Predictors of the therapeutic alliance in group therapy for individuals with treatment-resistant auditory hallucinations

Department of Psychology, University of North Carolina, Chapel Hill, NC 27599-3270, USA.
British Journal of Clinical Psychology (Impact Factor: 1.9). 07/2008; 47(Pt 2):171-83. DOI: 10.1348/014466507X241604
Source: PubMed


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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    • "The prognostic value of the therapeutic relationship therefore seems to be well established, and the challenge is now to determine what factors contribute to the development of a strong therapeutic relationship and what factors might undermine it. In the case of the former, it is known that less severe symptoms (Lysaker et al., 2011; Wittorf et al., 2009), higher levels of insight (Barrowclough et al., 2010; Johnson et al., 2008; Wittorf et al., 2009), and some sociodemographic variables (Bjorngaard et al., 2007) predict a better therapeutic relationship. However, there is relatively less known about those factors that lead to a deterioration in the therapeutic relationship. "
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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 · 1.69 Impact Factor
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    • "Davis and Lysaker (2004), for instance, reported that higher client ratings of therapeutic alliance were linked to poorer memory function in those clients, whereas better performance on tests of visual spatial reasoning was significantly related to therapist report of stronger alliance. Johnson et al. (2008) reported that greater insight, lower autistic preoccupation, and social functioning predicted higher therapeutic alliance among individuals with treatment-resistant auditory hallucinations. Wittorf et al. (2009) also found insight linked to therapeutic alliance. "
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    ABSTRACT: Recent studies have found that clients with schizophrenia rate therapeutic alliance more highly than therapists. Unclear is whether there are clinical characteristics which predict the degree of difference in client and therapist ratings. To explore this, we correlated client and therapist ratings of therapeutic alliance with baseline assessments of positive negative, and disorganized symptoms and awareness of need for treatment. Participants were 40 adults with schizophrenia enrolled in a 6-month program of cognitive behavior therapy. Results indicated that clients produced higher ratings of therapeutic alliance than therapists and that therapist and client general ratings were more disparate when clients had fewer negative symptoms and better insight. Higher overall client ratings of therapeutic alliance were linked to lower levels of positive, negative, and disorganized symptoms and better awareness of need for treatment. Higher overall therapist ratings were linked only to lower levels of disorganized symptoms among clients.
    The Journal of nervous and mental disease 03/2011; 199(3):191-5. DOI:10.1097/NMD.0b013e31820c73eb · 1.69 Impact Factor
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    • "These discussions typically outline a model of stages and predictable changes that occur through the life of the group. While development is generally depicted as a linear progression, findings indicate that often members must revisit previous stages of development prior to moving to a new developmental level (Yoon & Johnson, 2008). There are several empirical studies that have assessed group changes over time. "

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