Science topic

Therapeutic Alliance - Science topic

Explore the latest questions and answers in Therapeutic Alliance, and find Therapeutic Alliance experts.
Questions related to Therapeutic Alliance
  • asked a question related to Therapeutic Alliance
Question
3 answers
I`m conducting the translation of a very short scale of 12 ítems to assess therapeutic alliance in children. I have 61 answers and I wonder if that number of subjects it`s acceptable to run Exploratory Factor Analysis. I know that there is a suggestion of 5 participants for item to do EFA and 10 participants for item to do CFA. However, the number of participants here seem to be very smal for these analysys. What it´s your opinion?
Relevant answer
Answer
Hello Leandro,
The vague answer is, more cases is generally better than fewer cases. There are two reasons:
1. The factor model you seek must, ideally, be capable of providing good estimates for the (12*11/2 =) 66 unique observed relationships among your 12 variables (here, item scores). That's a lot to ask of 61 cases.
2. In general, the smaller the N of cases, the more volatile are the observed relationships among the variables from sample to sample. Hence, the less likely that your sample data will accurately represent the correlations that may exist in the population. As these correlations are what the EFA is intended to account for, if they are incorrect then you likely will identify a factor model that does not generalize well to the population. The literature is full of studies in which one set of authors using a small or modest sample claims their EFA shows "different" results than those from another set of authors, even if ostensibly drawing from the same population.
Can you still proceed? Yes, of course--the numbers won't leap up from your data file and protest! However, do be mindful that: (a) guidelines such as "at least 100 cases" and "10-20 cases per variable" for EFA abound; and (b) you likely would want to characterize your results as tentative or exploratory, rather than as a definitive solution to the question of the true factor structure.
Good luck with your work.
  • asked a question related to Therapeutic Alliance
Question
4 answers
Hi! I've reviewed the literature about developing therapeutic alliance with children but I couldn't find any article about at which session therapist and child started to develop therapeutic alliance. If you have any article suggestions related to that topic, I will be so glad
Relevant answer
  • asked a question related to Therapeutic Alliance
Question
4 answers
My systematic rewiew is about the therapeutic alliance in minorities, however the results in Publmed are not congruent with research, The Pubmed is the right database?
Relevant answer
Answer
best wishes Susana Couto
  • asked a question related to Therapeutic Alliance
Question
19 answers
The current pandemic is a huge challenge for mental health care providers for several reasons:
  • there will be an increase in treatment provision due to anxieties and uncertainties in the general population,
  • many community care services have been shut down or completely closed in response to public health instructions,
  • some people with mental disorders are not able to adhere to public health restrictions,
  • most clients live in the community nowadays and their mental health needs and their basic needs must be met,
  • the provision of mental health care in general and the therapeutic alliance in particular is difficult to do while adhering to infection control (masks, gowns etc.),
  • mental health care providers across the western world have been unprepared for the current situation - similar to the rest of public and private institutions.
To gather and to share information, documents and links (e.g. guidance, recommendations), Bern University Hospital for Mental Health, Switzerland, has set up a website that collects useful information, currently in German, English and French.
If you are interested in collaborating and discussing the best way to conduct mental health care during the crisis, please visit our website and/or respond to this post.
Regards,
Dirk Richter
Relevant answer
Answer
Dear all, many thanks for your contributions. What concerns me most in these days, is the dilemma we have to solve between infection control and therapeutic alliance. On one hand mental health services are part of the entire (public) health system that works in order to contain or to mitigate the virus spread. On the other hand, I have the impression that we haven't got a real solution for how to conduct person-centered care given the restrictions in daily life and in psychiatric settings. And we have to be aware that this situation will probably last for months, if not years according to the latest simulation study
In addition, I hear from across Europe that service users now try to avoid mental health care services and institutions. By not having sufficiently staffed and equipped outreach resources, there is a risk that service users become abandoned at home while being isolated, lonely and suffering from anxiety. Inpatient care, however, is not an adequate alternative at the moment, I guess. There you will face restrictive environments and, more importantly, a higher risk of becoming infected. New data from EU countries show that about fifty percent of deaths happen in care homes, especially care homes for the elderly.
Once the virus is inside the institution, you have a real problem. And a lot of hospitals and care homes have already been closed due to high infection rates of both, service users and staff.
Any ideas for possible solutions?
Best,
Dirk
  • asked a question related to Therapeutic Alliance
Question
16 answers
I'm attempting to write a lit-review on issues/benefits (assumptions, biases, resistance, counter transference, etc.) found specifically in a therapeutic alliance between a therapist and therapist-client. But I haven't found any literature or research regarding this question. Admittedly, this topic may be to broad to write a lit-review, thus any help would be greatly appreciated!
Relevant answer
Answer
A lot of good literature above, but going back to the basics. Some therapists misdiagnose themselves due to UTE, they need another therapist. As a therapist, I try to get 2-3 therapy every month to avoid burnout because my clients trauma may be vicarious, depressive states due empathy. We have the guidelines, but we are just as human as our clients e.g. An subconscious thought process we may be unaware of may set in, and in many couples therapy, where one partner is a therapist will come with the notion they know what the problem i.e. the other partner, it does good as a therapist to get therapy once in a while. It may be at times difficult to have a therapist as a client, just avoid intellectualizing during therapy.
  • asked a question related to Therapeutic Alliance
Question
13 answers
Looking at Anorexia Nervosa - the evidence base for CBT's effectiveness is inconclusive. Though, I was thinking before about the link between Anorexia and emotions (not being able to express / experiencing negative emotions - and partly "using" food restriction as a way to control these) - let's say a strong therapeutic bond is formed, and an individual feels comfortable discussing extraneous feelings / thoughts - could this help with the need for food as a control mechanism and aid recovery in some way..
Not sure there is much evidence on this though.
Any thoughts?
Relevant answer
Answer
Yes, there isn't conclusive evidence to support the efficacy of CBT for Anorexia Nervosa. In general, CBT, family-based treatment, and interpersonal therapy for eating disorders.
These articles may interest you:
  • asked a question related to Therapeutic Alliance
Question
7 answers
I need to quote some critics to Bordin´s model of therapeutic alliance. There is any paper for recommend?
Relevant answer
These researchers are here on RG. Discuss the topic with these experts:
Revisiting Bordin's Theory on the Therapeutic Alliance: Implications for Family Therapy
  • June 2002
  • Contemporary Family Therapy 24(2):257-269
  • DOI:
  • 10.1023/A:1015395223978
  • 📷Lee N Johnson
  • David W. Wright
  • asked a question related to Therapeutic Alliance
Question
5 answers
as you know every psychological approaches have its own description of therapeutic alliance tensions. Although a general view point of alliance is important, I think for repairing and managning it we need a especific approach.
thanks
Mojgan
Relevant answer
Answer
Mojgan:
To give you a general sense of the study, here is the summary from the grant:
Over 1 million Canadians use psychotherapy each year to alleviate their mental health problems. Psychotherapy is highly efficacious, and several therapeutic approaches are equally effective (cognitive, interpersonal, psychodynamic) for common disorders (depression, anxiety). Common therapy factors like establishing a therapeutic alliance are related to positive patient outcomes. However, there is a well-documented gap between practice and research in psychotherapy. To address this gap, we developed the Psychotherapy Practice Research Network (PPRNet; www.pprnet.ca) to engage therapists and researchers in practice-based patient-oriented research. PPRNet initiated a deliberative priority setting process in which over 1000 therapists ranked their top research priorities that included: (1) identifying and repairing therapeutic alliance tensions, and (2) professional development. This proposal is the next step of this collaborative process. Therapeutic alliance is one of the most researched and important therapist practices that is robustly related to patient outcomes across all psychotherapy modalities. Tensions in the alliance (breakdowns in the collaborative relationship between patient and therapist) are reliably associated with poor patient outcomes. OBJECTIVE: to evaluate the effectiveness of professional development training designed to improve therapists’ skills to detect and repair alliance tensions. OUTPUTS: (1) training will increase therapist competence to detect and repair alliance tensions; and (2) increased therapist competence will improve patient mental health outcomes. HYPOTHESES: compared to therapists in the control condition who receive no intervention, therapists who do receive the professional development intervention will: (1) show greater competence in detecting and repairing alliance tensions; (2) have patients who experience better outcomes; (3) report greater self-efficacy in detecting and repairing alliance tensions; and (4) have greater increase in patient and therapist reported alliance during psychotherapy. This study will use a cluster randomized trial design, with patients clustered within therapists. Therapists will be assigned to study condition with 1-1 allocation to compare: (1) therapists (n = 40) who receive a professional development intervention to identify and repair alliance tensions to (2) therapists (n = 40) who do not receive the intervention. Therapists will each recruit 7 new patients that will be seen for at least 6 psychotherapy sessions (N = 560 patients). Therapists’ competence in identifying and repairing alliance tensions will be assessed by reliable trained blind judges using a valid observer-based rating system to assess audio recordings of the psychotherapy sessions. Patient outcomes will be assessed by patient and therapist self-report at baseline, post-study period, and at follow-up. Knowledge translation will be informed by qualitative analysis of post-study interviews with therapists, and knowledge dissemination will be facilitated by our existing network of therapists. Our team represents Canada’s leaders in psychotherapy research and training. Co-applicants developed the evidence-based learning modules to identify and repair alliance tensions. Research to improve practicing therapists’ ability to identify and repair therapeutic alliance ruptures will result in better mental health outcomes for the many Canadians who seek psychotherapy each year.
As for the actual therapist training, here is a summary:
The professional development
intervention is an educational program constructed on evidence-based methods, which was developed
and published by members of our team (Ravitz & Leszcz). The intervention teaches therapists to
make the most of psychotherapeutic relationships, including: methods to successfully form an alliance,
using meta-communication, mentalizing, and identifying and repairing alliance tensions. Alliance
tensions may be detected when there is a disagreement on tasks or goals of psychotherapy or there is a
strain in the relational bond between therapist and patient. Interventions to repair tensions include:
repeating the therapeutic rationale, changing tasks or goals, clarifying misunderstandings, or exploring
relational themes.
The professional development consists of case-based descriptions and DVDs
with role plays by experts and standardized patients. These are state of the art methods of education
practice based on quality evidence and recommendations from systematic Cochrane Reviews. We
will conduct 2 separate 2-day workshops for therapists randomized to this condition. The workshops
will occur prior to therapists recruiting patients. Following the workshop and after the therapists enroll
their first patient, the therapist will attend monthly 2-hour virtual or face to face supervision meetings
with up to 10 therapists at a time and led by one of the trainers. Therapists will end supervision when their patients complete the trial (if necessary,
number of supervisions attended may be controlled in the analyses). Independent reliable trained judges
will rate audio recordings of each psychotherapy session for alliance tensions and repairs. These
ratings will be used by the supervisor/trainer to focus the supervision meetings, to provide feedback to
therapists, and to ensure adherence/fidelity to the model.
I hope this gives you the information you were seeking.
Best wishes,
John
  • asked a question related to Therapeutic Alliance
Question
4 answers
We are interested in studying the efficacy of the therapeutic relationship in ICBT interventions for internalizing problems in children and adolescents
Relevant answer
Answer
Nexhmedin Morina, thank you for your help.
  • asked a question related to Therapeutic Alliance
Question
8 answers
I am currently in early stages of qualitative research design in the areas of perceptions and exploration of older adults . I am looking at investigating older adults with personality disorders and their experiences with Schema therapies to learn how as therapists we may then correlate it to younger patients in the life span and in addition enhance older patients quality of life
I am look to incorporate Delphi technique, qualitative questionnaire , focus groups and discussion
your thoughts in an area that is not well developed are valuable to a proof of concept or initial paper on the area of enhancing therapy for older patients and of course applying it to younger patients .
regards
Gary Darbyshire
MMgmt , MstratMktng, GradDip-CouPsych
Relevant answer
2018 free paper:
Adolesc Health Med Ther. 2018; 9: 199–210.
Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies
Jean Marc Guilé,1,2,3 Laure Boissel,1,2 Stéphanie Alaux-Cantin,1,2 and Sébastien Garny de La Rivière1
  • asked a question related to Therapeutic Alliance
Question
6 answers
In therapy of personality disorder , How far down in the super ego can we go to re initiate change in client therapy .What is the new divide in experiential therapy.
Please enlighten us ..
Please enlighten us .
Cheers
Gary Darbyshire MMgmt MstratMktng
Masters Student in Psychotherapy.
University of Southern Queensland ( USQ )
Relevant answer
Answer
What a fabulous question Gary. Sorry I don't know the answer.
  • asked a question related to Therapeutic Alliance
Question
18 answers
I am interested to find subtle differences in presentation and other symptoms of older people with borderline personality disorder ( bpd )
As I continue my research and build my knowledge in this area I find it curious that not more work has been done in this area which would greatly assist the therapist whether they be a psychologist or counsellor in the areas of understanding the mind of an older person and therapies to assist the client more holistically in therapy
I am curious to understand if there is possible new presentations of BPD in older age , as was the case in myself as a patient the possibility symptoms that otherwise would not appear earlier .
Or are we to assume that older people have had BPD from a younger age ?
Interested in your thoughts in this area as I increase my knowledge my masters in Counselling ( Mental Health practices) at the University of Southern Queensland
Kind regards
Gary Darbyshire MMgmt MStratMktng ACA ( Australian Counselling Association) student member.
Relevant answer
Answer
I have to admit that I have not undestood everything claimed by you in your question. The problem of the presentation of BPD symptoms in older patient is interesting and I would like to give you some hints:
- I dont think that you can find BPD symptoms in a patient that never showed signifiants psychiatric symptoms, someway suggesting a Personality Disorder. A personality disorder has a longtime history.
- there is a consensus that BPD sympotms can become milder in old age.
- It can happen in my opinion that a personality disorder like BPD can adapt himself very well under certains conditions of his life and show a severe maladjustment symptomatology in other circumstances.
  • asked a question related to Therapeutic Alliance
Question
18 answers
Are you familiar with work that examines the effect of humor on therapeutic alliance and ruptures? client mentalizing? other outcome measures?
Alternatively, can you point me to a clinician's description of his or her use of humor in therapy?
Relevant answer
Answer
I recommend the following articles:
Franzini, L. R. (2001). Humor in therapy: The case for training therapists in its uses and risks. The Journal of general psychology, 128(2), 170-193.
Dziegielewski, S. F. (2003). Humor: An essential communication tool in therapy. International Journal of Mental Health, 32(3), 74-90.
Sultanoff, S. M. (2013). Integrating humor into psychotherapy: Research, theory, and the necessary conditions for the presence of therapeutic humor in helping relationships. The humanistic psychologist, 41(4), 388.
Scott, C. V., Hyer, L. A., & McKenzie, L. C. (2015). The healing power of laughter: The applicability of humor as a psychotherapy technique with depressed and anxious older adults. Social Work in Mental Health, 13(1), 48-60.
Yonatan-Leus, R., Tishby, O., Shefler, G., & Wiseman, H. (2017). Therapists’ honesty, humor styles, playfulness, and creativity as outcome predictors: A retrospective study of the therapist effect. Psychotherapy Research, 1-10.
Fox, L. E. (2016). The Use of Humor in Family Therapy: Rationale and Applications. Journal of Family Psychotherapy, 27(1), 67-78.
  • asked a question related to Therapeutic Alliance
Question
1 answer
I am looking for scales on therapeutic relations or alliance that have been standardised and used with Greek participants and have been administered in Greek.
Relevant answer
Answer
Look for the source who said about peace before Troyan War. Paris theft Helen on Feast after the Alliance.
  • asked a question related to Therapeutic Alliance
Question
7 answers
I am researching resistance in therapy by comparing the strength of the therapeutic alliance between "resistant" clients and mental health counselors vs "resistant" clients and art therapists. I am already using the STAR to measure alliance, but am looking for a way to quantify "resistance" to help therapists identify clients for the study.
Relevant answer
Answer
If you are interested in the patient-therapist relationship, that should be the focus. It places or emphasises the dynamic relationship between "the two frightened people in the room" (Wilfred Bion.) I am from a psychoanalytic background and thus will perceive this question in a very different way. Since the relationship is the single most important factor in psychotherapy, regardless of whether it is CBT, psychoanalytic, etc we look at the moment-by-moment happenings in a session.
We would begin with a single case study which would be repeated again and again in order to build up clinical knowledge of what takes place between the patient and therapist and only after multiple studies can we begin to generalise. The work of RD Hinshelwood would be very important here. Hinshelwood is a British Kleinian whose work has included single case studies as a viable format.
You might also enquire into the work of Lester Lubosky and Paul Crits-Christoph who deveoped a "manualised" system which might be helpful to you. I know the Menniger Clinic has done a great deal of work through Lubosky's ideas - although there are those who are critical because of the assumptions he makes - we all make assumptions!
I am somewhat puzzled by your reference to "resistance" and "challenging". All patients are challenging in one way or another. Similarly, therapists are also challenging to the patient! We (I) do not necessarily respond in the same way to all patients; it is dependent on my understanding of the patient.
It is also the question of how you understand "resistance." There are many reasons for "resistance" in a patient, including defence mechanisms which require the therapist to understand. This is especially important because in some patients, breaking down a resistance too soon could lead to a "break-down." That is, either the patient's vulnerability is too overwhelming; or the break-down in the relationship itself.  Understanding the meaning of "resistance"or how you define resistance is therefore important. I am uncertain as to what you mean; and it can also seem to be something that is objectively problematic, rather than a normal part the therapeutic relationship. Can "resistance" be objectively described? Can the therapist aslo be "resistant"? I think that is also possible.
I am concerned about how human relationships can be "generalised" in such a way that we forget that the therapist is not objective in a way that scientific methodology is objective. To give an example, in the UK, which is where I was trained, psychoanalytic or psychodynamic models have to be "manualised" else there is no NHS (National Health Service) funding. Some very accomplished psychoanalysts like Prof. Peter Fonagy and Prof. Alessandra Lemma etc have developed "manualised" versions of "mentalisation" and also developed "Dynamic Internpersonal Psychotherapy (DIT) which means than non-psychoanalytic clinicians or even non-therapists eg nurses can follow a manualised format. It was done on the basis that preserving psychodynamic therapy in the NHS is better than nothing.
Nevertheless, the idea we can or should manualise or generalise involves philosophical questions as well. There will always be natural incompatibilities between patient and therapist, but the question is whether both parties are sufficiently committed to work at the relationship. It has been my experience that working through these "break-downs" are far more important and can lead to the patient (and therapist) really gaining insight into their relationships outside the consulting room. Since the concept of transference is crucial, these working-throughs in therapy are taken "outside" by the patient.
For me, understanding why is there an impasse is vitally important. The patient could be "diagnosed" as being "resistant" but I believe it is far more complex. Another question that comes to mind is how do you recognise and isolate "resistance"?
Sorry if this is unhelpful to you, but I am fascinated by your study.
Kind regards,
Ros
:
";
  • asked a question related to Therapeutic Alliance
Question
23 answers
Endogenous is in DSM - I am interested to find out about the psychological impact of having this diagnosis, is there correlation to brain or body?  What interventions are available? Any research in relation to this diagnosis.
Relevant answer
Answer
Hi Maureen,
The individual (or group) psychotherapy intervention for the treatment of depression with the strongest empirical evidence is called Behavioral Activation; this is the "active ingredient" in Cognitive Behavioral Therapy. If you review the scientific literature, you will find it is as effective as medications at treating depression and more effective at preventing relapse. FYI, while there are undoubtedly cases where it makes sense to consider a purely biological source of depression (e.g., thyroid or brain disease) and to treat the underlying medical condition accordingly, there are compelling reasons to question the medical model of depression as simply reflecting a neurotransmitter imbalance (you can read more in the link below). Also, it may be worth considering that "having" everything doesn't necessarily result in fulfillment; for many (all?) people greater satisfaction is to be found in what you are "giving" through purposeful activity guided by personal values (check out the literature on Acceptance and Commitment Therapy, which combines behavioral activation, mindfulness practice, and values clarification to treat depression).
Warm regards,
Paul
  • asked a question related to Therapeutic Alliance
Question
11 answers
We are interested in studying the predictive value of therapeutic alliance for acute and  enduring therapeutic effects of a medicine-assisted psychotherapy.
Relevant answer
Answer
Dear Mendel,
The following resources may help:
  • Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research by Rita B. Ardito and Daniela Rabellino reviewed the most common alliance measures available in literature for adult psychotherapy in Table 1.
  • In Therapeutic Alliance as a Measurable Psychotherapy Skills, Summers and Barber reviewed the Penn Helping Alliance, the Working Alliance Inventory, and the CALPAS.
  • asked a question related to Therapeutic Alliance
Question
22 answers
Good evening..
I am working on a project and am looking for information on how clinical psychology supervisors can assist supervisees in approaching pt emotions instead of avoiding. Any information on teaching how to identify pt emotions, mindfulness of pt emotion, and increasing comfort in approaching pt emotion will be helpful. I am interested in how supervisors can assist supervisees with their therapeutic alliances with pts.
Thank you, Research Gate community!
Relevant answer
Answer
In my training of students, we use many strong elements from David Burns' TEAM model and the second element of TEAM after Testing, is Empathy. We work on that continuously as they interview patients and practice active listening.  The mantra that we focus on and repeat over and over again is "Let the Ego Go".  You can't truly show empathy for another if you are, often in the background, focused on yourself, your anxieties, trying to look professional, etc. Learning to Let the Ego Go, and to free yourself up to actually show emotion, the echo of the patient's emotion, is the key, I think. When I watch videos of their interviews, we emphasize this issue in both personal and group supervision.  I think in-depth discussions and exercises where they have to think about their own reasons for going into counseling that are often NOT discussed such as feeling superior and wanting to "help" others, or trying to fix their own problems, or because they feel proud and have been told repeatedly that they are good listeners, etc. is also really important.  Burns has a great list of Self-Defeating Beliefs that we also use as part of this discussion of letting the ego go.  We also talk about countertransference reactions and how the natural tendency is to back away or avoid strong emotions, especially negative emotions like guilt, shame, pain, sorrow -- but that professionals, just like firefighters rushing into a burning building, learn to move toward the emotion, not away from it.  
  • asked a question related to Therapeutic Alliance
Question
18 answers
From any theoretical orientation & not necessarily specific to DSM categorization.  Also, curious about any take on the impact of the therapist personality on the therapeutic relationship.
Relevant answer
Answer
There's a really interesting approach by Italian authors: Colli, A., Tanzili, A., Dimaggio, G., Lingiardi, V. (2014). Patient Personality and Therapist Response: An Empirical Investigation. American Journal of Psychiatry, 171(1), 102-108
  • asked a question related to Therapeutic Alliance
Question
4 answers
Interested in any exploration of the dimension of friendship in the therapeutic relationship.  This may include considerations of intimacy and mutuality, but I'm particularly interested in explicit considerations of "friendship" in this context.
Relevant answer
Answer
Hi John, I know a text by Derrida referring to French philosopher Montaigne:
Derrida, J.; Montaigne, M. de (2000): Über die Freundschaft, Frankfurt (Suhrkamp).
However, I do not know if it is available in English. It's worth reading!
What I know, then, is:
Greenwood, Alice (1998): Accommodating Friends: Niceness, Meanness, and Discourse Norms, in: Hoyle, Susan M. / Adger, Carolyn Temple (Hrsg.). Kids talk. Strategic language use in later childhood, New York, Oxford University Press, S. 68–81.
Schofield, W. (1964): Psychotherapy, the Purchase of Friendship, Englewood Cliffs (Prentice Hall).
Shechtman, Z. (1991): Small Group Therapy and Preadolescent Same-Sex Friendship, in: Int. J. Group Psychotherapy 41, S. 227–243.
Shechtman, Z. (1994): Group Counseling/Psychotherapy as a School Intervention to Enhance Close Friendships in Preadolescence, in: Int. J. Group Psychotherapy 44, S. 377–391.
Tannen, Deborah (2005): Conversational style. Analyzing talk among friends, New York (Oxford University Press).
Traverso, Véronique (2009): The dilemmas of third-party complaints in conversation between friends, in: Journal of Pragmatics 41, S. 2385–2399.
This is a mixture of psychotherapeutic essays and research on friendship. I hope it makes some use for you.
Best
Michael
  • asked a question related to Therapeutic Alliance
Question
6 answers
I'm interested on anything current or seminal on "self-agency" from various schools within the psychoanalytic, cognitive-behavioral & humanistic traditions. Anything from conceptual treatises to empirical investigations. I'm interested in how relevant self-agency is considered for well-being and how change in self-agency is effected from various perspectives.  Anything on method & measurement in addition to clinical theory.
Relevant answer
Answer
Chris
Not quite clear what you are looking for but I will tell you what I know. First, regarding “agency.” Are you interested in clients’ experience of agency? Or in the fact that they act agentically? They could act agentically without explicitly perceiving or experiencing themselves as being agentic. For instance, I have considered David Rennie’s qualitative studies as having demonstrated client agency in terms of action (so did David). But there was no explicit attempt to measure or even to ask clients if they were feeling agentic at the time. Second, I’m not sure if you mean something different by self-agency from agency per se.
            I’ve summarized evidence suggesting that clients act agentically in therapy. Most of it is qualitative and does not explicitly link to outcome, although I think you can infer a link. I will attach two chapters that summarize evidence. Both are page proofs so probably you shouldn’t quote directly, but the content is the same as is what is in the final chapters. The Bohart & Wade chapter is in the recent Handbook of Psychotherapy and Behavior Change. The Bohart & Tallman is in M. Cooper, J. C. Watson, & D. Hölldampf (Eds.), Person-centered and experiential therapy work: A review of the research on counseling, psychotherapy and related practices (pp. 91-133). Ross-on-Wye: PCCS Books.
            As far as the experience of agency, there is less. One study I know of is Hoener, Stiles, Luka, & Gordon, (2012). That is cited in both chapters, although mis-cited in Bohart & Tallman (2010) as “Hoerner” (I mis-spelled her name; it is Hoener, and in that chapter it is her conference presentation that is cited).
Art
  • asked a question related to Therapeutic Alliance
Question
3 answers
Any data on therapist actual use of the CST manual and whether it was found to be beneficial or useful by clinicians?  I'm interested in data beyond the value of feedback regarding progress on the OQ (Outcome Questionnaire) and regarding reasons for poor progress on the ASC (Assessment for Signal Clients: alliance, motivation, social support, life events).
Relevant answer
Answer
My  experience is somewhat tangential using an adapted CST as part of a feedback system that used different outcome measures but used the ASC routinely.
I am convinced that the overall clinical setting and the mindset of clinicians and managers are vital variables here as is the patient population. I think that in the UK, at least there has been a drift away from clinical psychologists seeing themselves individually as active researchers but this does not mean that they have necessarily become good users of research even such eminently practical research as exemplified by Mike's work. Furthermore there has been a cultural dilution with the advent of psychological therapists without a scientific background.
While our forthcoming paper (Lucock et al.) and indeed the Pychotherapy Research Special issue (2016?) should give you some hard data, my belief is that the way ahead is more about developing cultures (where therapists are receptive to feedback and accept that when things are not going well they need to stop think and go in another direction) [I have just been moving my rather large van in a rather confined space!] rather than systems. Systems are great but they can only function in the right culture. lambert himself spoke on this at SPR Barcelona but I am not sure how much the negative data gets published.
If the CST is to work it probably needs to be an interactive device that pulls and pushes the therapist into changing direction trying new tactics getting help and advice and using other resources. Of course good supervision or the combination of CST supervision and outcome data could do this. We also need therapists who are prepared to carry on working when they are out of their comfort zone and statistically are more likely to produce less results than if they abandon the client and move onto someone else who is easier to work with. ie a system that rewards persistence and flexibility.
  • asked a question related to Therapeutic Alliance
Question
6 answers
I need comparison of CALPAS, WAI, Haq, VTAS, VPPS, TARS, TBS. 
Relevant answer
Answer
You're welcome.  Let me know if you need anything more as I (& know others who) have some experience with many of these measures.
  • asked a question related to Therapeutic Alliance
Question
11 answers
Any research on patient personality disorder as it impacts patient-therapist interactions or the therapeutic alliance since 2010.
For example: Tufekclioglu, S., Muran, J.C., Safran, J.D., & Winston, A. (2013). Personality disorder and early therapeutic alliance in two time-limited therapies. Psychotherapy Research. 
Relevant answer
Answer
Thank you, Adriano, for your thoughtful comments, & best wishes for the new year, Chris
  • asked a question related to Therapeutic Alliance
Question
6 answers
Anyone aware of new research on problems or difficulties in the therapeutic relationship, alliance ruptures, therapeutic impasses, treatment resistance, patient-therapist hostility? Anything since the attached review/meta-analysis (Safran, Muran, & Eubank-Carter, 2011)?
Psychotherapy Relationships That Work: Evidence-Based Responsiveness, 2 edited by J.C. Norcross, 05/2011: chapter Repairing Alliance Ruptures: pages 224-238; Oxford University Press, New York, NY., ISBN: 0199737207
Relevant answer
Answer
Hello John,
check these out:
  • Haskayne, D., Larkin, M. and Hirschfeld, R. (2014). What are the Experiences of Therapeutic Rupture and Repair for Clients and Therapists within Long-Term Psychodynamic Therapy?. British Journal of Psychotherapy, 30: 68–86. doi: 10.1111/bjp.12061 http://onlinelibrary.wiley.com/doi/10.1111/bjp.12061/full
  • Gerostathos, A.; de Roten, Y.; Berney, S.; Despland, J-N.; Ambresin, G. (2014). How Does Addressing Patient’s Defenses Help to Repair Alliance Ruptures in Psychodynamic Psychotherapy?: An Exploratory Study. Journal of Nervous & Mental Disease, 202(5), 419-424. doi: 10.1097/NMD.0000000000000112 ...and many more by JN Despland: https://www.researchgate.net/profile/Jean-Nicolas_Despland/publications
  • Cash, S. K., Hardy, G. E., Kellett, S., Parry, G. (2014). Alliance ruptures and resolution during cognitive behaviour therapy with patients with borderline personality disorder. Psychotherapy Research, 24(2), 132-45. doi: 10.1080/10503307.2013.838652
  • Altenstein, D., Krieger, T., Grosse Holtforth, M. (2013). Interpersonal microprocesses predict cognitive-emotional processing and the therapeutic alliance in psychotherapy for depression. Journal of Counseling Psychology, 60(3), 445-452.  doi: 10.1037/a0032800
Also, these two reviews could be of help:
  • Baillargeon, P. , Coté, R. & Douville, L. (2012). Resolution process of therapeutic alliance ruptures: A review of the literature. Psychology, 3, 1049-1058. doi: 10.4236/psych.2012.312156. http://file.scirp.org/Html/25454.html
  • Degnan A., Seymour-Hyde A., Harris A., Berry K. (2014). The role of therapist attachment in alliance and outcome: A systematic literature review. Clinical Psychology & Psychotherapy, doi: 10.1002/cpp.1937.
Edit:
I've just found one more. It's in French though, but has an extended English abstract:
  • Bouvet, C., Cleach, C. (2011). [Early dropout patients in psychiatric psychosocial rehabilitation treatment and their bindings with relational skills, object relation and intensity of psychopathology]. L'Encéphale, 37, Suppl 1, S19-26.
  • asked a question related to Therapeutic Alliance
Question
4 answers
Third wave CBT can for example be less symptom focused, which may be beneficial for comorbid clients. I'm interested in anything surrounding this, but especially whether the therapeutic alliance is (positively) affected by the third wave approach?
Relevant answer
Answer
Not much in the form of research.  Good chapters on the therapeutic relationship in DBT & ACT in the edited book The Therapeutic Relationship in the Cognitive Behavioral Therapies (Gilbert & Leahy, 2007).  Our own research (funded by NIMH) includes investigating the impact of mindfulness training for therapists on the interpersonal process in a CBT for PDs (I posted a recent presentation of preliminary results on my profile page, more to come),
  • asked a question related to Therapeutic Alliance
Question
79 answers
We all know that good therapeutic relationship is associated with better psychotherapy outcome. I have a simple question, some theoreticians/clinicians and researchers suggest that the therapeutic relationship is curative on its own. As I have tried to study that question I am interested to hear people thoughts on what about the relationship is curative and how does that work?
Relevant answer
Answer
Hi Juergen, Thanks for your useful clarifications. I agree, I think that the distinction that Jacques is posing is between the quality of the therapeutic relationship as important in promoting a process of change or the relationship itself as integral to that change. So one might think that a good alliance between therapist and patient/client would encourage trust, understanding and identification. These qualities might lead the patient to be more open to accept suggestions by the therapist or to be motivated to undertake exercises or study. However, in my work I'm more interested in the way that entering into the relationship itself becomes part of the mechanism of change.
Winnicott has written usefully about this. In 'Fear of breakdown' he describes how the patient's difficulties arise from a fear that something will happen that will destrroy his or her sense of self. In order to prevent this catastrophe, the patient will adopt various defensive strategies to isolate and repudiate the feared thoughts. Winnicott's insight is that this breakdown has in fact already occured. The individual as an infant experienced that catastrophe in the form of a failure of his or her environment to respond in sufficient time to their need. At that time the infant lacked the ability to deal with the failure. A defensive structure was then established, what WInnicott calls a False Self, which lays a pattern for future living and relating.
Winnicott suggests that optimally the patient will experience a similar and inevitable failure in the therapeutic relationship. (As no relationship can be perfect.) However, this time the patient as an adult, and with a facilitative therapist, can re-experience that earlier trauma and grow beyond the earlier defensive structures. An earlier relationship contained a trauma that could not be experienced, was frozen or sealed off and because it was thus timeless, continued to have a limiting effect upon the individual's capacity to relate and to fully live. Re-experiencing, even mildly, in the safer setting of the therapeutic relationship enables that experience to enter into time and then to become past.
So the relationship with the therapist itself is a vehicle for change, not a useful attribute to increase the effectiveness of other tools.
And I totally agree with you, Juergan, that we exist within a social nexus. It is not useful to think of ourselves as existing outside of relationships. Within psychoanalysis there are useful models to describes these processes, projective identification being a major insight into the way inwhich we shape eachother and are shaped by others. Winnicott, again, has useful things to say about this - for example, his statement that there is no such thing as an infant, rather there is always an infant/mother, from which the infant emerges. More recently Christopher Bollas has described the ways in which we use our environment of people, physical objects, ideas to construct our 'character', in the sense of a character in our personal story.
Regards
Geoff
  • asked a question related to Therapeutic Alliance
Question
35 answers
Can anyone recommend studies/books that have explored the ways in which transference and countertransference unfold in psychotherapy with patients that have experienced abuse or suffer from complicated grief?
Relevant answer
Answer
Reading is nice, but a good supervision will be more important...