Alliance Process Research Articles

The National Institute for Health Research Critical Care Research Priority Setting Survey 2018.

Defining research priorities in intensive care is key to determining appropriate allocation of funding. Several topics were identified from the 2014 James Lind Alliance priority setting exercise conducted with the Intensive Care Society. The James Lind Alliance process included significant (and vital) patient/public contribution, but excluded professionals without a bedside role. As a result it may have failed to identify potential early-stage translational research topics, which are more likely identified by medical and/or academic members of relevant specialist basic science groups. The objective of the present project was to complement the James Lind Alliance project by generating an updated list of research priorities by facilitating academic research input. A survey was conducted by the National Institute for Health Research (NIHR) to identify the key research priorities from intensive care clinicians, including allied health professionals and academics, along with any evolving themes arising from translational research. Feasibility of all identified topics were then discussed and allocated to themes by a joint clinical academics/NIHR focus group. The survey was completed by 94 intensive care clinicians (including subspecialists), academics and allied health professions. In total, 203 research questions were identified, with the top five themes focusing on: appropriate case selection (e.g. who and when to treat; 24%), ventilation (7%), sepsis (6%), delirium (5%) and rehabilitation (5%). Utilising a methodology distinct from that employed by the James Lind Alliance process, from a broad spectrum of intensive care clinicians/scientists, enabled identification of a variety of priority research areas. These topics can now inform not only the investigator-led research agenda, but will also be considered in due course by the NIHR for potential future funding calls.

Alliantie in Beeld

Alliance at Work – Observation research on the working relationship between care providers and families in intensive outreach family treatment Alliance is an important common factor in the treatment of youth and family problems. When working with multiple family members, building and maintaining strong alliances can be particularly challenging. Alliance at Work (Alliantie in Beeld) is a research project that investigates how alliance processes affect the treatment outcome of IAG, a Dutch homebased family preservation program. Two videotaped IAG sessions of sixty families are analyzed with the System for Observing Family Therapy Alliances. Participants completed the working alliance inventory and treatment outcomes were monitored. Methodological implications and relevance of this observational research project are discussed.

Nonprofit Alliance in China: Effects of Alliance Process on Goal Achievement

Nonprofit alliances have characterized the dynamic of nonprofit sector over the past three decades. While much scholarly attention has focused on formation and outcome of alliances, less is known about process of alliances in emerging nonprofits in developing countries. Using 11 cases of nonprofit alliances in Ya’an earthquake in China in 2013, this study examined the connection between process and outcome of alliances. Our research demonstrates that process of nonprofit alliances plays an important role in goal achievement of the alliance. Specifically, resource distribution and trust building are the two critical process factors. The results indicate that the process factors change dynamically along with the process of the alliance, and that the synergy of the process factors facilitated the fulfillment of alliance goals in emerging nonprofits.

Using a Film Intervention in Early Addiction Treatment: a Qualitative Analysis of Process.

There is a need for knowledge about how self-help materials can be made useful in treatment for Substance Abuse Disorders (SUD), as a supplement to ongoing treatment, or as independent tools for change. In this study, we explored the use of self-help films in early addiction treatment, taking into account both patient and therapist perspectives, as well as dyadic functions. We explored how active mechanisms might be related to intervention format and implementation context. A secondary aim was to examine the potential mechanisms related to the specific content of the intervention: mindfulness and acceptance psychoeducation. A qualitative exploratory research design, including a general inductive analytic approach, constructivist grounded theory, and source triangulation features, was used to code and analyze interview material. Emerging themes were developed into concepts, and finally an operational model. Participants included 12 patients and 22 therapists, in in-/outpatient addiction clinics, all in urban areas of Norway. The purpose of the design was empirical grounding of developed concepts, to promote different potential user perspectives (patients' and therapists') and obtain process data. The core concept constructed, "Alliance as experiential process," gives a description of the data where patients and therapists accept or reject the film as a result of an experience process conceptualized as alliance formation. The alliance process model reflects the observation that patients constructed alliances autonomously, while therapists built alliances indirectly through their patients' experiences. Use of a self-help film may be a helpful adjunct to face-to-face therapy for patients who create a personally meaningful attachment to the film. Mindfulness/acceptance may offer one basic framework for such connection to take place.

The complementary effects of transaction cost economics and resource-based view: a technological alliance perspective

This paper examines the impact of two theoretical frameworks - transaction cost economics (TCE) and resource-based view (RBV) - on alliance processes among Korean high-tech manufacturing ventures. Results show that TCE and RBV can be applied complementarily to explain the formation of technological alliances. TCE variables are more related with alliance partner characteristics, while RBV is linked with partner capabilities. Both show positive effects on performance. No significant effect is found regarding alliance governance structure. While selecting appropriate technological alliance partners shows positive effects on performance, no significant effect is found between alliance governance structure and performance. Elements of both theories impacting each alliance stage and analytical explanations of such impacts are discussed.

The complementary effects of transaction cost economics and resource-based view: a technological alliance perspective

This paper examines the impact of two theoretical frameworks - transaction cost economics (TCE) and resource-based view (RBV) - on alliance processes among Korean high-tech manufacturing ventures. Results show that TCE and RBV can be applied complementarily to explain the formation of technological alliances. TCE variables are more related with alliance partner characteristics, while RBV is linked with partner capabilities. Both show positive effects on performance. No significant effect is found regarding alliance governance structure. While selecting appropriate technological alliance partners shows positive effects on performance, no significant effect is found between alliance governance structure and performance. Elements of both theories impacting each alliance stage and analytical explanations of such impacts are discussed.

Determinants of International Strategic Alliance Process and Alliance Failure: Learning from the Volvo-Renault Break-up

While the scholarly focus has shifted from strategic alliance formation to alliance performance and thus alliance outcome, the process that leads to a particular outcome: alliance success or alliance failure remains indeterminate. Given their high failure rate, this study aims to identify factors that contribute to an alliance failure to better understand the strategic alliance management process to help alliances survive. Purposefully, the Volvo-Renault alliance break-up is investigated. A Process Model for International Strategic Alliance Lifecycle is developed. The findings establish that post-formation, the strategic alliance process necessitates managing interactions among: partners' objectives; partners' resource contribution; access to partner's network; and alliance performance. However, for an alliance to sustain, learning and assessment must be an integral part. Learning and assessment are critical strategic inputs that serve as 'binding forces', and as an 'alert mechanism' whereby timely corrective managerial actions are triggered in favour of an alliance sustainability and vice versa.

Determinants of the international strategic alliance process and alliance failure: learning from the Volvo-Renault break-up

While the scholarly focus has shifted from strategic alliance formation to alliance performance and thus alliance outcome, the process that leads to a particular outcome: alliance success or alliance failure remains indeterminate. Given their high failure rate, this study aims to identify factors that contribute to an alliance failure to better understand the strategic alliance management process to help alliances survive. Purposefully, the Volvo-Renault alliance break-up is investigated. A Process Model for International Strategic Alliance Lifecycle is developed. The findings establish that post-formation, the strategic alliance process necessitates managing interactions among: partners' objectives; partners' resource contribution; access to partner's network; and alliance performance. However, for an alliance to sustain, learning and assessment must be an integral part. Learning and assessment are critical strategic inputs that serve as 'binding forces', and as an 'alert mechanism' whereby timely corrective managerial actions are triggered in favour of an alliance sustainability and vice versa.

The Comparative Effects of Transaction Cost Economics and Resource Based View: A Technological Alliance Motivational Perspective

<p>This paper examines the impact of two main alliance motivation theories, transaction cost economics (TCE) and resource based view (RBV), on alliance processes among Korean manufacturing high-tech ventures. Results show that TCE and RBV are complimentarily explaining the formation of inter-firm alliances. TCE variables are more related with alliance partner characteristics while RBV is more linked with partner capabilities. Both show positive effects on performance. No significant effect is found on determining an alliance governance structure. While selecting appropriate technological alliance partners show positive effects on performance, no significant effect is found between alliance governance structure and performance. Factors of both theories impacting each alliance stage and analytical explanations of such impacts are discussed.</p>

Making Sense of Changing Hats: A Study of the Nigeria, Vietnam, and Azerbaijan/Kazakhstan Projects within the Norwegian Statoil and British BP Strategic Alliance

To explore group-based identities and collective sensemaking in the context of a cross-border alliance, a qualitative exploratory study was initiated. The emphasis was on interpretation of issues, within and around an interfirm partnership and the alliance process, perceived by those involved as important. The BP and Statoil strategic alliance, formed to carry out joint oil and gas exploration and development in Nigeria, Vietnam and Azerbaijan/Kazakhstan, provided 52 interviews with staff from both partner headquarters and team members from the three projects. By studying an alliance process from multiple perspectives, it was possible to identify differences in sensemaking across different groups of employees. The organizational level (the alliance business unit level and the alliance team level) proved to be more important for shared sensemaking of the alliance process than group identities, such as nationalities, companies or locations. The alliance business unit level had been tasked with strategically developing and shaping the alliance, while the alliance teams had the operational responsibility for the project. The main theoretical implication is the primacy of project team-based identity to sensemaking regarding critical issues, emphasizing the importance of developing an alliance “supra-identity”. Implications for interfirm partnerships in Africa and Asia are also addressed.

Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder.

This study aimed to investigate alliance rupture and repair processes in psychotherapy for youth with borderline personality disorder. It sought to examine whether alliance processes differ between treatments, across the phases of therapy, and what associations these processes might have with therapeutic outcomes. The study involves repeated measurement of both process and outcome measures. Hypotheses were addressed using within- and between-subjects analyses. Forty-four people, aged 15-24, with a diagnosis of BPD were randomized to receive either 16 sessions of Cognitive Analytic Therapy (CAT) or a supportive treatment known as Befriending. In addition to pre-post outcome assessments, alliance processes were rated using the observer-based Rupture Resolution Rating Scale. Results indicated that CAT and Befriending did not differ in terms of number of ruptures, although CAT was associated with more stages of rupture resolution. Examination of alliance processes across time pointed to increasing ruptures, more frequent confrontation ruptures and increasing rupture resolution, suggesting increased volatility, directness and productivity in the therapeutic process across time. Contrary to hypotheses, there was no consistent link between alliance processes and outcome. However, two specific phases were significant. Early treatment ruptures were associated with poor outcome whereas greater late treatment resolution was associated with better outcomes. This study suggests that alliance processes can differ across treatments and the phases of therapy in psychotherapy for youth with BPD. Alliance ruptures are more likely to be problematic early in therapy but later in therapy, they appear to be opportunities for therapeutic growth. Alliance ruptures are more likely than not to occur in any given session with a young person with Borderline Personality Disorder. Early in therapy, withdrawal type ruptures are more frequent, whereas late in therapy, confrontation ruptures are more frequent. Late in therapy, alliance ruptures should be viewed as opportunities for therapeutic change, rather than barriers to good outcomes.

Disentangling the change–alliance relationship: Observational assessment of the therapeutic alliance during change and stuck episodes

The therapeutic alliance is considered the most robust process variable associated with positive therapeutic outcome in a variety of psychotherapeutic models [Alexander, L. B., & Luborsky, L. (1986). The Penn Helping Alliance Scales. In L. S. Greenberg & W. M. Pinsoff (Eds.), The psychotherapeutic process: A research handbook (pp. 325–356). New York: Guilford Press; Horvath, A. O., Gaston, L., & Luborsky, L. (1993). The alliance as predictor of benefits of counseling and therapy. In N. Miller, L. Luborsky, J. Barber, & J. P. Docherty (Eds.), Psychodynamic treatment research: A handbook for clinical practice (pp. 247–274). New York, NY: Basic Books; Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16; Orlinky, D., Grawe, K., & Parks, B. (1994). Process and outcome in psychotherapy: Noch einmal. In A. Bergin & J. S. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 270–378). New York, NY: Wiley and Sons]. The relationship between alliance and outcome has traditionally been studied based on measures that assess these therapy factors at a global level. However, the specific variations of the alliance process and their association with therapy segments that are relevant for change have not yet been fully examined. The present study examines the variations in the therapeutic alliance in 73 significant in-session events: 35 change and 38 stuck episodes identified through the observation of 14 short-term therapies of different theoretical orientations. Variations in the alliance were assessed using the VTAS-SF [Shelef, K., & Diamond, G. (2008). Short form of the revised Vanderbilt Therapeutic Alliance Scale: Development, reliability, and validity. Psychotherapy Research, 18, 433–443]. Nested analyses (HLM) indicate a statistically significant better quality of the alliance during change episodes.

Determining the research priorities for patients with chronic kidney disease not on dialysis.

The importance of engaging key stakeholders, and patients in particular, in determining research priorities has been recognized. We sought to identify the top 10 research priorities for patients with non-dialysis chronic kidney disease (CKD), their caregivers, and the clinicians and policy-makers involved in their care. We used the four-step James Lind Alliance process to establish the top 10 research priorities. A national survey of patients with non-dialysis CKD (estimated glomerular filtration rate <45 mL/min/1.73 m 2 ), their caregivers, and the clinicians and policy-makers involved in their care was conducted to identify research uncertainties. A Steering Group of patients, caregivers, clinicians and researchers combined and reduced these uncertainties to 30 through a series of iterations. Finally, a workshop with participants from across Canada (12 patients, 6 caregivers, 3 physicians, 2 nurses, 1 pharmacist and 1 policy-maker) was held to determine the top 10 research priorities, using a nominal group technique. Overall, 439 individuals responded to the survey and identified 1811 uncertainties, from which the steering group determined the top 30 uncertainties to be considered at the workshop. The top 10 research uncertainties prioritized at the workshop included questions about treatments to prevent progression of kidney disease (including diet) and to treat symptoms of CKD, provider- and patient-targeted strategies for managing CKD, the impact of lifestyle on disease progression, harmful effects of medications on disease progression, optimal strategies for treatment of cardiovascular disease in CKD and for early identification of kidney disease, and strategies for equitable access to care for patients with CKD. We identified the top 10 research priorities for patients with CKD that can be used to guide researchers, as well as inform funders of health-care research.

Investigating an approach to the alliance based on interpersonal defense theory

Objective: Notwithstanding consistent findings of significant relationships between the alliance and outcome, questions remain to be answered about the relatively small magnitude of those correlations, the mechanisms underlying the association, and how to conceptualize the alliance construct. We conducted a preliminary study of an approach to the alliance based on interpersonal defense theory, which is an interpersonal reconceptualization of defense processes, to investigate the promise of this alternative approach as a way to address the outstanding issues. Method: We employed qualitative, theory-building case study methodology, closely examining alliance processes at four time points in the treatment of a case in terms of a case formulation based on interpersonal defense theory. Results: The results suggested that our approach made it possible to recognize key processes in the alliance and that it helps explain how the alliance influences outcome. Our analyses also provided a rich set of concrete illustrations of the alliance phenomena identified by the theory. Conclusions: The findings suggest that an approach to the alliance based on interpersonal defense theory holds promise. However, although the qualitative method we employed has advantages, it also has limitations. We offer suggestions about how future qualitative and quantitative investigations could build on this study.

Alliance Process: A Micro Behavioral View

&lt;p&gt;Alliances are subject to heightened instability and while process based explanations are attracting increasing attention (e.g., Ring &amp;amp; Van De Ven, 1994), process based theorizing continues to remain an emergent field of study. In this paper I articulate a process based perspective of alliance instability that is rooted in the motivational orientation of the alliance boundary spanners (Das &amp;amp; Kumar, 2011). The process based perspective exemplifies the micro behavioral view which highlights the importance of individual’s cognitions and actions in shaping alliance outcomes. The paper explicates the linkages between the alliance boundary spanners motivational orientation, the alliance discrepancy model, and legitimacy repair strategies. I postulate that alliance boundary spanners may possess either a promotion focused or a prevention focused self-regulatory system. Alliance boundary spanners with a promotion focus are geared towards maximizing positive outcomes whereas alliance boundary spanners with a prevention focused self-regulatory system are geared towards minimizing negative outcomes. Alliance partners with a promotion focused self-regulatory system will detect outcome discrepancies sooner whereas alliance partners with a prevention focused self-regulatory system will detect process discrepancies sooner. Unfavorable outcome discrepancies are associated with a crisis of pragmatic legitimacy whereas unfavorable process discrepancies are associated with a crisis of moral legitimacy. I discuss the alternative ways in which alliance partners can seek to repair legitimacy. Implications for research and practice are discussed.&lt;/p&gt;

Periphery: Israel's Search for Middle East Allies

Periphery: Israel's Search for Middle East Allies

Periphery: Israel's Search for Middle East Allies

Periphery: Israel's Search for Middle East Allies

Therapist interpretation, alliance rupture-resolution and outcome

This exploratory study aimed at complementing the study of the relationship between therapist technique and the alliance process by examining the link between interpersonal accuracy and the sequence of rupture-resolution of the therapeutic ­alliance.

Alliance: a common factor of psychotherapy modeled by structural theory.

There is broad consensus that the therapeutic alliance constitutes a core common factor for all modalities of psychotherapy. Meta-analyses corroborated that alliance, as it emerges from therapeutic process, is a significant predictor of therapy outcome. Psychotherapy process is traditionally described and explored using two categorically different approaches, the experiential (first-person) perspective and the behavioral (third-person) perspective. We propose to add to this duality a third, structural approach. Dynamical systems theory and synergetics on the one hand and enactivist theory on the other together can provide this structural approach, which contributes in specific ways to a clarification of the alliance factor. Systems theory offers concepts and tools for the modeling of the individual self and, building on this, of alliance processes. In the enactive perspective, the self is conceived as a socially enacted autonomous system that strives to maintain identity by observing a two-fold goal: to exist as an individual self in its own right (distinction) while also being open to others (participation). Using this conceptualization, we formalized the therapeutic alliance as a phase space whose potential minima (attractors) can be shifted by the therapist to approximate therapy goals. This mathematical formalization is derived from probability theory and synergetics. We draw the conclusion that structural theory provides powerful tools for the modeling of how therapeutic change is staged by the formation, utilization, and dissolution of the therapeutic alliance. In addition, we point out novel testable hypotheses and future applications.

Toward a research-informed, evidence-based psychoanalytic supervision

Although establishing an evidence base for psychoanalytic practice has become a matter of increasing practical and accountability concern, the establishment of an evidence base for psychoanalytic supervision has yet to be given any consideration. In establishing a more comprehensive evidence-informed approach to treatment and training, the corollary need to build an evidence base for psychoanalytic treatment supervision would accordingly seem an important next step to address. What research supports the use of psychoanalytically informed constructs in supervision? With that research base considered, is there any sort of an evidence base for psychoanalytic supervision practice itself? In this paper, I would like to examine those two questions, giving particular attention to two psychoanalytically derived variables of supervision import: the supervisory alliance and parallel process. Based on research review, data thus far provide a high degree of empirical support for the supervisory alliance as perhaps being the crucial fundamental and foundational variable in making supervision work or not. While comparatively far more limited and less robust in nature, data about parallel process offer a tentative degree of support for that construct's importance in supervision as well. While still only in its most formative period, we at least appear to have an informed and informing evidence base for psychoanalytic supervision beginning to take more substantial shape.