The therapist, the client, and the real relationship: An actor–partner interdependence analysis of treatment outcome.

Abstract

The relationship between treatment progress (as rated by both clients and therapists) and real relationship (also rated by both clients and therapists) was decomposed into between-therapist and within-therapist (between-client) effects and analyzed using the actor-partner interdependence model. We reanalyzed a subset of the data, 12 therapists and 32 clients, from Gelso et al.'s (2012) study of brief, theoretically diverse outpatient treatment. Consistent with and extending previous research, clients whose therapists provided higher average levels of client-perceived real relationship across the clients treated by a given therapist had better progress ratings from both themselves and their therapists. Within each therapist's caseload, differences between clients in client- or therapist-rated real relationship were unrelated to either client- or therapist-rated outcome. Clients whose therapists provided higher average levels of therapist-perceived real relationship, across the clients treated by the therapist, had worse progress ratings from the therapists. The results provide additional evidence for the importance of between-therapist differences in therapeutic relationship qualities, both client and therapist rated.

Therapist-reported alliance: Is it really a predictor of outcome?

“…It follows that taking a more active approach may improve therapists’ attunement to fluctuations in the alliance. These suggestions are also consistent with previous findings showing that therapists who rated themselves as generally forming stronger real relationships also rated poorer treatment progress (Kivlighan, Gelso, Ain, Hummel, & Markin, 2014), and with findings showing that patients rated sessions less smooth when their ratings of the alliance were lower than their therapists’ ratings of the alliance, and they rated sessions as more smooth when their ratings of the alliance were higher than their therapists’ ratings of the alliance (Marmarosh & Kivlighan, 2012). …”

“…Patient and therapist reports of alliance may capture related but distinct concepts, as indicated by the significant but small correlation we found between these perspectives, so that the two concepts may influence different aspects of outcomes. In the present study, the therapist’s contribution was less related to the diagnostician’s evaluation of depressive symptoms than to the patient’s report, but it remains unclear whether the therapist’s report on the alliance has a greater effect on therapist-reported outcomes (e.g., Bachelor, 2013; Kivlighan et al, 2014, but see also Kivlighan, 2007) or on outcomes related to other aspects of the patient’s life (e.g., coping with intra-individual struggles).…”

Dynamic relationships of therapist alliance and group cohesion in transdiagnostic group CBT for anxiety disorders.

“…If these data are replicated, therapists can expect that strong alliance (especially group agreement on goals, tasks, and bond) will be associated with decreased subsequent symptom reduction at all stages of the intervention. Future research on alliance could be assessed within individual tCBT where processes would be more personalized (McMain, Newman, Segal, & DeRubeis, 2015) and could more readily take account of client attributes (Marmarosh et al, 2014), and perspectives on alliance (Gelso et al, 2012; Kivlighan, Gelso et al, 2015). …”

“…It is therefore recommended that future research adopt a multimodal approach to assessing changes in anxiety (e.g., clinician-ratings, physiological assessments), as well as clinician and independent-observer ratings of therapist alliance and group cohesion. Novel independent-observer calculation methods are currently being evaluated (e.g., Petrik, Farchione, Dobson, & Kazantzis, 2015) along with examinations within therapist practices as a function of data source (Kivlighan, Gelso, et al, 2015), which both show promise. Second, as only one form of psychotherapy (tCBT) was assessed in the current study, it is unclear whether the current results would extend to other group-based interventions (Hofmann & Barlow, 2014), and to what extent other unmeasured client attributes, such as attachment style (Marmarosh et al, 2014) may moderate process-outcome relations (see Lorenzo-Luaces et al, 2014).…”

Facilitative interpersonal skills performance test: Psychometric analysis of a German language version

“…One piece of evidence for the role of interpersonal skills comes from studies suggesting that therapists differ in their ability to establish a positive relationship with patients (Kivlighan, Gelso, Ain, Hummel, & Markin, 2015;Zuroff, Kelly, Leybman, Blatt, & Wampold, 2010). Using multi-level or one-with-many methodologies, these studies were able to differentiate the prognostic effect of therapists' and patients' contributions to the relationship (i.e., to separate betweentherapist and within-therapist variability).…”