The development of the therapeutic working alliance, patients' awareness and their compliance during the process of brain injury rehabilitation
ABSTRACT To examine the development and interaction of the therapeutic alliance, patients' compliance and awareness during the process of brain injury rehabilitation and the role of demographic and injury related variables in this process. Subjects were 86 patients who underwent a holistic neuropsychological outpatient rehabilitation programme. Patients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10).
The therapeutic alliance between clients and their primary therapists, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists.
The development of the process measures over time is described in the article. Clients' and therapists' perspectives on their alliance tended to converge over time. Clients' experience of their emotional bond with their therapist added as much to the prediction of clients' awareness as the localization of their brain injury. Clients' awareness was related to their compliance and mediated the impact of the therapeutic alliance on their compliance.
A good working alliance is the basis of successful rehabilitative work. The article discusses therapeutic implications of the results.
- SourceAvailable from: Jonathan G Tubman
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- "Future studies are needed that examine the generalizability of the findings of the current study among more diverse samples of youths. While the findings of the current study are congruent with some existing treatment process research identifying significant conceptual and empirical overlap among the therapeutic alliance, working alliance, and client involvement constructs, other studies have conceptualized these constructs as distinct (hartley & Strupp, 1983; hogue et al., 2006; Principe, Marci, Glick, & ablon, 2006; Schönberger, humle, & Teasdale, 2006). although the current study identified substantial covariation among treatment process constructs, longer taped segments of therapist-client interactions might have contained sufficient additional information for observers' ratings to make distinctions among the three constructs. "
ABSTRACT: This study documents significant differences in alliance in a predominantly Latino sample of adolescents who either completed or dropped out of a Guided Self-Change treatment program. Therapeutic alliance, working alliance, and patient involvement were assessed via ratings of audio-recorded segments of participants’ counseling sessions. Descriptive discriminant function analysis identified working alliance goals, patient participation, and therapist warmth and friendliness variables as significantly predictive of completion status. These results were confirmed via follow-up logistic regression analyses. The use of brief clinical tools to monitor and manage alliance among adolescents receiving treatment who are at risk for dropout is discussed.Journal of Child & Adolescent Substance Abuse 01/2012; 21(1):51-68. DOI:10.1080/1067828X.2012.636697 · 0.62 Impact Factor
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ABSTRACT: During intensive neurorehabilitation, it is a professional challenge that patients with severe traumatic brain injury may have changed abilities to learn. To develop, initially test, and evaluate a model for neurorehabilitation aimed at systematizing and facilitating professionals' efforts of promoting patients' participation and learning. Qualitative study inspired by action research. Empirical data were analyzed by a theoretical framework of "didactic relation model," "situated learning theory," and neurophysiologic/neuropsychological categories of learning premises. Our findings indicate that the model for neurorehabilitation expands and systematizes the professional's reflections and interventions aimed at facilitating learning among patients with traumatic brain injury.ANS. Advances in nursing science 01/2011; 34(1):E1-E17. DOI:10.1097/ANS.0b013e318209b01a · 0.87 Impact Factor