Therapists’ experiences of alliance formation in short-term counselling

Abstract

While therapeutic alliance formation has been widely researched over many sessions of psychotherapy, the question of alliance formation in short-term counselling has been less explored. Given the increasing evidence in the literature for the positive impact of alliances on therapy outcomes, providing counsellors -who may work with clients for a limited number of sessionswith enhanced insight into alliance formation will be of value. This qualitative study investigated the experiences of eight counsellors forming alliances with clients over short periods. Semi-structured interviews were analysed using interpretive phenomenological analysis. Five major themes emerged, that while congruent with the alliance literature, add some details relevant to day-to-day practice. These themes included: the importance of strong alliances; the need for psychologically comfortable environments; the timing of alliance formation; and the impact of counsellor personal qualities -such as being realin strengthening and maintaining alliances. In addition, an unexpected sixth theme revealed that body language was highly valued as an indicator of strong or weak alliances. Implications for increasing the use of body language to enhance counselling practice and education are discussed. Body language, Counselling, Phenomenology, Therapeutic alliance, Rapport. 3 Therapists' experiences of alliance formation in short-term counselling. KEY WORDS:The therapeutic alliance concept evolved throughout the development of Western psychotherapy, first appearing in 1912 in Freud's early work (Elvins & Green, 2008).Alliances have been defined as "the collaborative and affective bond between therapist and patient" (Daniel, Garske, & Davis, 2000) and "the degree to which the patient experiences the relationship with the therapist as helpful or potentially helpful in achieving the patient's goals in psychotherapy" (Luborsky & Luborsky, 2006, p. 63). Over many decades the influences on, and the value of, strong working alliances in the context of long-term psychotherapy have For example, counsellors working in social support agencies often find clients attending once, twice or even three times, whereas psychotherapists may be accustomed to clients attending for one or more years. Research on therapeutic alliances has emerged predominantly from long-term data in the field of psychotherapy (e.g. Barnicot et al., 2012;Hersoug, Høglend, Havik, von der Lippe, & Monsen, 2009;Langhoff, Baer, Zubraegel, & Linden, 2008;Munder, 2010). Through analysing the experiences of eight counsellors and their observations of clients' alliance signals, this study identified specific issues that can emerge in short-term counselling. Counselling and therapeutic alliancesIt is generally considered conclusive that counselling is effective (e.g. Lambert, 2004;Rosenthal, 1990). An influential factor contributing to this effectiveness is the strength or depth of the counsellor-client relationship. Reviewers of the research are "virtually unanimous in their opinion that the...

The first sessions of psychotherapy: A qualitative meta-analysis of alliance formation processes.

“…It appeared that therapists did not separate their professional role from who they were as a person. As one therapist said: “When I have to start that connection, it’s really, way more about who I am than anything I have to offer” (Pearson & Bulsara, 2016, p. 83). This made it important to take good care of oneself as a therapist, as workload, energy level, stress, weather conditions, and so on, were all factors contributing to the ability to form good alliances.…”

“…This made it important to take good care of oneself as a therapist, as workload, energy level, stress, weather conditions, and so on, were all factors contributing to the ability to form good alliances. Many therapists noted that some cases triggered their own issues, awakening conflicting and potentially harmful emotions toward the client, and as a result, created distance or destructive patterns (Oyer et al, 2016; Pearson & Bulsara, 2016; Spiers & Wood, 2010). Being aware of one’s own history and reactions and sorting these things out—for example, in their own therapy—were brought up as solutions to such problems.…”

“…Therapists promoted this by applying a nonjudgmental and accepting attitude, and by adjusting to the personality of the client. One article exemplified this: “It’s about creating some sort of safe place—it’s safety that’s needed, and an openness and an ‘acceptingness’ of what they have to say” (Pearson & Bulsara, 2016, p. 82). This quote may further highlight how the therapist may adjust to the client to create safety and trust: I try to make them as comfortable as possible by finding things in common.…”

“…One study used structured written assignments in an “alliance workbook” as the data (MacFarlane, Anderson, & McClintock, 2015). Six articles explored alliance-formation processes from the perspective of the therapist, using qualitative interviews (Braga, 2015; Carr, 2010; Healy, 2003; Oddli & Halvorsen, 2014; Pearson & Bulsara, 2016; Spiers & Wood, 2010). The last study explored both perspectives through semistructured interviews of client and therapist participants (Oyer, O’Halloran, & Christoe-Frazier, 2016).…”

“…Paying attention to body language. Three of the articles mentioned that attentiveness to body language was important for the process of alliance development (Braga, 2015;Carr, 2010;Pearson & Bulsara, 2016), and one article had this as a major theme (Pearson & Bulsara, 2016). Several therapists discussed their interpretations of body language as an indicator of By monitoring and interpreting the body language of the client, therapists could glean important signals and adapt to the unique needs and personality of each client.…”