Therapeutic Working Alliance Research Articles

The relationship between clients’ cognitive functioning and the therapeutic working alliance in post-acute brain injury rehabilitation

Objective: To examine the impact of brain-injured patients’ cognitive abilities on their working alliance (WA) with their therapist in post-acute rehabilitation.Design: Cognitive tests were administered to brain-injured individuals at the beginning of post-acute, holistic brain-injury rehabilitation. Clients as well as their primary therapists rated their mutual WA at four time points throughout a 14-week rehabilitation programme. Subjects consisted of 86 clients as well as their primary therapists. Clients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10).Measures: (1) Neuropsychological tests of attention, memory and higher cognitive functions; (2) the Working Alliance Inventory, client and therapist short form.Results: Overall, the relationships between cognitive tests and WA ratings were weak. The tests of attention, memory and higher cortical functions were differentially related to clients’ and therapists’ view of their mutual WA at the different stages of their collaborative work.Discussion and conclusion: Clients’ cognitive profile affects clients’ and therapists’ view of their WA in different ways. The weakness of the correlations between cognitive tests and WA ratings may indicate that a good WA is achievable also with clients with severe cognitive difficulties.

Prädiktoren für die Inanspruchnahme einer Psychotherapie

The aim of this study was to discover prognostic criteria for outpatients' making use of psychotherapy. Data from patients and therapists were collected. After initial psychoanalytic interviews, 92 patients at a university psychotherapy outpatient department were asked to complete narrative forms and standardized questionnaires (FMP) regarding their motivation to seek psychotherapy. In addition, the therapists contributed a Global Assessment of Functioning (GAF) and estimate of the initial therapeutic working alliance (iTAB) for each patient. In the follow-up, we investigated patients' actual use of psychotherapy. Sociodemographic variables, personality variables, and diagnoses had only minor prognostic relevance, whereas therapists' assessments of patient resources for therapeutic relationship and work proved to be of high predictive value. Positive assessment of a patient's ability for therapeutic working alliance in the initial diagnostic interview is shown to be an important prognostic factor of a patient's entering psychotherapy.

Subjective outcome of brain injury rehabilitation in relation to the therapeutic working alliance, client compliance and awareness

Objective: To investigate the relationship between working alliance, compliance, awareness and subjective outcome of brain injury rehabilitation. Subjects were 86 patients who were clients in an holistic neuropsychological outpatient rehabilitation programme. They had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or some other neurological insult (n = 10).Measures: The therapeutic alliance, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists. Clients completed the European Brain Injury Questionnaire (EBIQ) at programme start and end. Clients and therapists rated the overall success of their collaboration at programme end.Results: Clients' experience of a good emotional bond between themselves and therapists in mid-therapy was predictive for the reduction of clients’ report of depressive symptoms on the EBIQ depression sub-scale (R = 0.68, n = 43, p < 0.001). Good compliance early in the programme was predictive of changes on the EBIQ. Improvement of awareness was related to the amplification of depressive symptoms (r = −0.27, n = 56, p < 0.05).Conclusions: Brain injury rehabilitation should be seen as a dynamic process that develops between clients and therapists. Future research should further investigate the relationship between process and outcome and how the therapeutic process can be optimized.

The development of the therapeutic working alliance, patients’ awareness and their compliance during the process of brain injury rehabilitation

Purpose: To examine the development and interaction of the therapeutic alliance, patients’ compliance and awareness during the process of brain injury rehabilitation and the role of demographic and injury related variables in this process. Subjects were 86 patients who underwent a holistic neuropsychological outpatient rehabilitation programme. Patients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10).Measures: The therapeutic alliance between clients and their primary therapists, clients’ awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists.Results: The development of the process measures over time is described in the article. Clients’ and therapists’ perspectives on their alliance tended to converge over time. Clients’ experience of their emotional bond with their therapist added as much to the prediction of clients’ awareness as the localization of their brain injury. Clients’ awareness was related to their compliance and mediated the impact of the therapeutic alliance on their compliance.Discussion: A good working alliance is the basis of successful rehabilitative work. The article discusses therapeutic implications of the results.

The role of the therapeutic alliance in psychotherapy.

The article traces the development of the concept of the therapeutic working alliance from its psychodynamic origins to current pantheoretical formulations. Research on the alliance is reviewed under four headings: the relation between a positive alliance and success in therapy, the path of the alliance over time, the examination of variables that predispose individuals to develop a strong alliance, and the exploration of the in-therapy factors that influence the development of a positive alliance. Important areas for further research are also noted.

A treatment‐planning grid for clinical case managers

AbstractTwo variables are crucial to the development of treatment plans for chronic mental patients. Acceptance of the patient role and ability to form a therapeutic working alliance shape the clinical context within which treatment planning occurs.

Problems in the psychotherapy of children with histories of incest.

Therapists must be cognizant of the meaning of the patients' presentation and the extreme need for therapeutic safety. The therapists must be keenly aware of the deprivation issues for these patients and not be seduced by the sexual "red herring." At the same time, the therapist must be careful that his own discomfort does not make him run away from the sexual material. Thus the therapist must strike a difficult balance between the two. The therapist must avoid allying with the child solely as a victim, an alliance which would hinder an understanding of the child's motivation and subsequent guilt, and thus foster further difficulties. The therapist must work through his own outrage that a child has been molested so that he may avoid blame seeking. By attending to these issues, the individual psychotherapist will pass the patients' "test" and take the first step in helping patients and their families in forming a therapeutic working alliance.

The uses of dreams in conjoint marital therapy.

Abstract Where a strong therapeutic working alliance exists, dreams can be used in conjoint marital therapy. Certain simple techniques are helpful in encouraging the recall and recounting of dreams. Dreams can be reported and discussed either between the marital couple or with the therapist in the three-way therapeutic situation. The therapist must structure the discussion in such a way as to encourage positive uses of the dream material, such as the recall of childhood memories and the mutual discussion of areas of deep feeling. Communication and closeness between a couple can be enhanced by proper use of this technique.

DEVELOPING A THERAPEUTIC WORKING ALLIANCE WITH THE ADOLESCENT GIRL

DEVELOPING A THERAPEUTIC WORKING ALLIANCE WITH THE ADOLESCENT GIRL