The therapeutic relationship between the practitioner and the patient is between the client and therapist of the tasks and goals of therapy (Bordin, ). The therapeutic nurse-client relationship is the basis, the very core, of all psychiatric nursing treatment ap- proaches regardless of the specific aim. The very first. But while the therapeutic alliance is a common factor across all therapies, it is apply judgment, and help the patient define and reach their goals in therapy.
There are hundreds of studies that show that a purposeful collaborative relationship between a therapist and the patient correlates with positive therapeutic progress. The most important aspect of effective therapy requires the patient and the therapist work collaboratively. But even so, the power of the alliance is often far stronger than many realize, and the most effective therapists are those who focus specifically on building the alliance.
Research shows that many clients make an improvement between making the telephone call to book the first session, and the actual first session Wampold, By the time they arrive in the therapy room and meet the therapist for the first time, they are often feeling better, more empowered.
However once in the therapy room there are many factors that can help build empathy and accord, as the smart therapist knows, and equally, many factors that can undermine it. But while the therapeutic alliance is a common factor across all therapies, it is more than the bond between therapist and client.
Understanding the Therapeutic Alliance - Psychotherapy Treatment And Psychotherapist Information
The therapist needs to be experienced and intuitive enough to critically formulate and apply judgment, and help the patient define and reach their goals in therapy. Not that experience itself is necessarily the key to a powerful and effective alliance — in fact in some studies e.
Castonguay et al, it has been shown that as some therapists became more technically able, paradoxically they can became less effective therapeutically. Although some studies are based on a very limited number of cases, the results appear consistent: While recent theorists have stressed on the dynamic nature of the therapeutic alliance over time, most researchers have used static measures of alliance.
There are currently several therapy models that consider the temporal dimension of the alliance, and these can be divided into two groups: Few studies have analyzed alliance at different stages in the treatment process. According to the results proposed by Traceythe more successful the outcome, the more curvilinear the pattern of client and therapist session satisfaction high—low—high over the course of treatment.
When the outcome was worse, the curvilinear pattern was weaker. Kivlighan and Shaughnessy use the hierarchical linear modeling method an analysis technique for studying the process of change in studies where measurements are repeated to analyses the development of the alliance in a large number of cases.
According to their findings, some dyads presented the high—low—high pattern, others the opposite, and a third set of dyads had no specific pattern, although there appeared to be a generalized fluctuation in the alliance during the course of treatment.
In recent years, researchers have analyzed fluctuations in the alliance, in the quest to define patterns of therapeutic alliance development. Kivlighan and Shaughnessy distinguish three patterns of therapeutic alliance development: They based their analysis on the first four sessions of short-term therapy and focused their attention on the third pattern, in that this appeared to be correlated with the best therapeutic outcomes.
In further studies of this development pattern, Stiles et al. Unlike Kivlighan and Shaughnessy, these authors considered therapies consisting of 8 and 16 sessions, using the ARM to rate the therapeutic bond, partnership, and confidence, disclosure, and patient initiative.
No significant correlation was observed between any of the four patterns and the therapeutic outcome. However, the authors observed a cycle of therapeutic alliance rupture—repair events in all cases: On the basis of this characteristic, the authors hypothesize that the V-shaped alliance patterns may be correlated with positive outcomes.Therapeutic Relationships in Nursing: The Professions' Perspective (Part 1 of 2)
In particular, Stiles et al. The results of the study by De Roten et al. According to De Roten et al. De Roten et al. According to Castonguay et al. This has supported the idea that therapeutic alliance may be characterized by a variable pattern over the course of treatment, and led to the establishment of a number of research projects to study this phenomenon.
Discussion and Conclusion According to their meta-analysis based on the results of 24 studies, Horvath and Symonds demonstrate the existence of a moderate but reliable association between good therapeutic alliance and positive therapeutic outcome. More recent meta-analyses of studies examining the linkage between alliance and outcomes in both adult and youth psychotherapy Martin et al. Thus, it is not by chance that in their meta-analysis, Horvath and Luborsky conclude that two main aspects of the alliance were measured by several scales regardless of the theoretical frameworks and the therapeutic models: This accounts for the difficulties associated with the concept of alliance, which is built interactively, and so any assessment must also consider the mutual influence of the participants.
In a helpful contribution, Hentschel points out that the problematic aspect of empirical studies investigating the alliance is their tendency to view the alliance construct as a treatment strategy and a predictor of therapeutic outcome: The use of neutral observers or the creation of counterintuitive studies is therefore recommended. From this historical excursus, it is clear that research into the assessment of the psychotherapeutic process is alive and well.
The development of a dynamic vision of the concept of therapeutic alliance is also apparent. The work of theorists and researchers has contributed toward enriching the definition of therapeutic alliance, first formulated in Research aimed at analyzing the components that make up the alliance continues to flourish and develop. Numerous rating scales have been designed to analyses and measure the therapeutic alliance, scales that have enabled us to gain a better understanding of the various aspects of the alliance and observe it from different perspectives: Attention has recently turned toward the role of the therapeutic alliance in the various phases of therapy and the relationship between alliance and outcome.
So far, few studies have regarded long-term psychotherapy involving many counseling sessions. This topic, along with a more detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects.
Equally important, in our opinion, will be the findings of studies regarding drop-out and therapeutic alliance ruptures, which must necessarily consider the differences between that perceived by the patient and that perceived by the therapist.
Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Acknowledgments The authors thank Mauro Adenzato for his valuable comments and suggestions to an earlier version of this article. A Research Handbook, eds Greenberg L. Guilford Press;— Bibring E.
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Thinking about thinking in therapy: Relation between working alliance and outcome in psychotherapy: Clinical Prediction in Psychotherapy. Jason Aronson Howard I. Therapeutic alliance mediates the relationship between interpersonal problems and depression outcome in a cohort of multiple sclerosis patients. Group climate, cohesion, alliance, and empathy in group psychotherapy: Meta-analysis of therapeutic relationship variables in youth and family therapy: