Article

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

ABSTRACT 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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    • "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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