Distinct roles of state-like and trait-like patient–therapist alliance in psychotherapy

Zilcha‐Mano, Sigal; Fisher, Hadar

doi:10.1038/s44159-022-00029-z

Cited by 46 publications

(39 citation statements)

References 184 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies that implemented the TL–SL distinction have produced important findings about the role of alliance in different treatments for various patients (for a review, see [ 14 ]. First, findings support the assumption that patients differ significantly in their TL potential to develop a strong alliance and that these differences are a product of their baseline characteristics, especially interpersonal characteristics [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Section: The Utility Of the Sl–tl Distinction In Psychotherapy Resear...mentioning

confidence: 99%

Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry

Zilcha‐Mano

Solomonov

Posner

et al. 2022

JPM

Self Cite

View full text Add to dashboard Cite

Background: Identifying individual-specific mechanisms of action may facilitate progress toward precision medicine. Most studies seeking to identify mechanisms of action collapse together two distinct components: pre-treatment trait-like characteristics differentiating between individuals and state-like characteristics changing within each individual over the course of treatment. We suggest a conceptual framework highlighting the importance of studying interactions between trait-like and state-like components in the development of moderated mediation models that can guide personalized targeted interventions. Methods: To facilitate implementation of this framework, two empirical demonstrations are presented from a recent clinical trial and neuroimaging study. The first examines limbic reactivity during an emotional face task; the second concerns striatal activation in a monetary reward task. Results: In both tasks, considering the interaction between trait-like and state-like components predicted treatment outcome more robustly than did the trait-like or state-like components examined individually. Conclusions: These findings suggest that the extent to which state-like modulation of neural activations can serve as a potential treatment target depends on the pre-treatment, trait-like levels of activation in these regions. Thus, the interaction between trait-like and state-like components can serve as a promising path to the development of personalized interventions within a precision medicine framework in which mechanisms of action are individual-specific.

show abstract

Section: The Utility Of the Sl–tl Distinction In Psychotherapy Resear...mentioning

confidence: 99%

Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry

Zilcha‐Mano

Solomonov

Posner

et al. 2022

JPM

Self Cite

View full text Add to dashboard Cite

show abstract

“…In precision medicine, a more important part is the interplay between the two: As the result of exposure-based treatment (vs. nonexposure therapy), those with highest trait-like scores on avoidance ( higher between-individuals levels), will also show larger state-like reductions ( lower within-individual levels) in it, which in turn predict greater symptom reduction (as in the moderated-mediation model of Hesser et al, 2018). Thus, it matters not only where you come from (your trait-like characteristics), but also where you are going and which state-like changes you display in the course of treatment (Zilcha-Mano & Fisher, in press). A complementary effect (capitalizing on strength, e.g., Cheavens et al, 2012): When the two components run in the same direction.…”

mentioning

confidence: 99%

It matters not only where you come from but also where you are going, and the interplay between the two: Reply to Huppert (2022).

Zilcha‐Mano

2022

American Psychologist

Self Cite

View full text Add to dashboard Cite

Two main sources of confusion dominate research on trait-like (between-patients) and state-like (within-patient) effects in psychotherapy. The first is that being higher than another person on a given construct (between-individuals differences) has the same statistical and clinical implications as showing increases from one time point to the next on that construct (within-individual changes). However, research shows that it is a mistake to mix together the two effects. The second is overlooking the interplay between trait-like (between-individuals) differences and state-like (within-individual) changes in the same construct, although such interactive effects between the two may reveal critical information for guiding clinical decision-making. Two types of such interplays are briefly discussed, as well as their distinct clinical implications. The first refers to a compensatory effect according to which those with the lowest trait-like levels on a mechanism of change are the ones benefiting most from state-like improvements in that mechanism, so that where you start from need not have a deterministic effect if you are going in a promising new direction; on the contrary, it may point to the most critical state-like change required to return to healthy homeostasis. The second refers to a complementary effect, according to which treatment should focus on identifying individuals’ trait-like strengths and capitalizing on them in treatment planning to drive state-like improvement. Differentiating between the two types of interplay is critical for basing treatment planning (determining the required state-like changes) on the individual’s case conceptualization (trait-like characteristics).

show abstract

“…Then, based on this integration, we discuss the need for better understanding of the roles of alliance in different populations of youths (based, for example, on diagnoses) in various interventions. Finally, we propose that two components of alliance identified in adult psychotherapy (Zilcha-Mano, 2017; Zilcha-Mano & Fisher, 2022) can be instrumental in making progress toward context- and individual-specific understanding of the roles of alliance in youth psychotherapy as well.…”

mentioning

confidence: 99%

“…In the example of the youth with good interpersonal skills and a secure attachment, the strong alliance is a product of their trait-like abilities, which make it easier for them to work collaboratively with their therapist, rather than being the product of therapeutic processes or active intervention. For alliance to be an active ingredient in treatment, changes in alliance, as the mechanism of change, must be able to predict subsequent changes in treatment outcome (Zilcha-Mano, 2021; Zilcha-Mano & Fisher, 2022).…”

mentioning

confidence: 99%

“…The between-patients effect has been referred to as the trait-like alliance because it reflects the differences between individuals in alliance strength, whereas the within-patient effect has been referred to as the state-like alliance because it reflects the strengthening (or weakening) of alliance within the individual (Zilcha-Mano, 2017). Trait-like alliance was found to be the product of the patients’ pretreatment trait-like characteristics (such as interpersonal skills), whereas state-like alliance was found to be the product of the patients’ and therapists’ work over the course of treatment and to predict subsequent treatment outcome (for a review, see Zilcha-Mano & Fisher, 2022).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Not so common anymore? Beyond the common factor understanding of the role of alliance in youth psychotherapy.

Lebowitz¹,

Zilcha‐Mano²

2022

Clinical Psychology: Science and Practice

Self Cite

View full text Add to dashboard Cite

Distinct roles of state-like and trait-like patient–therapist alliance in psychotherapy

Cited by 46 publications

References 184 publications

Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry

Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry

It matters not only where you come from but also where you are going, and the interplay between the two: Reply to Huppert (2022).

Not so common anymore? Beyond the common factor understanding of the role of alliance in youth psychotherapy.

Contact Info

Product

Resources

About