Article

De therapeutische alliantie als voorspeller van vooruitgang in relatietherapie

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Abstract

De therapeutische alliantie of werkrelatie heeft in de psychotherapie de status ‘gemeenschappelijke factor’ gekregen, vanwege het robuuste verband met de uitkomst van behandelingen. De opdracht voor ons werkveld is nu om een genuanceerder beeld te krijgen van de invloed van de alliantie op de mate waarin tijdens de therapie vooruitgang wordt geboekt. In dit onderzoek is de alliantie gemeten op drie dimensies: (a) de perceptie van partners individueel en het koppel gezamenlijk van hun alliantie met de therapeut (dimensie ‘zelf/groep-therapeut’), (b) de perceptie van cliënten van de alliantie tussen hun partner en de therapeut (‘ander-therapeut’), en (c) de beoordeling van het paar van hun onderlinge alliantie (‘binnen-systeem’). Aan de hand van zelfrapportagedata van 165 volwassen cliënten hebben we geanalyseerd of de scores op deze alliantiedimensies aan het begin van de therapie voorspellers waren voor de, tijdens de behandeling frequent gemeten uitkomsten voor individuele symptomen en relatieproblemen. We vonden dat twee van de alliantiedimensies, namelijk ‘zelf-groep-therapeut’ en ‘ander-therapeut’, aan het begin van de behandeling de helling van de scores op de uitkomstmaten voorspelden. Deze bevindingen bevestigen de uitkomsten van eerdere studies die suggereren dat het vroegtijdig opbouwen van een therapeutische alliantie een belangrijke voorspeller is voor de vooruitgang die tijdens een behandeling wordt geboekt. De verschillen in resultaten tussen de drie alliantiedimensies suggereren dat therapeuten er verstandig aan doen om de verschillende aspecten van de werkrelatie in relatietherapie apart te beoordelen.

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The second edition of The Great Psychotherapy Debate has been updated and revised to expand the presentation of the Contextual Model, which is derived from a scientific understanding of how humans heal in a social context and explains findings from a vast array of psychotherapies studies. This model provides a compelling alternative to traditional research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specific ingredients of treatment. The new edition also includes a history of healing practices, medicine, and psychotherapy, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.
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Reviews and elaborates the psychoanalytic concept of the working alliance. It is argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances (WA) embedded in them. Moreover, the strength, rather than the kind of WA, will prove to be the major factor in change achieved through psychotherapy. Strength of alliance will be a function of the goodness of fit of the respective personalities of patient and therapist to the demands of the WA. The WA includes 3 features: agreement on goals, assignment of tasks, and the development of bonds. (36 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The Integrative Psychotherapy Alliance model brought an interpersonal and systemic perspective to bear on theory, research, and practice on the psychotherapeutic alliance. Questions have been raised about the independence of the theoretical factors in the model and their operationalization in the Individual, Couple, and Family Therapy Alliance Scales. This paper presents results of a confirmatory factor analysis of the scales that delineated at least three distinct interpersonal factors as well as shorter versions of the three scales to facilitate their use in research and practice. The paper also presents the results of a study testing each factor's association with client retention and progress over the first eight sessions in individual and couple therapy. At least two of the interpersonal factors were uniquely associated with progress in individual and couple functioning. Implications of the results for theory, research, practice, and training in individual, couple, and family therapy are elaborated.
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In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
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The complexity of the relation between alliance and outcome in couple therapy was investigated in a study of 47 couples in brief therapy. Self-rated alliance was measured after the first and third sessions using the couple version of the Working Alliance Inventory. The results indicated that the correlation between alliance and outcome was significantly stronger when the partners agreed about the strength of the alliance, when the male partner's alliance was stronger than the female's, and when the strength of both partners' alliance increased as therapy progressed. The authors suggest that a unique feature of couple therapy is that the partners have both a preexisting relationship with each other (allegiance) and an alliance with the therapist to balance.
Article
This study examines the predictive validity of several clinical variables--including marital distress, individual symptomatology, and family-of-origin experiences--on the formation of the alliance in couple therapy. Eighty people who were treated with a naturalistic course of integrative conjoint psychotherapy at a large midwestern outpatient clinic were assessed on the clinical variables before session 1. They also completed ratings of the therapeutic alliance after sessions 1 and 8. Individual symptomatology did not predict alliance formation at either treatment stage. Higher levels of marital distress predicted poorer alliances to treatment between partners at session 1. Marital distress also predicted therapeutic alliance quality for men and women at session 8. Family-of-origin distress predicted alliance quality for men at session 1, and for women at session 8. Family-of-origin distress for men and women predicted split alliances early in treatment, and marital distress predicted split alliances for women at session 8. Clinical implications for the assessment and treatment of couples are discussed.
Article
This study examined the ability of the therapeutic alliance to predict treatment progress on individual- and relationship-level variables from the early to middle phase of couple treatment. Although alliance did not predict progress in individual functioning, it accounted for 5-22% of the variance in improvement in marital distress. Women's mid-treatment alliance uniquely predicted improvement in marital distress, over and above early treatment alliance. When men's alliances with the therapist were stronger than their partners' at session 8, couples showed more improvement in marital distress. Treatment response was also positively associated with women's ratings of their partners' alliance. Results confirm that the therapeutic alliance in conjoint treatment is composed of distinct client subsystems that are useful predictors of treatment progress.
Research-based change mechanisms
  • M L Friedlander
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Monitoring therapeutic change through diversity or simplicity? A conservative, critical confirmatory factor analysis test of a routine outcome monitoring system
  • R Zahl-Olsen
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  • T Tilden
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  • A T Beck
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Internett-basert tilbakemelding i par- og familieterapi: Erfaringer med empiriinformert terapi [Internet-based feedback in couple- and family therapy: Experiences with empirically informed therapy
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Research-based change mechanisms. Advances in process research
  • ML Friedlander
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