Is alliance therapeutic in itself? It depends.

Zilcha‐Mano, Sigal; David-Sela, Tal Ben

doi:10.1037/cou0000627

Cited by 10 publications

(7 citation statements)

References 50 publications

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“…Conversely, one could speculate that the improvement in well-being noted among patients of untrained therapists was not specifically associated with the alliance but might have been associated with some other specific therapeutic factor. This is consistent with a recent study by Zilcha-Mano and Ben David-Sela (2022) in which a treatment that relied on the therapeutic relationship as the primary change agent resulted in better outcomes when the alliance improved in a previous session. However, an increase in the alliance was not related to next session outcomes for a treatment that relied primarily on specific therapeutic interventions.…”

Section: Discussionsupporting

confidence: 92%

Training community-based psychotherapists to maintain a therapeutic alliance: A psychotherapy practice research network study.

Tasca¹,

Ravitz²,

Hunter³

et al. 2023

Psychotherapy

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The goal of this study was to test the efficacy of training community-based psychotherapists who were part of a practice research network to be more attuned to their patients' experiences of the therapeutic relationship. We were particularly interested in the effect of therapist training on the congruence of alliance ratings with their patients. Forty psychotherapists who treated 117 patients were randomly assigned to receive either no training or training, whose learning objectives were to help therapists to develop and maintain a therapeutic alliance. The training included workshops and ongoing consultations to help the clinician to strengthen the therapeutic relationship with the use of mentalizing, attachment theory, countertransference management, and metacommunication. Therapeutic alliance and well-being outcomes were measured at each of six consecutive early psychotherapy sessions. We used the truth and bias model and response surface analysis within a multilevel modeling context to test hypotheses. There was a significantly faster rate of alliance growth in the training versus the no training condition when the alliance was rated by therapists, but not when rated by patients. Trained therapists experienced greater temporal congruence in alliance ratings with their patients compared to untrained therapists. Patient well-being outcomes improved in a session when trained therapists and their patients agreed in their positive alliance ratings in a previous session. This association not significant among untrained therapists. Training therapists in key interpersonally focused skills may lead them to be better attuned to their patients' experiences of the therapeutic relationship.

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Section: Discussionsupporting

confidence: 92%

Training community-based psychotherapists to maintain a therapeutic alliance: A psychotherapy practice research network study.

Tasca¹,

Ravitz²,

Hunter³

et al. 2023

Psychotherapy

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show abstract

“…The findings of this study might have several theoretical and clinical implications. First, this study supports the notion that common factors and specific change processes are highly interdependent, a notion stressed in authoritative models of psychotherapeutic change (see Wampold & Imel, 2015; Zilcha-Mano & Ben David-Sela, 2022). Further, this study supports an existing notion that different aspects of the therapeutic relationship might be at work depending on whether one focuses on building emotional capacity (i.e., emotional clarity) or attempts to target a cognitive process that regards behavior (i.e., rumination).…”

Section: Discussionsupporting

confidence: 83%

Emotional and cognitive processes in psychotherapy are associated with different aspects of the therapeutic relationship.

Finsrud,

Nissen-Lie,

Ulvenes

et al. 2024

Journal of Consulting and Clinical Psychology

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Objective: In this naturalistic study we aimed to investigate the relationships between two central change processes (affective and cognitive) and two common relationship factors ("Confidence in the therapist" and "Confidence in the treatment"), which have been shown to impact outcomes in a clinical context. We also investigated whether these interrelationships varied across treatment orientations (i.e., cognitive or psychodynamic focused). Method: The sample consisted of 631 patients with a primary anxiety or depressive disorder who were admitted to an inpatient program and treated with psychotherapy. The data consisted of weekly measures of cognitive (i.e., "rumination") and affective (i.e., "problems with emotional clarity") change processes as well as scores on Confidence in the therapist and Confidence in the treatment and symptom distress. A multivariate version of the latent curve model with structured residuals was used to investigate the within-patient effects of week-to-week changes in all variables. Results: Initial analyses established that both problems with emotional clarity and rumination predicted symptom distress. Further, we found that higher Confidence in the therapist predicted higher emotional clarity (but not lower rumination) whereas higher Confidence in the treatment predicted lower rumination (but did not affect emotional clarity). Post hoc analyses found that these interrelationships varied across treatment orientation (i.e., cognitive vs. psychodynamic). Discussion: The results indicate that patients' experience of the therapist is associated with emotional change processes, and that patients' experience of the coherence and meaningfulness of treatment, on the other hand, is associated with cognitive change processes. Implications for clinical practice are discussed. What is the public health significance of this article?This study suggests that emotional and cognitive change processes are associated with different aspects of the therapeutic relationship. Specifically, emotional change seems to be associated with patients' experience of the personal relationship with their therapist, while cognitive change seems to be associated with patients' experience of the treatment as a meaningful remedy for their problems. Different treatment orientations (i.e., psychodynamic and cognitive focused) seem to activate different pathways of change through the therapeutic relationship.

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“…Effectiveness of RS or PS might also be due to factors not assessed in the present study, such as the relationship between the intervener and the parent, parents’ subjective level of felt security during savoring, or the emotions or levels of physiological arousal parents experience during the savoring. These factors are known to differ among therapists or participants and to predict therapy outcomes (Borelli et al., 2019; Zilcha‐Mano & Ben David‐Sela, 2022).…”

Section: Discussionmentioning

confidence: 99%

Savoring interventions for mothers of young children: Mechanisms linking relational savoring and personal savoring to reflective functioning

Borelli

Kazmierski

Gaskin

et al. 2023

Infant Mental Health Journal

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Parenting interventions can improve parenting outcomes, with widespread implications for children's developmental trajectories. Relational savoring (RS) is a brief attachment-based intervention with high potential for dissemination.Here we examine data from a recent intervention trial in order to isolate the mechanisms by which savoring predicts reflective functioning (RF) at treatment follow-up through an examination of the content of savoring sessions (specificity, positivity, connectedness, safe haven/secure base, self-focus, child-focus). Mothers (N = 147, M age = 30.84 years, SD age = 5.13; Race: 67.3% White/Caucasian, 12.9% other or declined to state; 10.9% biracial/multiracial, 5.4% Asian, 1.4% Native American/Alaska Native, 2.0% Black/African American; Ethnicity: 41.5% Latina) of toddlers (M age = 20.96 months, SD age = 2.50; 53.5% female) were randomized to four sessions of RS or personal savoring (PS). Both RS and PS predicted higher RF, but through different means. RS was indirectly associated with higher RF through greater connectedness and specificity of savoring content, while PS was indirectly associated with higher RF through greater self-focus in savoring content. We discuss the implications of these findings for treatment development and for our understanding of the emotional experience of mothers of toddlers.

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Is alliance therapeutic in itself? It depends.

Cited by 10 publications

References 50 publications

Training community-based psychotherapists to maintain a therapeutic alliance: A psychotherapy practice research network study.

Training community-based psychotherapists to maintain a therapeutic alliance: A psychotherapy practice research network study.

Emotional and cognitive processes in psychotherapy are associated with different aspects of the therapeutic relationship.

Savoring interventions for mothers of young children: Mechanisms linking relational savoring and personal savoring to reflective functioning

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