Therapeutic alliance predicts symptomatic improvement session by session.

Abstract

Background: The therapeutic alliance has been found to predict psychotherapy outcome in

Development and validation of a 6-item working alliance questionnaire for repeated administrations during psychotherapy.

“…Lately, however, more complex models of the alliance-outcome relationship have been used: in a small number of studies, the alliance has been measured after each psychotherapy session and this measure was used to predict symptom change to the next session (Crits-Christoph, Gibbons, Hamilton, Ring-Kurtz, & Gallop, 2011;Falkenström, Granström, & Holmqvist, 2013;Hoffart, Øktedalen, Langkaas, & Wampold, 2013;Tasca & Lampard, 2012).…”

“…The mean age was 37.3 years (median 35, SD = 14.3, range 14-88), 74 % were women and 92 % were born in Sweden. More details are available in Falkenström, Granström and Holmqvist (2013; for cross-validating the factor structure derived from an exploratory factor analysis of their first sample. The sample consisted of 235 adult outpatient clients (71% women, 24% men, and 5% Running head: 6-item working alliance 8 unidentified as to gender) from a number of counseling centers and outpatient facilities primarily from the southwestern United States filling out the WAI at session three.…”

“…Horvath, Del Re, Fluckiger, & Symonds, 2011). Most studies to date have relied upon a single alliance measurement early in treatment to predict outcome in the form of symptom relief or improvement in functioning at the end of treatment.Lately, however, more complex models of the alliance-outcome relationship have been used: in a small number of studies, the alliance has been measured after each psychotherapy session and this measure was used to predict symptom change to the next session (Crits-Christoph, Gibbons, Hamilton, Ring-Kurtz, & Gallop, 2011;Falkenström, Granström, & Holmqvist, 2013;Hoffart, Øktedalen, Langkaas, & Wampold, 2013;Tasca & Lampard, 2012).The working alliance is usually measured using self-report instruments, most commonly filled out by the patient. In contrast to observer methods for measuring the working alliance, questionnaires tend to focus not just on the current session, but on the quality of the alliance so far in treatment.…”

Petrificación epistémica y la restauración de la confiabilidad epistémica: Una nueva conceptualización del trastorno límite de la personalidad y su tratamiento psicosocial

“…Dos estudios recientes han puesto atención a la controversia acerca de si la mejora sintomática es una causa o una consecuencia de una fuerte alianza terapéutica (Falkenstrom, Granstrom, & Holmqvist, 2013;Tasca & Lampard, 2012). El recurrente rechazo de adscribir un rol causal a la relación terapéutica en el proceso de cambio ha sido el potencial para el cambio sintomático para mejorar la alianza de tratamiento (Baldwin, Wampold, & Imel, 2007;Kazdin, 2009).…”

“…Pero el cambio primeramente podría ser traído sobre lo que sucede más allá de la terapia -por la forma en que una persona usa su ambiente social. Destacadamente, la evidencia empírica del monitoreo de sesión por sesión para el cambio, sugiere que la alianza terapéutica en la sesión anterior predice el cambio para la siguiente (Falkenstrom et al, 2013;Tasca & Lampard, 2012). Esto sugiere que el cambio ocurre entre sesiones, a consecuencia de los cambios de actitud para aprender engendrados por la terapia.…”