Ruptures and repairs of group therapy alliance. an untold story in psychotherapy research

Although previous studies investigated the characteristics of therapeutic alliance in group treatments, there is still a dearth of research on group alliance ruptures and repairs. The model by Safran and Muran was originally developed to address therapeutic alliance in individual therapies, and the usefulness of this approach to group intervention needs to be demonstrated. Alliance ruptures are possible at member to therapist, member to member, member to group levels. Moreover, repairs of ruptures in group are quite complex, i.e., because other group members have to process the rupture even if not directly involved. The aim of the current study is to review the empirical research on group alliance, and to examine whether the rupture repair model can be a suitable framework for clinical understanding and research of the complexity of therapeutic alliance in group treatments. We provide clinical vignettes and commentary to illustrate theoretical and research aspects of therapeutic alliance rupture and repair in groups. Our colleague Jeremy Safran made a substantial contribution to research on therapeutic alliance, and the current paper illustrates the enduring legacy of this work and its potential application to the group therapy context

When adolescents stop psychological therapy: rupture-repair in the therapeutic alliance and association with therapy ending

therapeutic alliance consistently predicts dropout from psychological therapy, and ruptures in the therapeutic alliance may also predict dropout, yet there is a dearth of research with adolescents. This study investigated whether markers of rupturerepair in the therapeutic alliance were indicative of different types of treatment ending in adolescents who received psychological treatment for depression. Data were from the IMPACT study, a trial investigating the effectiveness of therapies for adolescent depression. Participants were randomly allocated to receive a psychological therapy: Brief Psychosocial Intervention, Cognitive-Behavioural Therapy or Short-Term Psychoanalytic Psychotherapy. The sample (N=35) comprised adolescents who had either completed their treatment (n=14) or dropped out (n=21) according to their therapist. Dropout cases were further classified as dissatisfied (n=14) or got-whatthey- needed (n=7) based on post-therapy interviews with the adolescent and therapist. Selected audio-recordings of therapy sessions were rated using the Rupture Resolution Rating System and Working Alliance Inventory (observer-version). Therapeutic alliance and rupture-repair during therapy were similar for completers and got-what-they-needed dropouts, while dissatisfied dropouts had poorer therapeutic alliance, more ruptures, ruptures were frequently unresolved, and therapists contributed to ruptures to a greater extent. Qualitative analysis of the sessions led to the construction of three categories of therapist contribution to ruptures: therapist minimal response; persisting with a therapeutic activity; and focus on risk. Results suggest that ruptures, especially when unresolved, could be regarded as warning signs of disengagement and dropout from psychological treatment. Future research should investigate how ruptures may be effectively identified and resolved in treatment with adolescents

The Effects of Therapeutic Alliance in Physical Therapy and Possible Transfer to Intervention in Speech Language Pathology

In this presentation, the techniques used within therapy sessions to strengthen therapeutic alliance between the therapist and client will be discussed along with current tools used to measure therapeutic alliance. Current perspectives on therapeutic alliance in speech language pathology will be discussed and compared to that of therapeutic alliance in Physical Therapy.https://griffinshare.fontbonne.edu/slp-posters-2022/1013/thumbnail.jp

The Relationship between Psychotherapist Personality and Therapeutic Alliance

Time-limited effective psychotherapy is a topic that is frequently addressed in clinical therapy research. Though a wide range of therapeutic factors, expectancy effects, techniques, and extratherapeutic have all been demonstrated to be related to outcome, researchers have consistently identified the therapeutic alliance as one of the strongest factors in predicting psychotherapy outcomes. Researchers are beginning to measure the effectiveness of therapy by evaluating improvements in outcome measures, and client reported therapeutic alliance. Researchers have recently began investigating the common personality profiles among psychotherapists, and have hypothesized that there is a relationship between psychotherapist personality and therapeutic alliance. The goal of this research was to determine if the relationship between psychotherapist personality traits and therapeutic alliance existed and whether a therapeutic alliance focused intervention would improve client reported therapeutic alliance. Researchers recruited pre-licensed graduate level psychotherapists from community-based outpatient clinics. A total of 50 psychotherapists participated by completing a NEO-Five Factor Inventory (NEO-FFI).Clients of these therapists were also asked to complete a Working Alliance Inventory-Short Form (WAI-S) and an Outcome Rating Scale (ORS). Results indicated that psychotherapists, in general, have lower levels of Neuroticism, and higher levels of Openness and Agreeableness, compared to community normative data. The researchers found that Agreeableness played a significant role in client-reported therapeutic alliance. Psychotherapists who had the highest ratings of therapeutic alliance had significantly higher scores on the Agreeableness scale compared to psychotherapists who had the lowest ratings of therapeutic alliance. Researchers were unable to statistically demonstrate that therapeutic alliance focused interventions were related to higher ratings of therapeutic alliance or psychotherapy outcomes. However, reports from participants suggest that additional therapeutic alliance focused interventions are beneficial for individuals providing direct service to clients and for supervisors

Exploring the Therapeutic Alliance with Adolescents and Their Caregivers: A Qualitative Approach

The therapeutic alliance is largely recognized as an important component of the therapeutic process. For clients of all ages, the therapeutic alliance has been associated with positive outcomes and increased engagement in therapy (Bachelor, 2013; Bhola, & Kapur, 2013; Liber et al., 2010). However, very few studies have explored the complex process of fostering the therapeutic alliance with adolescent clients, while also maintaining a positive therapeutic relationship with the adolescent’s caregivers. The present study attempted to fill the gap in the literature through qualitatively exploring therapists’ perspectives of the therapeutic alliance with adolescents and their caregivers. In order to discover the essence of therapists’ experiences of the therapeutic alliance with adolescents and their caregivers, a phenomenological research design was employed. Nine therapists were interviewed about their experiences of the therapeutic alliance with adolescents and their caregivers. The interviews were transcribed and analyzed, and various themes and subthemes were revealed. The themes were divided into three sections: (1) conceptualizing the therapeutic alliance, (2) therapeutic alliance with adolescents, and (3) therapeutic alliance with caregivers. Two themes emerged within the ‘conceptualizing the therapeutic alliance’ section: (1) trust, and (2) foundation of therapy. Two themes and various subthemes emerged within the ‘therapeutic alliance with adolescents’ section. The first theme describes the obstacles that therapists face when attempting to build the alliance with adolescent clients, and contained three subthemes: (1) viewed as an authority figure, (2) resistance to therapy, and (3) differences in SES. The second theme describes the strategies that therapists use to develop the therapeutic alliance and contains three subthemes: (1) discuss interests, (2) honor their voice, and (3) describe limits of confidentiality. Two themes were unveiled within the ‘therapeutic alliance with caregivers’ section: (1) obstacles, and (2) strategies. The ‘obstacles’ theme describes barriers that therapists face when constructing the alliance with caregivers of adolescent clients, and contains two subthemes: (1) fear of triangulation, and (2) caregivers’ expectations. The ‘strategies’ theme contains four subthemes: (1) empathy, (2) give caregivers an active role, (3) collaborative approach, and (4) establish clear boundaries. Clinical implications, recommendations for future research, and limitations of the study are discussed

Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: A scoping review of the literature

© 2017 The Author(s). Background: Most conventional treatment for musculoskeletal conditions continue to show moderate effects, prompting calls for ways to increase effectiveness, including drawing from strategies used across other health conditions. Therapeutic alliance refers to the relational processes at play in treatment which can act in combination or independently of specific interventions. Current evidence guiding the use of therapeutic alliance in health care arises largely from psychotherapy and medicine literature. The objective of this review was to map out the available literature on therapeutic alliance conceptual frameworks, themes, measures and determinants in musculoskeletal rehabilitation across physiotherapy and occupational therapy disciplines. Methods: A scoping review of the literature published in English since inception to July 2015 was conducted using Medline, EMBASE, PsychINFO, PEDro, SportDISCUS, AMED, OTSeeker, AMED and the grey literature. A key search term strategy was employed using physiotherapy , occupational therapy , therapeutic alliance , and musculoskeletal to identify relevant studies. All searches were performed between December 2014 and July 2015 with an updated search on January 2017. Two investigators screened article title, abstract and full text review for articles meeting the inclusion criteria and extracted therapeutic alliance data and details of each study. Results: One hundred and thirty articles met the inclusion criteria including quantitative (33%), qualitative (39%), mixed methods (7%) and reviews and discussions (23%) and most data came from the USA (23%). Randomized trials and systematic reviews were 4.6 and 2.3% respectively. Low back pain condition (22%) and primary care (30.7%) were the most reported condition and setting respectively. One theory, 9 frameworks, 26 models, 8 themes and 42 subthemes of therapeutic alliance were identified. Twenty-six measures were identified; the Working Alliance Inventory (WAI) was the most utilized measure (13%). Most of the therapeutic alliance themes extracted were from patient perspectives. The relationship between adherence and therapeutic alliance was examined by 26 articles of which 57% showed some correlation between therapeutic alliance and adherence. Age moderated the relationship between therapeutic alliance and adherence with younger individuals and an autonomy support environment reporting improved adherence. Prioritized goals, autonomy support and motivation were facilitators of therapeutic alliance. Conclusion: Therapeutic Alliance has been studied in a limited extent in the rehabilitation literature with conflicting frameworks and findings. Potential benefits described for enhancing therapeutic alliance might include better exercise adherence. Several knowledge gaps have been identified with a potential for generating future research priorities for therapeutic alliance in musculoskeletal rehabilitation

Predicting the early therapeutic alliance in the treatment of drug misuse

Aims - To predict the early therapeutic alliance from a range of potentially relevant factors, including clients' social relationships, motivation and psychological resources, and counsellors' professional experience and ex-user status. Design - The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Counsellor and client information was assessed at intake, and client and counsellor ratings of the alliance were obtained during weeks 1, 2 and 3. Measurements - The intake assessment battery included scales on psychological wellbeing, treatment motivation, coping strategies and attachment style. Client and counsellor versions of the Working Alliance Inventory (WAI-S) were used for weekly alliance measurement. Hierarchical linear models were used to examine the relationship between alliance and predictor variables. Findings - Clients who had better motivation, coping strategies, social support and a secure attachment style were more likely to develop good alliances. Findings with regard to counsellor characteristics were not clear cut: clients rated their relationships with ex-user counsellors, experienced counsellors and male counsellors as better, but more experienced counsellors rated their alliances as worse. Conclusions - The findings offer important leads as to what interventions might improve the therapeutic alliance. Further work will need to establish whether the therapeutic alliance and ultimately treatment outcomes can be enhanced by working on improving clients' motivation and psychosocial resources

Therapeutic Alliance Between Youth and Staff in Residential Group Care: Psychometrics of the Therapeutic Alliance Quality Scale

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service provider, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time

ASSESSING IMPACT OF AFFECT RECOGNITION ON THERAPEUTIC RELATIONSHIP

Therapeutic alliance and its relationship to client nonverbal behavior, specifically facial expressions, were examined. Therapist interpretation of the client nonverbal behavior, or affect, influences the therapeutic alliance and process. Based on a sample of clients from a graduate school therapy training facility, results suggest therapist training in facial expressions, and how they relate to client emotion, improve the therapeutic alliance between therapist and client. After a micro-expression training for therapists, clients reported higher life functioning on the Outcome Rating Scale (ORS) and an improved therapeutic alliance on the Session Rating Scale (SRS). Overall, these findings support the benefit of incorporating micro-expression training into therapy instruction

Examining the Relationship Between the Therapeutic Bond and the Phases of Treatment Outcome

Examined the association between the therapeutic bond—an element of the therapeutic alliance—and treatment effectiveness. 114 psychotherapy clients completed self-report questionnaires at intake and throughout open-ended, psychodynamically oriented psychotherapy. Three bond scales, role investment (RI), empathic resonance (ER), and mutual affirmation (MA), were contrasted to session quality and the three phases of outcome (remoralization, remediation, and rehabilitation). Results indicated that different aspects of the bond predicted session quality and treatment outcome. Clients who felt motivated and invested in therapy (relatively high RI) and who reported that the therapeutic environment was friendly and affirmative (relatively high MA) were likely to rate the session as being helpful and productive. Clients who had a relatively high sense of understanding and of being understood (ER) experienced greater remoralization and remediation (but not rehabilitation). The results are placed within the context of recent research into the therapeutic alliance