The Impact of Patients' and Therapists' Views of the Therapeutic Alliance on Treatment Outcome in Psychotherapy

Tschuschke, Volker; Koemeda-Lutz, Margit; Wyl, Agnes von; Crameri, Aureliano; Schulthess, Peter

doi:10.1097/nmd.0000000000001111

Cited by 19 publications

(18 citation statements)

References 37 publications

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“…Successful treatments were conducted more often by therapists who showed significant convergence of their alliance ratings with their clients' ratings over time, whereas discrepant alliance ratings correlated significantly with unsuccessful 'Distant': Therapist's scores on the HAQ-A-T scale are continously > 1.37 lower than those of the client. 'Disconnects': Therapist's scores from a certain session are > 1.37 lower than those of the client and do not return to higher scores on the HAQ-A-T scale for the rest of the treatment treatments (Tschuschke et al, 2020). In the present study, therapists with low and, compared to their clients, distant alliance ratings have highly significantly more treatment ruptures and run risks for premature treatment endings (in our study, 12 of 25 premature treatment terminations).…”

Section: Discussionmentioning

confidence: 99%

“…Our findings point to the differential effectiveness of psychotherapists beyond their theoretical orientations and regardless of clients' symptoms (Berglar et al, 2016). Recent research results suggest that more successful treatment outcomes in psychotherapy are due to therapists' ability to adjust their orientation on relatedness or selfdefinition to their clients' predominant personality configuration or to their clients' sense of the working alliance (Werbart et al, 2018;Tschuschke et al, 2020). Research in this domain has to address such topics as therapists' competence (whatever it may look like) and their capability to attune to their clients' feelings and experience (keyword 'attachment').…”

Section: Implications For Future Researchmentioning

confidence: 99%

“…In the last decades, psychotherapy research has consistently addressed the importance of the working alliance between therapists and their clients (Horvath et al, 2011;Flückiger et al, 2018;Tschuschke et al, 2020). In general, studies tend to show that the quality of the therapeutic relationship is a strong predictor of therapeutic outcome (O'Connor et al, 2019).…”

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confidence: 99%

“…Process-outcome research has increasingly focused on personality characteristics of therapists and clients: Studies have addressed therapists' and clients' attachment styles (Marmarosh et al, 2014;O'Connor et al, 2019), therapists' professional experience (Goldberg et al, 2016), therapists' effectiveness (Wampold & Brown, 2005;Baldwin & Imel, 2013;Berglar et al, 2016), therapists' and clients' interpersonal skills and verbal capabilities (Wampold et al, 2017), the role of treatment adherence (Tschuschke et al, 2015;Kivlighan et al, 2019), clients' initial symptom distress profiles (Tschuschke et al, 2015;Kivlighan et al, 2019;Uckelstam et al, 2019), or the working alliance congruence between client and therapist (Kivlighan et al, 2014;Zilcha-Mano et al, 2018;Tschuschke et al, 2020).…”

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confidence: 99%

“…Researchers found that clients' severity of psychological distress had a strong impact on the quality of the therapeutic alliance. Also, more successful treatments were characterized by therapists' ability to adapt their own sense of therapeutic alliance by approaching their clients' level of alliance ratings as treatment progressed (Tschuschke et al, 2020).…”

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confidence: 99%

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The Impact of Clients’ and Therapists’ Characteristics on Therapeutic Alliance and Outcome

Tschuschke

Koemeda-Lutz²,

Wyl

et al. 2021

J Contemp Psychother

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This article investigates distances between therapists and their clients in their experience of the therapeutic alliance across the duration of the psychotherapeutic treatments in a naturalistic study. We looked at the working alliances from different vantage points—rupture, repair of ruptures, distances in the alliance impressions of both clients and therapists—and their correlation with treatment outcome. The only predictive variable of alliance ruptures was the inability of therapists to bond sufficiently with their clients regarding a sustainable working atmosphere, which could be identified through a continuous distant alliance rating by the therapists. Alliance ruptures in turn significantly predicted premature termination of treatments, whereas alliance ruptures per se did not necessarily predict treatment outcome. The paper discusses the possible role of the quality of therapists’ attachment styles as a potentially crucial variable in an effective working alliance in psychotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Implications For Future Researchmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Impact of Clients’ and Therapists’ Characteristics on Therapeutic Alliance and Outcome

Tschuschke

Koemeda-Lutz²,

Wyl

et al. 2021

J Contemp Psychother

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Integrative Dialogues in Family Therapy

Larner

2022

ANZ J of Family Therapy

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Like many family therapists today my approach to therapy can be described as integrative; it utilises various therapy frameworks and models and combines individual and family therapy approaches in response to the needs of clients and the nature of the work. This paper begins with a brief professional retrospective that illustrates the integrative therapy challenge. It then describes integrative therapy as systemic in the sense of bringing together multiple conversations about therapy based on the idea of an ethic of hospitality. Integration as an ethics of practice is grounded in a finely honed attunement between therapist and client as well as an openness to considering multiple perspectives and frameworks of therapy. This is discussed in relation to the contemporary family therapy literature and illustrated by a practice example.

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The psychometric properties and treatment outcomes associated with two measures of the adult therapeutic alliance using naturalistic data

Mahon,

Minami,

Brown

2023

Couns and Psychother Res

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PurposeThis is the first of two articles that examine the psychometric properties and treatment outcomes associated with measures of the therapeutic alliance collected in naturalistic settings rather than clinical trials. These articles break new ground in understanding the relationship between measures of alliance and treatment outcome by performing detailed item analyses in order to assess the psychometric properties of each individual item, its propensity to change from session to session and its utility in predicting change in the outcome measure.MethodsData were taken from the ACORN database for adults attending for psychotherapy treatment in naturalistic settings (N = 147,399). The sample, the largest to date, included only those completing both an alliance measure and an outcome measure at every session. Two sets of three different alliance items are used across three different treatment populations: general outpatient, substance use, and severe and persistent mental health difficulties. To investigate this possibility, the psychometric properties of each item were evaluated, including factor analysis, likelihood of change over time in treatment and correlations between changes in alliance and magnitude of client‐reported improvement in therapy. The predictive validity of each individual item is compared with the predictive validity of their respective three‐item measures. The problem of alliance scores being heavily skewed in a positive direction and the resulting lack of variability from session to session is addressed by categorising change in alliance as same, better or worse, regardless of the magnitude of change.ResultsFindings tended to differ from those in clinical trials, with the last alliance score being most predictive of outcome. In this data set, the alliance accounted for, at most, 2% of the variance in outcomes. Measures of the therapeutic alliance demonstrate ceiling effects, and the alliance–outcome correlation is far from linear. Change in alliance score, rather than a single assessment, is more predictive of outcome, regardless of the magnitude of change in the alliance measure, with effect sizes of up to 50% more for those who rated the alliance as worse than for those rating it as no change or better.ConclusionTherapists using therapeutic alliance questionnaires will benefit from being aware of how the psychometric properties of alliance measures impact outcomes. Even the smallest drop in alliance is predictive of significant clinically meaningful differences. Implications for practice, training and research are considered.

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The Impact of Patients' and Therapists' Views of the Therapeutic Alliance on Treatment Outcome in Psychotherapy

Cited by 19 publications

References 37 publications

The Impact of Clients’ and Therapists’ Characteristics on Therapeutic Alliance and Outcome

The Impact of Clients’ and Therapists’ Characteristics on Therapeutic Alliance and Outcome

Integrative Dialogues in Family Therapy

The psychometric properties and treatment outcomes associated with two measures of the adult therapeutic alliance using naturalistic data

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