Predictors of the therapeutic alliance in group therapy for individuals with treatment-resistant auditory hallucinations.
ABSTRACT This study hypothesized that several baseline client characteristics (i.e. age, symptoms, insight, social functioning) would significantly predict client-rated group alliance in out-patients with schizophrenia spectrum disorders.
Hierarchical linear modeling (HLM) was used to evaluate the contributions of selected baseline individual client characteristics and group level characteristics to client-rated group alliance at the sixth session of group therapy. The effect of treatment type (CBT vs. ST) on group alliance and interaction with predictor variables were also analysed. Finally, correlations were computed to explore the relationship between group alliance, attendance, and treatment engagement.
Sixty-three out-patients who had treatment-resistant auditory hallucinations were randomly assigned to either group CBT, which targeted reduction of distress associated with hallucinations, or group ST, which focused on improving social integration.
Results indicate that a stronger group alliance at the mid-point of treatment was associated with overall higher levels of group insight, and lower individual autistic preoccupation and social functioning at the baseline assessment. In addition, stronger group alliance was significantly correlated with higher attendance rates and therapists' ratings of treatment compliance.
These findings have implications for determining group composition and identifying clients low in therapeutic engagement. Suggestions for future research on group alliance are also discussed.
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ABSTRACT: The therapeutic relationship is one of the most central and important factors in the treatment of mental health disorders. A better therapeutic relationship is associated with service engagement, medication adherence, and satisfaction with services. This study aimed to compare the demographic and clinical factors associated with the therapeutic relationship in voluntarily and involuntarily admitted psychiatric service users. We found that individuals who had been admitted involuntarily, who had a diagnosis of a psychotic disorder, and who reported higher levels of perceived pressures on admission were more likely to have a poorer therapeutic relationship with their consultant psychiatrist. Greater levels of insight and treatment satisfaction, together with higher levels of procedural justice experienced on admission, were associated with a better therapeutic relationship. We found that the level of perceived coercion on admission was not related to the therapeutic relationship. Targeted interventions to improve the therapeutic relationship, particularly for involuntarily admitted service users, are discussed.The Journal of nervous and mental disease 03/2014; 202(3):186-92. DOI:10.1097/NMD.0000000000000102 · 1.81 Impact Factor
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ABSTRACT: Suicidal Behavior (CS) refers to ideas, attempts and acts of self-inflicted death, caused by self-referential negative cognitions (cognitive triad), rigid and generalized selective information processing, confirmatory bias and poor coping profiles. It can be treated with cognitive therapy (CT), which has proven effective for this problem, based on the modification of negative cognitions and dysfunctional copings strategies, desertion reduction, adherence to health services and social support. However, there are many difficulties in the empirical demonstration of the effectiveness of these psychotherapies (CBT type) as the sample selection (discrimination between ideation, intent, comorbidities, availability, reporting), control groups, generalization of results, among others. Therefore we analyze methodological possibilities as classifying the groups according type of psychiatric illness or suicidal behavior: attempt, suicidal ideation and control approaches carry risk behavior and hopelessness, and use statistical models to date. It concludes recommending CT, but requesting permanent methodological improvements.01/2013; 7(1):93-102.
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ABSTRACT: Abstract Background: Alliance is a well-studied construct; however, little research has investigated predictors of alliance in a group context. Aims: This study investigates the relationship between therapist characteristics and group alliance in 65 individuals with schizophrenia receiving outpatient group therapy for treatment-resistant auditory hallucinations. Methods: Raters coded 120 sessions of cognitive behavioral therapy or supportive therapy for therapist warmth and friendliness, therapist exploration and negative therapist attitude. Alliance was assessed at week six. Results: Higher average levels of therapist warmth and friendliness and lower average levels of negative therapist attitude in sessions one to five were associated with stronger alliance at week six at the trend level (p < 0.10). Therapist exploration did not predict alliance at week six. Higher negative therapist attitude at treatment engagement was associated with higher post-treatment symptom scores. Conclusions: Our results suggest that therapist attributes but not therapist techniques are associated with client's perceptions of alliance and that negative therapist behaviors are associated with higher symptom levels at post-treatment. Implications for clinical practice are discussed.Journal of Mental Health 08/2014; 23(4):166-170. DOI:10.3109/09638237.2013.869568 · 1.40 Impact Factor