The influence of therapy alliance and treatment motivation in patients with Cluster B personality disorders on incidents in forensic hospitals

Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

Do Changes in Emotional States Predict Therapy Alliance in Dutch Male Offenders in Mandated Clinical Care?

Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders’ emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders.

Conceptualising the therapeutic alliance: exploring the relevance of Bordin’s model for adults with intellectual disabilities

Purpose This study aims to explore the applicability of Bordin’s model of therapeutic alliance in talking therapies for people with intellectual disabilities. Design/methodology/approach People with intellectual disabilities and therapists in six therapy dyads were interviewed using a qualitative methodology. Data were analysed using thematic analysis to explore how people with learning disabilities constructed the dimensions of therapeutic alliance. Content analysis was then used to focus on therapy bond, therapy tasks and goals to explore the agreement on these dimensions between the therapist and client. Findings People with intellectual disabilities reported their experience of therapy in a way that initially validates the alliance dimensions of Bordin’s model. There was clear overlap within most dyads in the description of the characteristics of the bond, the tasks undertaken and the goals of therapy. Some therapists described additional goals based on their therapeutic model that were not clearly described by the client working with them. Research limitations/implications This study is limited by only including six therapy dyads; however, the results suggest further research on the impact of therapy alliance and how goals and tasks are agreed would be valuable. Originality/value Very few studies have explicitly examined the client’s view of therapy alliance.

The Competing Influences of Initial Depressive Symptomatology and Early Alliance on Early Outcome: A Preliminary Study

We examined 40 psychotherapies, some delivered in combination with pharma-cotherapy, which were all conducted by cognitive behavioral or psychodynamically oriented therapists in a general hospital center for the treatment of light to moder-ate depressive disorders. Our goal was to examine the relationship between early outcome (defined as change in Beck Depression Inventory scores between sessions 2 and 15) and early therapy alliance (as measured at sessions 1 to 5 by the Working Alliance Inventory). We also wanted to concurrently examine the effect of initial depressive symptomatology (BDI at session 2) on early outcome. For the entire sample, both early alliance and initial depressive symptomatology were found to significantly correlate with outcome, the latter more strongly so. However, after di-viding the patient sample into subgroups based on different initial levels of depres-sion, early outcome for patients with depression of intermediate severity was found to be better predicted by early alliance than by initial depression. These results sug-gest that there may be a patient subgroup for whom a good early alliance optimally mitigates the self-perpetuating action of initial depression.