outpatients, those with low and those with high quality of object relations (QOR). Significant (p < .05) variation in the pattern of change in the therapeutic alliance was found within each sample.
Influence of Therapist and Client Behaviors on Therapy Alliance
Contemporary Family Therapy, 2005
This study considers the combined effect of therapist behaviors and couples' interaction dynamics on therapeutic alliance because it seems to be a significant predictor of successful therapy outcomes. We measured therapeutic alliance using the Working Alliance Inventory, Observer Version (WAI-O), which includes three subscales: goals, tasks, and bond. We investigated the combined effect of therapist behaviors and couples interactions on therapeutic alliance. There were three significant findings: (1) the models better predicted therapeutic alliance for men clients than women clients; (2) combined consideration of partner behaviors and therapist behaviors provided the stronger prediction of therapeutic alliance; and (3) different variables predicted alliance for women clients versus men clients.