Therapeutic Alliance In Cognitive-behavioral Therapy Research Articles

Therapeutic Alliance and Treatment Outcome in Cognitive Behavior Therapy for Obsessive-Compulsive Disorder.

ObjectiveTherapeutic alliance has consistently been found to predict treatment outcomes across various psychotherapies and patient diagnosis. However, the relationship between therapeutic alliance and outcome in Cognitive Behavioral Therapy (CBT) has shown mixed results. This study investigated the impact of different aspects of therapeutic alliance in CBT for Obsessive-Compulsive Disorder (OCD).MethodData from two previously completed randomized controlled trials of 208 patients with OCD and their therapists were analyzed. Therapeutic alliance was assessed at week 4 of treatment with the patient-rated and therapist-rated Working Alliance Inventory (WAI), which includes three subscales to measure alliance domains (Goal, Task and Bond). Higher WAI score reflects a better therapeutic relationship. OCD severity was rated by independent assessors at baseline and post-treatment using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Linear regression analyses were used to examine the effects of the different aspects of therapeutic alliance on treatment outcome, adjusted for baseline symptom severity.ResultsA higher total WAI score as rated by therapists significantly predicted a lower post-treatment Y-BOCS. Further, higher scores on the Goal and Task subscales of the WAI were associated with lower post-treatment severity. However, these significant outcomes reflected only small effect sizes.ConclusionsIn the treatment of OCD, the strength of the therapeutic alliance contributes to outcomes, though to a limited extent. Effective OCD treatment involves the delivery of specific therapy interventions, in the context of a strong therapeutic alliance.

Η θεραπευτική σχέση στη γνωσιακή συμπεριφοριστική θεραπεία

The article describes the distinctive features of the therapeutic relationship in cognitive behavioral therapy (CBT) and the ways of dealing with problems in the therapeutic interaction. The development of the way that the therapeutic relationship is understood within the context of cogntive behavioral therapy is presented, from the initial view that the therapeutic relationship is a necessary but not sufficient condition in order to achieve therapeutic change, to the modern view that the therapeutic change is produced by the therapeutic techniques, as well as the therapeutic relationship. The role of the therapist and the features of the therapeutic alliance in CBT are described, central among which is collaborative empiricism and Socratic questioning. The difficulties in the therapeutic relationship and the ways that can be addressed are discussed in the context of the related concepts of resistance, of ruptures in the therapeutic alliance and of transference and countertransference. The rationale regarding boundaries to the therapeutic relationship is discussed. In conclusion, in CBT the emphasis on the therapeutic relationship is not so central as in other therapeutic models and the relationship is integrated with techniques, although there is ongoing effort to enhance and expand the understanding of the therapeutic interaction. Nonetheless the quality of the relationship is not inferior to that of other treatment models and the therapeutic change in CBT is attributed equally to the implementation of techniques and relationship factors.

The therapeutic alliance in cognitive-behavioral therapy for school-aged children with autism and clinical anxiety.

Little is known about the alliance between therapists and children with autism spectrum disorder who are receiving psychological therapies in outpatient treatment settings. This study examined the therapeutic alliance in children with autism spectrum disorder and clinical anxiety, who were receiving cognitive behavioral therapy in a randomized, controlled trial. The Therapeutic Alliance Scale for Children was administered to a sample of children and youth with autism spectrum disorder and anxiety (N = 64; aged 7-14) as well as to their parents and therapists. A comparison sample of typically developing youth with clinical anxiety (N = 36; aged 5-12) was included. The child-therapist alliance was more positive among typically developing children than among children with autism spectrum disorder; correspondingly, the parent-therapist alliance was also more positive among parents of typically developing children. Therapist reports of positive child-therapist alliance predicted post-treatment reductions in anxiety among children with autism spectrum disorder, although child reports of this alliance did not. Parent reports of positive parent-therapist alliance also predicted post-treatment reductions in the child's anxiety in the group with autism spectrum disorder. A strong therapeutic alliance appears to be associated with better treatment outcomes in children with autism spectrum disorder receiving cognitive behavioral therapy, although a thoughtful and diagnostically sensitive approach is advisable to promote a positive alliance with children with autism spectrum disorder.

Therapeutic alliance in a randomized clinical trial for bulimia nervosa.

This study examined the temporal relation between therapeutic alliance and outcome in two treatments for bulimia nervosa (BN). Eighty adults with BN symptoms were randomized to 21 sessions of integrative cognitive-affective therapy (ICAT) or enhanced cognitive-behavioral therapy (CBT-E). Bulimic symptoms (i.e., frequency of binge eating and purging) were assessed at each session and posttreatment. Therapeutic alliance (Working Alliance Inventory) was assessed at Sessions 2, 8, 14, and posttreatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine differences in alliance growth by treatment and patient characteristics. Mixed-effects models examined the relation between alliance and symptom improvement. Overall, patients in both treatments reported strong therapeutic alliances. Regardless of treatment, greater therapeutic alliance between (but not within) subjects predicted greater reductions in bulimic behavior; reductions in bulimic behavior also predicted improved alliance. Patients with higher depression, anxiety, or emotion dysregulation had a stronger therapeutic alliance in CBT-E than ICAT, while those with more intimacy problems had greater improvement in therapeutic alliance in ICAT compared to CBT-E. Therapeutic alliance has a unique impact on outcome, independent of the impact of symptom improvement on alliance. Within- and between-subjects effects revealed that changes in alliance over time did not predict symptom improvement, but rather that individuals who had a stronger alliance overall had better bulimic symptom outcomes. These findings indicate that therapeutic alliance is an important predictor of outcome in the treatment of BN.

How does the therapeutic alliance develop throughout cognitive behavioral therapy for panic disorder? Sawtooth patterns, sudden gains, and stabilization

Objective: There has been little research on the development of the therapeutic alliance in cognitive behavioral therapy (CBT). This study aims to examine the development of therapeutic alliance in CBT for panic disorder. Method: Nineteen patients were treated with CBT for panic disorder. Pre- and post-session data of the therapeutic alliance and panic symptoms and cognitions were collected. Results: Several patterns were observed, including a sawtooth pattern (within-session improvements followed by decline between sessions; 63% of the patients), sudden gains in the alliance (58%), and late stabilization (89%). The sawtooth pattern was related to less symptom reduction between sessions (explained variance = 20–48%). Though not statistically significant, there were moderate effect sizes for the relationships between outcomes and early alliance and sudden gains (explained variance = 13–17%). Conclusions: Overall, results suggest that intensive data collection is likely to yield understanding of the relationship between therapy processes and outcomes.

Relationship and techniques in cognitive-behavioral therapy--A motivational approach.

Motivational attunement is presentedhere as a set of guiding principles thatcan be used to foster the therapeuticalliance in cognitive–behavioral ther-apy (CBT). The overarching goal ofmotivational attunement is to providethe client with need-satisfying experi-ences. In order to do so, the therapistmust attune his or her interventions tothe client’s motivational goals. The au-thors attempt to demonstrate how ther-apists can assess motivational goalsand use this information to foster thecentral components of the alliance. Theauthors also outline how motivationalattunement can be used to prevent andresolve alliance ruptures. Finally, em-pirical support for the effects of motiva-tional attunement is brie y described.Keywords: psychotherapy, relationship,techniques, motivation, CBT