Treatment Alliance Research Articles

The Importance of Facilitating Adherence in Maintenance Therapy for Bipolar Disorder

Treatment goals for patients with bipolar disorder differ depending on the phase in which the patient presents. During maintenance treatment, the goal of therapy should be for patients to become stable and improve their quality of life. However, the most challenging barrier to effective treatment of bipolar disorder is patient nonadherence with clinician-recommended therapy. A strong treatment alliance between patients and clinicians to provide good social support can help patients adhere to treatment.

Knowing Terrible Things: Engaging Survivors of Extreme Violence in Treatment

Survivors of extreme violence can be difficult to engage in treatment. Often this is caused by a sense of isolation drawn from the belief that no one who has not shared their experience can comprehend it. The only others who know what they know are those who have died of the violence, fellow survivors and the perpetrators. The clinician attempting to treat such patients may be placed in a dilemma: how to convey the capacity to know terrible things without being destroyed by the survivor, while at the same time not conveying that one is dangerous oneself. This paper suggests a method of utilizing unconscious aggressive fantasy to access the capacity to convey to the survivor that it is possible to hear, understand and contain violent experience. Case illustrations indicate how such capacity might be conveyed, so that a treatment alliance can begin.

Satisfaction with Components of the Therapeutic Model: Perspectives of Consumers and Professionals

We provide information about consumer and provider perceptions using a mixed-model pilot study within the Intensive Mental Health Project (IMHP), a school-based treatment service for children with SED and their families. Caregiver, youth, and provider questionnaires developed for this project elicited quantitative and qualitative information on treatment satisfaction, therapeutic alliance, and active involvement in treatment. Caregivers and children overall had positive perceptions of the services they received through IMHP. Providers reported very good working relationships with most children and families. Consumers also provided constructive comments about how to improve services. Our results add support to the importance of therapeutic alliance and collaboration, which are guiding principles of the IMHP.

Treatment Alliance in Residential Treatment of Criminal Adolescents

Research on relationship aspects in residential treatment of criminal young persons has largely been neglected despite the general finding in treatment research that such aspects have a large bearing on outcome. In this article, two studies of associations between relationship aspects and outcome in this treatment context are presented. In one of them, two treatment units practicing Aggression Replacement Training and CBT-techniques and 2 U with more conventional, relationally oriented treatment approaches were studied using process questionnaires and interviews. In the other study, adolescents who had been sentenced to treatment were interviewed about treatment experiences 1 year after release. Despite considerable attrition, several interesting findings were noted: The boys’ alliance ratings were associated with the collaborative aspect of the staff’s alliance ratings, but not with the bond aspect; warm and close staff feelings were related to negative outcome and the boys’ conceptions of the treatment model but not of the relationship with the staff was associated with positive outcome. The results suggest that a distinction should be made between a mutual bond aspect of the staff−boy relationship that was not related to outcome and a collaborative aspect which was related to outcome.

Can research influence clinical practice?

After briefly reviewing the unfavourable reception accorded empirical research by parts of the psychoanalytic community, as well as some of the benefits to clinical practice of analysts being involved in research activities, the author examines whether the findings of process and outcome research in psychotherapy and psychoanalysis can help identify the most appropriate forms of intervention for producing therapeutic change, given the specific condition of the patient and the relationship that the individual establishes with the analyst. He argues that research findings can influence clinical practice on various levels and in different areas, and goes on to examine a number of related issues: the specificity of therapeutic interventions versus the relevance of common curative factors; the dyadic conception of technique and ways of understanding the therapeutic action of the treatment alliance; and the strategic or heuristic conception in psychoanalytic therapy. Finally, the author presents clinical material with the aim of illustrating how the knowledge acquired through research can be applied to psychoanalytic treatment.

A feasibility study of a web-based performance improvement system for substance abuse treatment providers

We report here on the feasibility of implementing a semiautomated performance improvement system—Patient Feedback (PF)—that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4 weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at postintervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness.

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families.

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents' and youths' perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.

Clinical Presentation and Treatment Outcome of African Americans With Complicated Grief

This study sought to examine whether ethnic differences occur in the presentation of patients with complicated grief or their treatment outcome.Analyses of a randomized controlled trial comparing a novel psychotherapy for complicated grief with interpersonal psychotherapy contrasted the clinical presentation, treatment alliance, and rates of treatment completion and response for 19 African Americans with complicated grief and 19 Caucasian Americans with complicated grief matched by sex, age, and baseline grief severity. Participants were randomly assigned to receive 16 sessions of either standard interpersonal psychotherapy or interpersonal psychotherapy enhanced with focused complicated grief components.No differences were found in any clinical or treatment-related measure.African Americans and Caucasian Americans with complicated grief did not differ significantly in clinical presentation, treatment alliance, treatment completion, and outcome. The results suggest that standard treatment for complicated grief can be provided successfully for different racial and economic groups.

Clinical Presentation and Treatment Outcome of African Americans With Complicated Grief

This study sought to examine whether ethnic differences occur in the presentation of patients with complicated grief or their treatment outcome. Analyses of a randomized controlled trial comparing a novel psychotherapy for complicated grief with interpersonal psychotherapy contrasted the clinical presentation, treatment alliance, and rates of treatment completion and response for 19 African Americans with complicated grief and 19 Caucasian Americans with complicated grief matched by sex, age, and baseline grief severity. Participants were randomly assigned to receive 16 sessions of either standard interpersonal psychotherapy or interpersonal psychotherapy enhanced with focused complicated grief components. No differences were found in any clinical or treatment-related measure. African Americans and Caucasian Americans with complicated grief did not differ significantly in clinical presentation, treatment alliance, treatment completion, and outcome. The results suggest that standard treatment for complicated grief can be provided successfully for different racial and economic groups.

Therapeutic Alliance and Treatment Progress in Couple Psychotherapy

This study examined the ability of the therapeutic alliance to predict treatment progress on individual- and relationship-level variables from the early to middle phase of couple treatment. Although alliance did not predict progress in individual functioning, it accounted for 5-22% of the variance in improvement in marital distress. Women's mid-treatment alliance uniquely predicted improvement in marital distress, over and above early treatment alliance. When men's alliances with the therapist were stronger than their partners' at session 8, couples showed more improvement in marital distress. Treatment response was also positively associated with women's ratings of their partners' alliance. Results confirm that the therapeutic alliance in conjoint treatment is composed of distinct client subsystems that are useful predictors of treatment progress.

Payeeship, Financial Leverage, and the Client-Provider Relationship

Payeeship, Financial Leverage, and the Client-Provider Relationship

Finding Value in Client Resistance

The psychoanalytic concept of resistance is explored in the context of occupational therapy. Research suggests (1) noncompliance with treatment is tied to conflicting perceptions on the part of the therapist and client; (2) a treatment alliance is necessary for achieving successful treatment; and (3) paradigms have emerged that are moving away from a medical model of disability. These new paradigms offer an alternate lens through which to view client responses to treatment. Therapist error, based on either faulty attitudes or lack of psychosocial competence, may play a part in the development of resistance. It is asserted that the concept of resistance can be conceptualized as a powerful force that, if confirmed within the therapeutic alliance, can lead to positive outcomes in treatment.

Innovations: Psychoeducation: Multifamily Group Treatment in a Program for Patients With First-Episode Psychosis: Experiences From the TIPS Project

Innovations: Psychoeducation: Multifamily Group Treatment in a Program for Patients With First-Episode Psychosis: Experiences From the TIPS Project

Adapting interpersonal psychotherapy for borderline personality disorder

Background: Among the important characteristics of borderline personality disorder (BPD) are interpersonal difficulties and depressive symptoms. Interpersonal psychotherapy (IPT), one of the best tested time-limited psychotherapies for certain DSM-IV Axis I disorders, has demonstrated efficacy in improving psychosocial functioning and in treating major depressive disorder.Aims: This paper describes the rationale for testing IPT as a treatment for patients with BPD, the adaptation of standard IPT for such patients, and the commencement of an open, pilot study of initial tolerance and feasibility.Method: The authors developed a treatment manual adapting IPT to BPD. Changes from standard IPT included: (i) conceptualization, and (ii) chronicity of the disorder, (iii) difficulties in forming and maintaining the treatment alliance, (iv) length of treatment, (v) suicide risk, (vi) termination, and (vii) choice of subjects within the BPD spectrum of diagnosis.Results: The manual is being tested in an open, eight-month trial. Early results of the intervention are discussed.Conclusions: IPT may provide an alternative to existing treatments for patients with BPD who have interpersonal difficulties.Declaration of interest: This work was supported by a grant from the National Alliance for Research on Schizophrenia and Depression (NARSAD). The lead author has published books on IPT with American Psychiatric Press, Basic Books, Franco Angeli, and Editions Médecine & Hygiène Société.

Role of treatment alliance in the clinical management of bipolar disorder: Stronger alliances prospectively predict fewer manic symptoms

The strength of the treatment alliance between patients and their clinicians may play a unique role in the management of bipolar disorder. However, few empirical studies have examined the alliance in bipolar disorder or its effects on patient outcomes. This study investigates variables associated with a strong treatment alliance in bipolar disorder, and the prospective effects of treatment alliance on patients' mood symptoms and treatment attitudes. Participants were 58 longitudinally followed individuals with Bipolar I disorder. We found that alliance ratings covaried with depressive symptoms, such that alliance strength increased as depressive symptoms decreased, and stronger alliances were associated with more social support. Tests of temporal association indicated that stronger alliances predicted fewer manic symptoms 6 months later. Stronger alliances also predicted less negative attitudes about medication and less of a sense of stigma about bipolar disorder. Thus, a strong treatment alliance may help to reduce manic symptoms over time. It may be that a strong treatment alliance encourages patients' greater acceptance of bipolar disorder and psychopharmacological interventions, and thus contributes to improved medication adherence and clinical outcomes. Considered in sum, these findings suggest that the treatment alliance is an integral component of the long-term management of bipolar disorder.

HIV/AIDS Education and Treatment Alliance: Current Challenges in the Management of HIV

Journal of the American Academy of Physician Assistants: October 2006 - Volume 19 - Issue 10 - p 23

HIV/AIDS Education and Treatment Alliance: Current Challenges in the Management of HIV

HIV/AIDS Education and Treatment Alliance: Current Challenges in the Management of HIV

Anorexia nervosa: treatment satisfaction

Patient satisfaction plays a central role in treatment alliance and outcome. Investigating patient expectations and experiences of treatment sheds light on its importance. This study examines adolescent anorexia nervosa patients and their parents' satisfaction with family‐based treatment. Patients and parents answered a questionnaire at the eighteen‐month follow‐up focusing on expectations and experiences of treatment, therapists, aims of treatment and accomplishment. The results show that 73 per cent of the patients and 83 per cent of the parents felt that their pre‐treatment expectations had been fulfilled. The majority agreed that individual patient sessions and parental sessions were of great help, while the patients valued family therapy sessions as being less helpful than did parents. In overall terms, parents were more pleased with the therapists than were the patients. These data suggest that family‐based treatment with individual sessions for patients, in parallel with parental sessions combined with family sessions, corresponds well to patients' and parents' treatment expectations.

THREE PERSPECTIVES ON CLIENTs' EXPERIENCES OF THE THERAPEUTIC ALLIANCE: A DISCOVERY‐ORIENTED INVESTIGATION

To deepen our understanding of the therapeutic alliance in conjoint treatment, we interviewed clients in four families about their individual, private experience of the alliance after an early session. These qualitative data were triangulated with family members' scores on Pinsof's Family Therapy Alliance Scale-Revised and observational ratings of their behavior on the System for Observing Family Therapy Alliances. This discovery-oriented investigation focused on three interrelated aspects of the alliance: the family's shared sense of purpose about the needs, goals, and value of therapy (i.e., within-system alliance), split alliances with the therapist, and felt sense of safety within the therapeutic context. Results were highly consistent across the three perspectives and congruent with idiographic, therapist-rated outcomes.

Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression

Abstract Supervision of psychotherapists and counselors, especially in the early years of practice, is widely accepted as being important for professional development and to ensure optimal client outcomes. Although the process of clinical supervision has been extensively studied, less is known about the impact of supervision on psychotherapy practice and client symptom outcome. This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. The authors randomly assigned 127 clients with a diagnosis of major depression to 127 supervised or unsupervised therapists to receive eight sessions of problems-solving treatment. Supervised therapists were randomly assigned to either alliance skill– or alliance process–focused supervision and received eight supervision sessions. Before beginning treatment, therapists received one supervision session for brief training in the working alliance supervision approach and in specific chara...