Under this point of view, an alliance can be conceptualized as the totality of the alliances formed (Gillaspy et al., 2002). One conceptualization of therapeutic alliance in group psychotherapy follows Bordin’s theory, transferring this multifactorial construct from an individual to a group setting. Furthermore, research into the relationship between the process and outcome of psychotherapy has frequently attempted to explain the non-specific factors theorized by Strupp and Hadley (1979) which can have a significant impact on the outcome of different treatments. Yalom (1995) speaks of a sense of support, trust, belonging in the group, and also “the analog of relationship in individual therapy”; Budman et al. Psychotherapy (Chic.) 47, 478–484. Krupnick, J. L., Sotsky, S. M., Simmons, S., Moyer, J., Elkin, L., and Watkins, J. T. (1996). Safran, J. D., and Muran, J. C. (2000). Psychol. Psychol. 28, 1167–1187. Similarly, Greenson (1965) defines the working alliance as a reality-based collaboration between patient and therapist. B., Fields, S., and Bickman, L. (2006). In further studies of this development pattern, Stiles et al. Counseling: an interpersonal influence process. |, Evolution of the Concept of Therapeutic Alliance, Phases of the Alliance during the Therapeutic Process and the Relationship with the Outcome, Department of Psychology, Center for Cognitive Science, University of Turin, Turin, Italy. 18, 170–189. Psychoanal. In short, the optimal therapeutic alliance is achieved when patient and therapist share beliefs with regard to the goals of the treatment and view the methods used to achieve these as efficacious and relevant. Marziali, E. (1984). These were seen as the ideal conditions offered by the therapist but were later shown to be specifically essential for client-centered therapy (Horvath and Greenberg, 1989; Horvath and Luborsky, 1993). Psychother. Therapeutic Alliance • The collaboration and the affective bond between a therapist and the individual. There is much debate on the role of the therapeutic alliance during the psychotherapeutic process. 56, 448–451. Elvins, R., and Green, J. Clin. McLeod, B. D. (2011). According to Castonguay et al. (2000), the most frequently used scales in individual psychotherapy are the WAI, CALPAS, and Penn scales, followed by the Vanderbilt scales, TARS, and TBS. 26, 50–65. “The therapeutic alliance: its relationship to outcome in brief psychotherapy,” in Empirical Studies in Analytic Theories, ed. Psychother. (2008). The child had to see us as someone they wanted to work with, much like a client in a therapist’s office must see the therapist as someone they want to work with, and establish an alliance. Clin. J. Couns. HHS Consult. Couture SM, Roberts DL, Penn DL, Cather C, Otto MW, Goff D. J Nerv Ment Dis. When the outcome was worse, the curvilinear pattern was weaker. Comparison between first and revised version of the helping alliance questionnaire. J. Med. Towards the validation of the California therapeutic alliance rating system.  |  Results obtained by evaluating alliance through WAI-Client and WAI-therapist after 3, 15, and 33 months, showed clear alliance differences between treatments, suggesting that the quality of the alliance was affected by the nature of the treatment. Assess. 2019 Jun 11;10:364. doi: 10.3389/fpsyt.2019.00364. Patterns of helping alliance development and outcome. This research is extensively discussed (with many references) in The Heart and Soul of Change: What Works in Therapy, Mark A. Hubble, Barry L. Du… Northvale, NJ: Jason Aronson. Clin. On links to other constructs, determinants of its effectiveness, and its role for research in psychotherapy in general. Recognition of the fact that different types of psychotherapy often reveal similar results gave rise to the hypotheses regarding the existence of variables common to all forms of therapy, rekindling interest in the alliance as a non-specific variable. Nadort, M., Arntz, A., Smit, J. H., Giesen-Bloo, J., Eikelenboom, M., Spinhoven, P., van Asselt, T., Wensing, M., and van Dyck, R. (2009). (1997) tested the contribution of therapeutic alliance and group cohesion (both based on self-report) to outcome in group therapies for borderline personality disorder. Bibring, E. (1937). The Kim alliance scale: development and preliminary testing. Analysis of the development of the working alliance using hierarchical linear modeling. (2004) provide the first statistical demonstration of the hypothesis previously formulated by Safran and Muran (2000) and Samstag et al. 16, 252–260. Psychol. by Journal of Psychotherapy and Psychosomatics . Psychol. Consult. Psychother. 2020 Feb 10;20(1):59. doi: 10.1186/s12888-020-2482-z. Suh, C. S., Strupp, H. H., and O’Malley, S. S. (1986). Psychoanalysis is the therapeutic approach that was originally developed by Sigmund Freud. (2004) suggest that a process characterized by ruptures and repairs was more likely to occur in long-term psychodynamic treatment, particularly during phases of in-depth work. Psychol., 18 October 2011 J. Strachey (Trans.) There was evidence for specific client-related factors being linked to different perspectives of alliance. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. Psychol. 71, 997–1006. Meta-analysis is a possible research strategy that can be used to obtain the combined results of studies on the same topic. 15, 239–246. They found that alliance and group cohesion were closely related and that both were strongly related to improved self-esteem and reduced symptomatology. Rev. Therapeutic alliance (TA) is an essential factor underlying successful therapy across therapeutic models. The first phase coincides with the initial development of the alliance during the first five sessions of short-term therapy and peaks during the third session. J. Clin. Although a comparison between different treatment modalities is a topic beyond the scope of this paper, it is worth noting that in the late 1980s, some authors (Marmar et al., 1989a,b) failed to demonstrate significant differences between behavioral, cognitive, and brief psychodynamic therapies in the level of alliance as measured by CALPAS. Pubmed Abstract | Pubmed Full Text | CrossRef Full Text. Epub 2009 Sep 4. (2007). Journal. Please enable it to take advantage of the complete set of features! Furthermore, links have been made between the creation of strong alliances and successful therapeutic outcomes. Received: 29 June 2011; Couns. Marziali et al. 12/5001/62/DH_/Department of Health/United Kingdom. Riv. Saunders, S. M., Howard, K. I., and Orlinsky, D. E. (1989). Behav Cogn Psychother. The results of these studies have led researchers to consider the existence of two important phases in the alliance. Thus, we have to consider more than one relational level within the group: member to therapist alliance (the same as individual therapy), member to member alliance, group to therapist alliance, and member to other members as a whole alliance. 64, 532–539. Relationship to course and outcome. J. 27, 154–165. Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients. Migone, P. (1996). J. Clin. Res. Migone (1996) distinguishes three partially overlapping phases in the history of psychotherapy research: a first phase, between the 1950s and 1970s, when research focused on the outcome of psychotherapy and there was a proliferation of meta-analysis; a second phase between the 1960s and 1980s in which there was a growing interest for research into the relationship between process and outcome (the Vanderbilt Project is the most famous example of this); and a third phase from the 1970s onward, in which interest shifted to the therapeutic process and the desire for a greater understanding of the “micro-processes” involved in therapy. Crossref. Psychol. Thus, it is not by chance that in their meta-analysis, Horvath and Luborsky (1993) conclude that two main aspects of the alliance were measured by several scales regardless of the theoretical frameworks and the therapeutic models: personal attachments between therapist and patient, and collaboration and desire to invest in the therapeutic process. Psychol. USA.gov. Cohesion in group therapy. The therapeutic alliance might be the most important part of beginning a psychotherapy. 2020 Aug 7;7(8):e17204. Implementation of outpatient schema therapy for borderline personality disorder: study design. So far, few studies have regarded long-term psychotherapy involving many counseling sessions. This viewpoint was more recently confirmed by Strupp (2001), who showed that the outcome of a psychotherapeutic process is often influenced by so-called non-specific factors, namely, the personal characteristics of the therapist and the positive feelings that arise in the patient – feelings which can lead to the creation of a positive therapeutic climate from an emotional and interpersonal perspective. Br J Clin Psychol. The CALPAS Group used by Crowe and Grenyer (2008) consisted of four subscales: patient working capacity, patient commitment, working strategy consensus, and member understanding and involvement. Research aimed at analyzing the components that make up the alliance continues to flourish and develop. The therapeutic alliance is an integral part of a client's journey through therapy. Psychol. Front. Mehl S, Hesse K, Schmidt AC, Landsberg MW, Soll D, Bechdolf A, Herrlich J, Kircher T, Klingberg S, Müller BW, Wiedemann G, Wittorf A, Wölwer W, Wagner M. BMC Psychiatry. 36, 223–233. Is therapist alliance or whole group cohesion more influential in group psychotherapy outcomes? Consult. The use of neutral observers or the creation of counterintuitive studies is therefore recommended. Freniatr. The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Programme. Psychotherapy, 48(3), pp.237-248. Therapeutic alliance is a key predictor of therapy outcomes. Pinsof, W. M., and Catherall, D. R. (1986). Audri Lamers, Robert RJM Vermeiren, Assessment of the therapeutic alliance of youth and parents with team members in youth residential psychiatry, Clinical Child Psychology and Psychiatry, 10.1177/1359104514542304, 20, 4, (640-656), (2014). Consult. In situations such as this, the actual therapeutic alliance regularly and repetitively reflects the patient’s unresolved conflicts. Consult. Horvath, A. O. In particular, Stiles et al. J. Psychoanal. • The development and continued maintenance of the therapeutic relationship is a primary component to facilitating the individual’s change. 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. Client-Centered Therapy. The authors thank Mauro Adenzato for his valuable comments and suggestions to an earlier version of this article. Psychology & Psychiatry; August 28, 2020 Why therapeutic alliance is important in psychotherapy. According to Martin et al. Tracey, T. J. “On the beginning of treatment: further recommendations on the technique of psychoanalysis,” in The Standard Edition of the Complete Psychological Works of Sigmund Freud, ed. The relationship between the therapeutic alliance and client variables in individual treatment for schizophrenia spectrum disorders and early psychosis: Narrative review. Numerous studies have shown that the therapeutic alliance is one of the strongest predictors of treatment outcomes. More recent meta-analyses of studies examining the linkage between alliance and outcomes in both adult and youth psychotherapy (Martin et al., 2000; Shirk and Karver, 2003; Karver et al., 2006) have confirmed these results and also indicated that the quality of the alliance was more predictive of positive outcome than the type of intervention (but for slightly different results in youth psychotherapy see McLeod, 2011). Psychol. (1981). 15, 215–224. In order to determine the state of knowledge regarding TA in psychotherapy via videoconferencing, a literature review was conducted on research studies that formally measured TA as primary, secondary or tertiary outcome measures over the past 23 years. Today, many counselors view this bond as a key tool in helping clients make positive changes in their lives. The contribution of group cohesion and group alliance to the outcome of group psychotherapy. Psychol. The role of the therapeutic alliance in the treatment of schizophrenia. According to Safran and Segal (1990), many therapies are characterized by at least one or more ruptures in the alliance during the course of treatment. London: Routledge and Kegan Paul. eCollection 2019. J. Couns. Psychotherapy Session Report, Form P and form T. Chicago: Institute of Juvenile Research. Here, it is important to note that research in the field of psychotherapy is usually classified as outcome research and process research. Hasson-Ohayon I, Mashiach-Eizenberg M, Lavi-Rotenberg A, Roe D. Front Psychiatry. 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. The development and decay of the working alliance during time-limited counseling. Thinking about thinking in therapy: an examination of clients’ understanding of their therapists’ intentions. As such, we can say that clients in group therapies may attach greater importance to relationship factors. De Roten, Y., Fischer, M., Drapeau, M., Beretta, V., Kramer, U., Favre, N., and Despland, J.-N. (2004). The results of the study by De Roten et al. Tremain H, McEnery C, Fletcher K, Murray G. JMIR Ment Health. This process is what takes place between, and within, the patient and therapist during the course of their interaction (Orlinsky and Howard, 1986). Orlinsky, D. E., and Howard, K. I. A., Davies, D. R., and Gleave, R. L. (2005). The generalizability of the psychoanalytic concept of the working alliance. A Primer for Transference Focused Psychotherapy for the Borderline Patient. The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. 37, 369–375. Arch. 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. Agnew-Davies, R., Stiles, W. B., Hardy, G. E., Barkham, M., and Shapiro, D. A. Schema Therapy: A Practitioner’s Guide. Epub 2017 May 15. The Theory and Practice of Group Psychotherapy. Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature. However, the authors observed a cycle of therapeutic alliance rupture–repair events in all cases: very frequent ruptures followed by rapid resolution processes, that is, V-shaped patterns. 157, 23–28. 62, 1197–1204. (2004) analyzed therapeutic alliance growth during the course of short-term treatment of depressed patients, drawn from the Second Sheffield Psychotherapy Project, who received cognitive–behavioral and psychodynamic–interpersonal therapy. The development of a dynamic vision of the concept of therapeutic alliance is also apparent. These authors made a distinction between transference and the therapeutic (or working) alliance, and this distinction later extended beyond the analytical framework (Horvath and Luborsky, 1993). This work was supported by University of Turin (Ricerca scientifica finanziata dall’Università). Development and validation of the working alliance inventory. 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