schulman's working-alliance [16 articles]

Abstract

This preliminary study examined how patients' defense mechanisms and psychotherapists' techniques influence early alliance formation. The authors assessed the relationships among defense mechanisms, therapist interventions, and the development of alliance in a sample of 12 patients undergoing Brief Psychodynamic Investigation (4 sessions). Alliance development occurred rapidly and was clearly established by the third session. Neither defensive functioning nor supportive or exploratory interventions alone differentiated early alliance development. However, the degree of adjustment of therapists' interventions to patients' level of defensive functioning ...

Abstract

To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, ...

Abstract

The quality of the client-therapist connection was anonymously rated at 20-s intervals throughout the first 2 sessions with 34 clients. It was then related to the Working Alliance Inventory, administered after each session. Client-therapist connection and client personality characteristics accounted for more than 50% of the variance in clients' and therapists' alliance ratings. The depth of the client-therapist connection was largely established early in the first session and accounted for at least 20% of the variance in the second-session alliance ratings. ...

Abstract

Examined within-session interactional behavior in four brief-therapy cases, two characterized by high alliance and two by low alliance. Coded message units along dimensions of power and involvement. In all cases, there was general pattern of high power for therapists and low power for clients. High-alliance clients evidenced larger proportions of high-involvement messages than did low-alliance clients. ...

Abstract

The interaction of the working alliance with the therapy microprocess was explored in a sequential analytic study of brief therapy ( N = 32 ) . The alliance was largely formed within the first session and was most associated with a mutual emotional engagement process. Thereafter, log-linear modeling revealed marked alliance-related and primarily phase-specific effects on the therapy microprocesses. The alliance was associated with differing patterns of therapy activities, topics, emotions, and verbal content. High-alliance midtherapy displayed more of an alternating ...

Abstract

The relationship between therapeutic alliance and treatment outcome was examined for depressed outpatients who received interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Outcome was assessed from patients' and clinical evaluators' perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy. Ratings of patient ...

Abstract

Results of 24 studies (based on 20 distinct data sets) relating the quality of the working alliance (WA) to therapy outcome were synthesized using meta-analytic procedures. A moderate but reliable association between good WA and positive therapy outcome was found. Overall, the quality of the WA was most predictive of treatment outcomes based on clients' assessments, less so of therapists' assessments, and least predictive of observers' report. Clients' and observers' rating of the WA appear to be more correlated with all ...

Abstract

The Working Alliance Inventory (WAI) was completed after the 1st psychotherapy session by 84 university counseling center clients and 15 therapists rating their work with 123 clients. The factor structure of these responses was examined using confirmatory factor analysis. A model with 1 general factor, a model with 3 specific factors, and a bilevel model of the factor structure were examined. The bilevel factor structure, with a General Alliance factor as its primary factor and 3 secondary specific factors, fit the data ...

Abstract

This article outlines some of the main features of a research program on ruptures in the therapeutic alliance and reports some of the major findings to date. A rupture in the therapeutic alliance is a deterioration in the quality of the relationship between patient and therapist; it is an interpersonal marker that indicates a critical opportunity for exploring and understanding the processes that maintain a maladaptive interpersonal schema. Following the task-analytic research paradigin, a preliminary model of the resolution process was ...

Abstract

Argues that research on change processes is needed to help explain how psychotherapy produces change. To explain processes of change, it will be important to measure 3 types of outcomes--immediate, intermediate, and final--and 3 levels of process--speech act, episode, and relationship. Emphasis will need to be placed on specifying different types of in-session change episodes and the intermediate outcomes they produce. The assumption that all processes have the same meaning (regardless of context) needs to be dropped, and a context-sensitive process ...

Abstract

Since its original formulation the concept of therapeutic alliance has remained basically bound to the ego-psychology model. After a first phase of heated debate about its clinical utility and its theoretical foundation, interest in this concept has waned. Even though it refers to a relational dimension it plays a minor role in the contemporary relational trend in psychoanalysis. Starting from the premise that the concept of therapeutic alliance has made a distinctive contribution to the psychoanalytic theory of technique, the author ...

Abstract

The psychoanalytic concept of the working alliance is reviewed and elaborated. It is argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances embedded in them. Moreover, the strength, rather than the kind of working alliance, will prove to be the major factor in change achieved through psychotherapy. Strength of alliance will be a function of the goodness of fit of the respective personalities of patient and therapist to the demands ...

Abstract

The Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) and the Working Alliance Inventory-Short (WAI-S; Tracey & Kokotovic, 1989) are widely used measures of alliance in therapy. This study evaluated the factor structure of the WAI and WAI-S with confirmatory factor analysis in two samples (Ns=231 and 235). The hypothesized structures were not confirmed. An alternative 12-item WAI (WAI-SR), consistent with Bordin's (1979) model of alliance, was developed in one sample and cross-validated in the other. The WAI-SR better differentiated Goal, ...

Abstract

Provides present stages of development and preliminary validation of the Working Alliance Inventory (WAI), a self-report instrument for measuring the quality of alliance. Results from three studies were used to investigate instrument's reliability and validity and the relations among the WAI scales. Data show that WAI is reliably correlated with a variety of counselor and client self-reported outcome measures. ...