Levels and Patterns of the Therapeutic Alliance in Brief Psychotherapy

Abstract

We examined the relevance of the level and pattern of the therapeutic alliance in 44 cases of three different, manualized 30-session treatments using patient ratings of the Working Alliance Inventory after each session. It was hypothesized that both high-alliance level and either a linear increase in alliance rating or a series of brief rupture-and-repair episodes would be found in successful treatments. We also hypothesized that a more global high-low-high pattern predicted in the literature would not be present. Consistent with the literature, higher alliance levels were found to be related to improved outcome. As predicted, we did not find a global, high-low-high pattern. Local rupture-and-repair patterns were found in 50% of the cases; linear trends were found in 66% of the cases. There was no relationship between outcome and either pattern. We found no differences among the treatments.

Therapeutic alliance predicts symptomatic improvement session by session.

“…Although the concept of alliance ruptures has been defined differently in previous research (e.g. Stevens, Muran, Safran, Gorman, & Winston, 2007;Stiles et al, 2004), an alliance that is worse than usual for a particular patient could be seen as one way of defining a rupture.…”

Funcionamiento de la terapia cognitivo-interpersonal en los trastornos de la personalidad: Estudio de dos casos [Efficacy of interpersonal-cognitive therapy in personality disorders: Two cases]

“…Los resultados tras 10 sesiones de TCI son sugerentes pero merecen un análisis pormenorizado. En primer lugar, se puede destacar que en ambos casos la calidad de la alianza terapéu-tica es similar tanto en la primera como en la última sesión (Figuras 5 y 6), lo que es consonante con la literatura que sugiere que la calidad de la alianza en las primeras sesiones es uno de los mejores predictores del resultado fi nal de la psicoterapia (DeRubeis y Feeley, 1990;Horvath y Luborsky, 1993;Stevens et al, 2007). Mientras que en el paciente B la alianza mejora de una manera progresiva, en el paciente A se produce el fenómeno que Safran y Muran (2000) denominan ruptura de la alianza terapéutica.…”

Ciclos Cognitivos Interpessoais: Desafios E Estratégias De Fortalecimento Da Relação Terapêutica

“…No âmbito da reflexão que agora se finda, procuramos analisá-la a partir do referente conceptual da intervenção focada na relação, proposta por Safran e colaboradores (Safran & Seagal, 1990;Stevens, et al, 2007;Safran, Muran & EubanksCarter, 2011).…”

“…na relação (relationally focused intervention), em concreto no que concerne aos ciclos cognitivos interpessoais e às estratégias de potenciação da aliança terapêutica (Safran & Seagal, 1990;Stevens, et al, 2007;Safran, Muran & Eubanks-Carter, 2011). A nossa opção prende-se, na sua essência, com a centralidade conferida, pelos seus proponentes, à relação interpessoal pacienteprofissional, enquanto ferramenta do próprio processo clínico, da qual resulta uma notória preocupação com o desenvolvimento e promoção do robustecimento da aliança entre os/as envolvidos/as.…”