Levels and patterns of the therapeutic alliance in brief psychotherapy

Beth Israel Medical Center, Department of Psychiatry & Behavioral Sciences, First Avenue at 16th Street, New York, New York 10003, USA.
American journal of psychotherapy 02/2007; 61(2):109-29.
Source: PubMed


We examined the relevance of the level and pattern of the therapeutic alliance in 44 cases of three different, manualized 30-session treatments using patient ratings of the Working Alliance Inventory after each session. It was hypothesized that both high-alliance level and either a linear increase in alliance rating or a series of brief rupture-and-repair episodes would be found in successful treatments. We also hypothesized that a more global high-low-high pattern predicted in the literature would not be present. Consistent with the literature, higher alliance levels were found to be related to improved outcome. As predicted, we did not find a global, high-low-high pattern. Local rupture-and-repair patterns were found in 50% of the cases; linear trends were found in 66% of the cases. There was no relationship between outcome and either pattern. We found no differences among the treatments.

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    • "e graphically presented in Figure 1 and summarized in Table I : Both the Stiles et al . ( 2004 ) and Strauss et al . methods identified ruptures at session 5 , followed by repairs in session 6 . The Strauss et al . method also identified a rupture at session 16 followed by a repair at 18 , and a rupture at session 21 followed by repair at 22 . The Stevens et al . ( 2007 ) method , which defined a rupture as a drop of at least one point in the WAI between sessions , identified no ruptures because the largest drop ( from session 4 to session 5 ) was . 92 points in magnitude . This finding points to a potential limitation of criterion - based methods : the initial criteria can seem somewhat arbitrary and "
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    ABSTRACT: Analysis of change points in psychotherapy process could increase our understanding of mechanisms of change. In particular, naturalistic change point detection methods that identify turning points or breakpoints in time series data could enhance our ability to identify and study alliance ruptures and resolutions. This paper presents four categories of statistical methods for detecting change points in psychotherapy process: criterion-based methods, control chart methods, partitioning methods, and regression methods. Each method's utility for identifying shifts in the alliance is illustrated using a case example from the Beth Israel Psychotherapy Research program. Advantages and disadvantages of the various methods are discussed.
    Psychotherapy Research 06/2012; DOI:10.1080/10503307.2012.693772 · 1.75 Impact Factor
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    • "Traditionally, therapeutic alliance measures such as WAI and CALPAS (including in the observer versions), which evaluate the therapeutic alliance at a macrolevel, seem more suitable for assessing therapeutic alliance as a general factor related to the outcome than for ''depicting the idiosyncratic interactional patterns that unfold between patient and therapist'' (Charmann, 2004, p. 18). Because these measures can only study shifts between sessions rather than within the session itself, some rupture events may go undetected (Stevens et al., 2007). In short, these methodologies ''described shifts in alliance but did not directly examine in-session transactions. "
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    ABSTRACT: As we enter a new era of scientific evaluation and acceptance of Freud's ideas, psychodynamic practitioners need to be aware of the most valid and clinically useful findings relevant to their everyday work with patients. This handbook meets that need by integrating the best contributions of the clinical psychoanalytic literature with the latest generation of clinical-quantitative research, and translating these findings into pragmatic clinical wisdom about what works and what doesn't. In twenty-six chapters, forty-nine leading authorities and clinical-researchers discuss what is known about selecting patients, defining treatments, and measuring key processes and outcomes. This comprehensive volume not only offers the clinician the latest in psychodynamic research and thinking but can guide those who wish to shape their clinical hypothesis into a study. By reviewing the central clinical concepts and techniques of psychodynamic psychotherapy and by providing the necessary empirical documentation to support their validity and clinical relevance, "Psychodynamic Treatment Research" makes an important contribution to mapping out the future of therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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