Concept Of Therapeutic Alliance Research Articles

Adaptation of the working alliance inventory for the assessment of the therapeutic alliance in genetic counseling.

The concept of therapeutic alliance is central to genetic counseling as the mechanism through which the outcomes of empowerment and effective coping are likely to be achieved. To date, there have been no published systematic assessments of the therapeutic relationship in genetic counseling. We adapted a previously validated measure of the therapeutic alliance to genetic counseling and assessed its reliability and validity. Participants were enrolled in a clinical genomic study where they were randomized to receive education about carrier results via a Web platform or via a genetic counselor and then further randomized to receive genetic counseling (without additional education) or not. We rated the therapeutic alliance from audio recordings of 120 genetic counseling sessions. We modified the observer version of the Working Alliance Inventory (WAI-O), initially designed to assess therapeutic relationships in psychotherapy. We examined internal consistency reliability by calculating Cronbach's alpha and inter-rater reliability through both percent agreement and Gwet's alternative agreement coefficient (AC). Regression analyses were used to evaluate the relationship of WAI-O scores with session length and with the designation of the session as one in which prior education was delivered by the genetic counselor or not. The adapted scale had high-reliability characteristics with agreement of 88%-93%, Gwet's AC of 0.84-0.90, and Cronbach's alpha of 0.89-0.93 for the three WAI-O subscales (bonds, goals, and tasks). Although there was no difference in alliance based on whether prior education was provided by the genetic counselor, the total WAI-O score significantly increased with increasing session length (beta =0.667, p<.001), providing preliminary evidence of construct validity. The WAI-O that we have adapted can be used reliably with two independent raters to assess the therapeutic alliance in studies of genetic counseling. The initial evidence for construct validity is promising and should be reassessed in future genetic counseling studies using the WAI-O.

\u201cIt\u2019s better to have three brains working instead of one\u201d: a qualitative study of building therapeutic alliance with family members of critically ill patients

BackgroundStudies in the intensive care unit (ICU) suggest that better communication between families of critically ill patients and healthcare providers is needed; however, most randomized trials targeting interventions to improve communication have failed to achieve family-centered outcomes. We aim to offer a novel analysis of the complexities involved in building positive family-provider relationships in the ICU through the consideration of not only communication but other important aspects of family-provider interactions, including family integration, collaboration, and empowerment. Our goal is to explore family members’ perspectives on the enablers and challenges to establishing therapeutic alliance with ICU physicians and nurses.MethodsWe used the concept of therapeutic alliance as an organizational and analytic tool to conduct an interview-based qualitative study in a 20-bed adult medical-surgical ICU in an academic hospital in Toronto, Canada. Nineteen family members of critically ill patients who acted as substitute decision-makers and/or regularly interacted with ICU providers were interviewed. Participants were sampled purposefully to ensure maximum variation along predetermined criteria. A hybrid inductive-deductive approach to analysis was used.ResultsParticipating family members highlighted the complementary roles and practices of ICU nurses and physicians in building therapeutic alliance. They reported how both provider groups had profession specific and shared contributions to foster family communication, integration, and collaboration, while physicians played a key role in family empowerment. Families’ lack of familiarity with ICU personnel and processes, physicians’ sporadic availability and use of medical jargon during rounds, however, reinforced long established power differences between lay families and expert physicians and challenged family integration. Family members also identified informal interactions as missed opportunities for relationship-building with physicians. While informal interactions with nurses at the bedside facilitated therapeutic alliance, inconsistent and ad-hoc interactions related to routine decision-making hindered family empowerment.ConclusionsMultiple opportunities exist to improve family-provider relationships in the ICU.The four dimensions of therapeutic alliance prove analytically useful to highlight those aspects that work well and need improvement, such as in the areas of family integration and empowerment.

Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire.

BackgroundDigital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy.ObjectiveThis study presented the first attempt to (1) explore service users’ views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions.MethodsIn stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word “therapist” with the word “app.” In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt.ResultsFindings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person’s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (“The app is like having a member of my care team in my pocket”).ConclusionsThis study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif)

Therapeutic Alliance in Mental Health Nursing: An Evolutionary Concept Analysis

The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.

Irreducibly Human Encounters: Therapeutic Alliance and Treatment Outcome in Child and Adolescent Psychotherapy

The concept of therapeutic alliance is examined in relation to treatment outcomes in youth psychotherapy. The first section of the article develops an intuitive account wherein the relationship between the therapist and youth client is purported to hold great significance for treatment effectiveness in psychological interventions. The remainder of the article aims to validate this deep-rooted intuition via close examination of how therapeutic alliance has been defined, measured, and meta-analyzed in the current literature. Methodological and philosophical challenges to the concept and implications for future research and practice are discussed. Cautious, but optimistic conclusions are drawn affirming the intuitive position that the relationship between therapist and youth client does indeed impact treatment outcome.

Making rhetoric a reality: effective capacity building in mental healthcare provision

Patients diagnosed with mental illness are statistically less likely to access physical healthcare services, resulting in increased mortality rates and diminished quality and decreased longevity of lifespan. This article identifies key aspects of the need for capacity building in, and between, all professional healthcare disciplines and utilizes a clinical case study to demonstrate the relevance of basic psychosocial interventions to all healthcare professionals. Alongside the practicalities of mental healthcare provision within the context of 21st-century society, discussion is extended to two basic theoretical models for understanding the relationship of mental illness to factors over which there can be no intraneous or conscious control. In this sense, the portrayal of patients with mental illness first and foremost as people whose somewhat transient demise from general wellbeing serves only to brand and stigmatize them from the point of diagnosis as fundamentally different to others. Mechanisms of how these stark rhetorical issues may be altered through building on the concept of therapeutic alliance with appropriately designed and insightful pathways of development for multidisciplinary healthcare teams aptly conclude the article.

THERAPEUTIC ALLIANCE AND COLLABORATIVE INTERACTIONS

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 addresses the issue of the interactive dimension involved in the regulation of the collaborative relationship, focusing on some aspects of patient-analyst interactions aimed at fostering the collaborative process. These, illustrated with clinical material, concern: (1) the use of analytic method, considered as an object shared by the patient and the analyst, (2) the existence of different levels in the collaborative relationship, (3) the analysis of the pragmatic meaning of verbal communication as a tool for constructing collaborative interactions. By shifting her attention from the symbolic content of words to the pragmatic meaning of discourse--the author highlights the continuity between fostering the collaborative relationship in the course of proper interpretive activity and dealing with it directly by non-interpretive interventions.

Exploring the helping relationship between the schizophrenic client and rehabilitation therapist.

This paper argues that the enhanced efficacy of current rehabilitation strategies compared to insight-oriented therapies for schizophrenic clients cannot be understood in terms of differences in technique alone. Rather, the relationship that develops between rehabilitation therapist and schizophrenic client may represent a potent therapeutic ingredient warranting further study. The concept of therapeutic alliance is examined as a means toward understanding the mechanisms underlying successful rehabilitation.