Client factors that predict the therapeutic alliance in a chronic, complex trauma sample.

Abstract

This project was completed as a PhD dissertation by the first name author. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. AbstractThis investigation aimed to examine how specific client characteristics of individuals with chronic, complex trauma are associated with the type coping strategies they employ and the quality of the therapeutic alliance. Fifty-nine adult participants with diagnostic levels of posttraumatic stress disorder (PTSD) and who attended therapy for complex trauma in Northern Ireland were obtained via opportunity sampling. Participants completed self-report measures of client attachment style, alexithymia, coping strategies, and the therapeutic alliance. Preoccupied attachment factors such as "Need for Approval" and "Preoccupation with Relationships" were related to use of maladaptive coping strategies. In contrast, the adaptive coping strategies of "Acceptance" and "Instrumental Support" were significant predictors of a positive therapeutic alliance, whereas established psychological and traumatogenic factors (e.g., attachment, number of traumatic events) did not significantly predict the therapeutic alliance. The findings have implications for understanding the relationship between client characteristics and the therapeutic alliance within complex trauma populations, as well as developing protocols to assist this process.Keywords: Therapeutic Alliance, complex trauma, client factors, coping CLIENT FACTORS, THERAPEUTIC ALLIANCE, AND TRAUMA 3 Client characteristics, coping strategies, and the therapeutic alliance in a chronic, complex trauma sample Defined broadly as the collaborative and affective bond between therapist and client, the therapeutic alliance has long been considered an essential element of the therapeutic process. Research has consistently found a substantive relationship between the alliance and therapeutic effectiveness, regardless of therapeutic orientation, presenting problem, or problem severity (Goldsmith, Lewis, Dunn, & Bentall, 2015;Martin, Garske, & Davis, 2000). The capacity to engage in an effective therapeutic alliance, however, is thought to require concomitant implementation of certain coping strategies by clients (e.g., reflection, active coping, openness), which can prove challenging (Stiles, Agnew-Davies, Hardy, Barkham, & Shapiro, 1998).One clinical group in which this area of study is particularly relevant is individuals who have experienced chronic, complex or childhood trauma. Herman (1992) proposed the concept of 'Complex PTSD', or 'Complex Trauma' as it is also known, to describe the multifaceted clinical presentation of individuals experiencing protracted, recurring trauma, particularly of an interpersonal nature (e.g., childhood sexual abuse, sectarian violence).Compared to clients with a discrete or 'simple' PTSD presentation, individuals with complex PTSD have a more severe and comprehensive sympt...

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