Facets of the therapeutic alliance and perceived progress in psychotherapy: relationship between patient and therapist perspectives

Abstract Background: Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients’ and therapists’ estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument. Method: We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen’s d standardized mean effect size. Results: Heterogeneity analyses (k = 22, Cohen’s d = −.46, 95% confidence interval = .31–1.1) produced a significant Q-statistic (Q = 94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate. Conclusions: Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client’s diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients’ and therapists’ estimations than do more general instruments that are applied to assess TA.

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Therapeutic Alliance in Web-based Treatment for Eating Disorders: Patient and Therapist perspectives (Preprint)

10.2196/preprints.33813 ◽

2021 ◽

Author(s):

Claudia Stoeten

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Therapeutic Alliance ◽

Secondary Analysis ◽

Positive Association ◽

Treatment Completion ◽

Post Treatment ◽

Symptom Reduction ◽

Total Patient ◽

Therapist Perspectives

BACKGROUND In face-to-face therapy for eating disorders, the therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. Current, however, not much is known about the TA during web-CBT and its associations with symptom reduction, treatment completion and the perspectives of patients versus therapists. OBJECTIVE The present study aimed to investigate (1) differences between TA-ratings measured at interim and post-treatment, separately for patients and therapists, (2) the degree of agreement between therapists and patients (treatment completers and non-completers) for TA-ratings, and (3) associations between patient and therapist TA-ratings and both eating disorder pathology and treatment completion. METHODS A secondary analysis was performed on the RCT data of a web-CBT intervention for eating disorders. TA-ratings (HAQ) were measured at interim and post-treatment, focusing on treatment completers, non-completers and therapists. Paired t-tests were conducted to assess the change from interim to post-treatment. Intraclass correlations were calculated to determine cross-informant agreement with regards to HAQ-scores between patients and therapists. Through two stepwise regressive procedures (at interim and post-treatment), it was examined which HAQ-scores predicted (1) eating disorder pathology and (2) therapy completion. RESULTS Participants were 170 females with BN (n=33), BED (n=68), or EDNOS (n=69); mean age 39.6 (SD=11.5) years. For completers, HAQ-total scores and HAQ-Helpfulness scores improved significantly from interim to post-treatment. For non-completers, all HAQ-scores decreased significantly. For all HAQ-scales, agreement between patients and therapists was poor. However, agreement was slightly better post-treatment than at interim. The helpfulness subscale of the HAQ was negatively associated with eating disorder psychopathology at interim and post-treatment. A positive association was found between HAQ-total patient scores at interim and treatment completion. Lastly, post-treatment HAQ-total patient scores and post-treatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. CONCLUSIONS The results showed that for web-CBT for eating disorders, in particular the confidence to improve one’s situation (HAQ-Helpfulness) is important for predicting eating disorder pathology and treatment completion. Furthermore, in the current web-CBT, the TA increased for completers and decreased for non-completers, according to both patients and therapists.

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Patients’ crying experiences in psychotherapy: Relationship with the patient level of personality organization, clinician approach, and therapeutic alliance.

Psychotherapy ◽

10.1037/pst0000110 ◽

2017 ◽

Vol 54 (2) ◽

pp. 159-166

Author(s):

Pietro Zingaretti ◽

Federica Genova ◽

Francesco Gazzillo ◽

Vittorio Lingiardi

Keyword(s):

Therapeutic Alliance ◽

Personality Organization ◽

Patient Level ◽

Psychotherapy Relationship

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Child, caregiver, and therapist perspectives on therapeutic alliance in usual care child psychotherapy.

Psychological Assessment ◽

10.1037/pas0000031 ◽

2015 ◽

Vol 27 (1) ◽

pp. 347-352 ◽

Cited By ~ 15

Author(s):

Erin C. Accurso ◽

Ann F. Garland

Keyword(s):

Therapeutic Alliance ◽

Usual Care ◽

Child Psychotherapy ◽

Care Child ◽

Therapist Perspectives ◽

Child Caregiver

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The therapeutic alliance in offending behavior change programs: therapist perspectives and practises

Journal of Aggression Conflict and Peace Research ◽

10.1108/jacpr-08-2016-0245 ◽

2017 ◽

Vol 9 (3) ◽

pp. 210-219 ◽

Cited By ~ 3

Author(s):

Christina Julie Kozar ◽

Andrew Day

Keyword(s):

Behavior Change ◽

Therapeutic Alliance ◽

Group Treatment ◽

Criminal Behavior ◽

Violent Offenders ◽

Group Behavior ◽

Content Type ◽

Correctional Programs ◽

Offending Behavior ◽

Therapist Perspectives

Purpose Offending behavior change programs play an important role in the prevention of criminal behavior, particularly when offered to violent offenders. There is, however, little consensus about how content should be delivered, despite agreement that the development of a strong therapeutic alliance (TA) is an important determinant of outcome. The purpose of this paper is to explore how the TA is formed within correctional programs. Design/methodology/approach In total, 27 therapists who delivered correctional group treatment explored issues relating to the role of the alliance in offending behavior programs. A grounded theory methodology was employed to develop a conceptual understanding of therapist perspectives and practises. Findings Three different modes of practice were identified: “educative” to enforce boundaries of group behavior; “engagement” to promote a collaborative approach; and “therapeutic” to enhance client insight. Practical implications Greater awareness of the skills and supports required to successfully develop strong TAs in correctional populations may assist better retention and treatment outcomes in offending behavior programs. The ability to work flexibly between different modes of practise may prove important to rehabilitation efforts. Originality/value A model of the TA based on therapists’ accounts of their practise in correctional programs is presented. It is anticipated that, particularly for novice correctional therapists, exploration of the ways in which the alliance can be established and ruptures responded to will enhance treatment efficacy, particularly in treating violent offenders who can be challenging to engage.

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