White Counselor Trainees\u27 Racial Identity and Working Alliance Perceptions

Racial identity has been theorized to significantly affect cross-racial counseling relationships (Helms, 1984, 1995). This study examined the direct impact of White racial identity of 124 counselor trainees on working alliance formation in a same-racial and cross-racial vicarious counseling analogue. Regardless of the race of the client, disintegration and reintegration attitudes negatively affected working alliance ratings, and pseudoindependent and autonomy attitudes positively affected working alliance ratings. Implications for counseling, supervision, training, and research are discussed

White Counselor Trainees\u27 Racial Identity and Working Alliance Perceptions

Racial identity has been theorized to significantly affect cross-racial counseling relationships (Helms, 1984, 1995). This study examined the direct impact of White racial identity of 124 counselor trainees on working alliance formation in a same-racial and cross-racial vicarious counseling analogue. Regardless of the race of the client, disintegration and reintegration attitudes negatively affected working alliance ratings, and pseudoindependent and autonomy attitudes positively affected working alliance ratings. Implications for counseling, supervision, training, and research are discussed

Journal Staff

Background: Internet-based cognitive behavioral therapy (ICBT) is a form of guided self-help that has been found to be effective for addressing several problems. The target for this type of therapy is usually restricted to one specific disorder. Tailoring the treatment widens the scope of ICBT in that it can address comorbid conditions directly. Objectives: The working, or therapeutic, alliance has been found to predict outcome in studies of face-to-face therapy. The extent to which these findings apply to ICBT is largely unknown. We therefore decided to find out whether the working alliance could predict outcome in tailored ICBT for anxiety disorders. Methods: Data were obtained from the treatment group (n=27) in a randomized controlled trial aiming to test the effects of tailored ICBT for anxiety disorders. The forthcoming study was designed to test the hypothesis that the working alliance measured both pre-treatment and early in treatment (week 3) can predict treatment outcome as measured by the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) in a heterogeneous group of patients with anxiety disorders (n=27). Results: Working alliance measured at week 3 into the treatment correlated significantly with the residual gain scores on the primary outcome measure (r=-.47, P=.019, n=25), while expected working alliance pre-treatment did not (r=-.17, P=.42, n=27). Conclusions: These results raise questions about the importance of working alliance in ICBT treatments, and suggest that the working alliance could be important in ICBT.Funding Agencies|Swedish Council for Working Life and Social Research|2008-1145|</p

Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: an investigation of mediation

Patients’ outcome expectancies and the working alliance are two psychotherapy process variables that researchers have found to be associated with treatment outcome, irrespective of treatment approach and problem area. Despite this, little is known about the mechanisms accounting for this association, and whether contextual factors (e.g., psychotherapy type) impact the strength of these relationships. The primary aim of this study was to examine whether patient-rated working alliance quality mediates the relationship between outcome expectancies and pre- to post-treatment change in anxiety symptoms using data from a recent randomized clinical trial comparing a transdiagnostic treatment (the Unified Protocol [UP]; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Client workbook, Oxford University Press, New York, 2011a; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Patient workbook. New York: Oxford University Press, 2017b) to single diagnosis protocols (SDPs) for patients with a principal heterogeneous anxiety disorder (n = 179). The second aim was to explore whether cognitive-behavioral treatment condition (UP vs. SDP) moderated this indirect relationship. Results from mediation and moderated mediation models indicated that, when collapsing across the two treatment conditions, the relationship between expectancies and outcome was partially mediated by the working alliance [B = 0.037, SE = 0.05, 95% CI (.005, 0.096)]. Interestingly, within-condition analyses showed that this conditional indirect effect was only present for SDP patients, whereas in the UP condition, working alliance did not account for the association between expectancies and outcome. These findings suggest that outcome expectancies and working alliance quality may interact to influence treatment outcomes, and that the nature and strength of the relationships among these constructs may differ as a function of the specific cognitive-behavioral treatment approach utilized.This study was funded by grant R01 MH090053 from the National Institutes of Health. (R01 MH090053 - National Institutes of Health)First author draf

The Impact of Therapist Self-Disclosure on Client-Perceived Working Alliance amongst Psychiatrist Inpatients

Working alliance has been shown to predict positive psychotherapy treatment outcomes. Past research focuses on therapist characteristics that correlate with working alliance after multiple therapy sessions (e.g., warmth, trustworthy) rather than employing experimental designs examining specific techniques that quickly improve working alliance. Specific techniques that have been empirically shown to improve working alliance quickly may be particularly beneficial today in the age of managed care wherein clinicians often face constraints limiting the amount of time they can spend with clients. Therapist self-disclosure (TSD) of information about a clinician’s personal life, when used appropriately, may have the potential to quickly improve working alliance. Prior research has demonstrated a positive relationship between TSD and working alliance; however, most studies examining TSD are methodologically unsound. The present study employed a methodologically rigorous design in which psychiatric inpatients participated in a highly structured assessment as part of standard intake procedures. After the intake interview, participants completed a baseline working alliance measure, which was followed by the clinician making one personal TSD statement to half of the participants. Shortly after the TSD statement (or non-TSD statement for the control group), participants completed a second working alliance questionnaire. As hypothesized, participants in the TSD group exhibited significantly higher scores than controls on the Bond subscale of the post-manipulation working alliance measure, and paranoia was negatively correlated with baseline working alliance. Contrary to what was expected, paranoia did not moderate the effects of TSD on working alliance. Implications for clinical applications and future research directions are discussed

A Preliminary Investigation into the Use of Humor in Sport Psychology Practice

‘Creative efforts’, such as the use of humor,have been found to be beneficial to the nurse-patient, teacher-student , and psychologist-patient alliance. Potentially humoruse might benefit the working alliance in applied sport psychology, yet to datethere is limited research. Sportpsychology consultants (n = 55) completedan online survey that explored humor use within their practice. Statisticalanalyses revealed most participants used humor for adaptive purposes such as tofacilitate the working alliance, reinforce knowledge, and create healthylearning environments. Therefore, possible client change is likely to befacilitated by practitioners’ personal qualities and skills such as humor useand humor style. Recommendations are made for sport psychology practitioners inrelation to humor use and further research.Peer reviewedFinal Accepted Versio

Influence of supervisees' working alliance on supervision outcomes: a study in Malaysia context

Supervisory working alliance is an essential element in the supervision process. The experiences of supervisees during dyad or supervision process with their supervisors contribute to the levels of relationships (positive or negative) between supervisors and supervisees in their working alliance. The purposes of the research are to determine the relationships between supervisees’ working alliance and supervision outcomes and to investigate the influence of supervisees’ working alliance on the supervision outcomes. This quantitative study consists of two types of respondents: 1) supervisee (counselor trainee) and 2) supervisor (academic lecturer). A total of 120 supervisees and 18 supervisors participated in the research. This study found that there was a significant relationship between supervisees’ working alliance and supervision outcomes (supervisees’ satisfaction and performance) [F (1, 116) = 49.5, (β = 1.04, p < 0.05), r =. 55 (adjusted R2 =. 293)]. As a conclusion, the supervisees’ working alliance has a unique contribution on the supervision outcomes (supervisees’ satisfaction and performance) among supervisees (counselor trainees) in Malaysia

The Working Alliance: A Survey of an Outpatient Mental Health Center

This research investigated the working alliance between therapist and client at RiverView Clinic, an outpatient mental health center. Utilizing data captured by the Working Alliance Inventory-Short Revised (WAI-SR), the research posited the following: median total scores from therapist’s would be higher than median scores of the working alliance from clients clients who presented with mild to moderate concerns would have higher working alliance scores than clients who reported moderate to severe concerns new clients would have higher task and goal sub-scores than clients in therapy for more than fifteen sessions if working alliance scores reflected ruptures or strains in the working alliance, scores would increase if worked through with the client to identify the inconsistencies between their self-defeating behavior and the goals they committed to in therapy. Hypothetically, subsequent scores would then increase, possibly higher than before the rupture

The working alliance in a randomized controlled trial comparing online with face-to-face cognitive-behavioral therapy for depression

Background: Although numerous efficacy studies in recent years have found internet-based interventions for depression to be effective, there has been scant consideration of therapeutic process factors in the online setting. In face-to face therapy, the quality of the working alliance explains variance in treatment outcome. However, little is yet known about the impact of the working alliance in internet-based interventions, particularly as compared with face-to-face therapy. Methods: This study explored the working alliance between client and therapist in the middle and at the end of a cognitive-behavioral intervention for depression. The participants were randomized to an internet-based treatment group (n = 25) or face-to-face group (n = 28). Both groups received the same cognitive behavioral therapy over an 8-week timeframe. Participants completed the Beck Depression Inventory (BDI) post-treatment and the Working Alliance Inventory at mid- and post- treatment. Therapists completed the therapist version of the Working Alliance Inventory at post-treatment. Results: With the exception of therapists' ratings of the tasks subscale, which were significantly higher in the online group, the two groups' ratings of the working alliance did not differ significantly. Further, significant correlations were found between clients' ratings of the working alliance and therapy outcome at post-treatment in the online group and at both mid- and post-treatment in the face-to-face group. Correlation analysis revealed that the working alliance ratings did not significantly predict the BDI residual gain score in either group. Conclusions: Contrary to what might have been expected, the working alliance in the online group was comparable to that in the face-to-face group. However, the results showed no significant relations between the BDI residual gain score and the working alliance ratings in either group

Forming Bonds to Challenge Fears: Course of the Working Alliance during Cognitive Behavioral Treatment for Social Anxiety Disorder

Social anxiety disorder (SAD) is the 3rd most common psychiatric diagnosis, and is associated with significant social, occupational, health, and educational impairment. Fortunately, both pharmacological and psychological treatments can reduce symptoms. Cognitive behavioral therapy is considered the gold standard treatment for SAD, and a robust literature supports its effectiveness. In contrast, process related factors, including the role of the working alliance, have received less attention in treatment of SAD. The current study examined development of the working alliance for a SAD sample. The working alliance is characterized as the collaborative relationship between a client and therapist, and includes shared goals, strategies, and an attachment bond. Within the context of SAD, the working alliance is particularly interesting, as the alliance itself is a social relationship that may elicit anxiety, which, in turn, may impact development of the alliance. The present study also investigated whether treatment type, that is, exposure group therapy (EGT) versus virtual reality exposure (VRE) therapy, or pre-treatment symptom severity influenced the working alliance trajectory. Data were provided by an adult sample presenting with a primary diagnosis of SAD. Participants were randomly assigned to one of two treatment conditions, both involved use of a manualized CBT treatment approach. Standardized measures of social anxiety were administered pre-treatment whereas working alliance ratings were obtained after each session. Results indicated high levels of working alliance and significant change in ratings over time. Treatment condition did not contribute to significant differences in the working alliance trajectory. Regarding the impact of SAD symptoms, initially high ratings of fear was associated with progressively increasing rates of growth in the working alliance whereas high initial ratings of avoidance signified steeper increase in the working alliance earlier in treatment followed by a declining rate of change over time. The current study contributes to the limited literature regarding the working alliance trajectory for clients with SAD, and is the first to consider the impact of VRE treatment on this trajectory. Findings also provide preliminary evidence for the differential impact of initial fear and avoidance as well as a potential curvature for the working alliance trajectory when using CBT