Toward the validation of the California Therapeutic Alliance Rating System.

Abstract

The California Therapeutic Alliance Rating System, CALTARS, was used by judges to rate four therapy sessions for each of 52 subjects treated in brief dynamic psychotherapy for pathological grief. A principal-components analysis provided support for the theoretically proposed domains of alliance. The interrater reliability at the treatment level was satisfactory for the five component-based scales. As hypothesized, scores reflecting positive contribution to the alliance were positively related to educational attainment, motivation for psychotherapy, pretreatment interpersonal functioning, patient experiencing in therapy, symptom improvement, and gains in interpersonal functioning but negatively associated with stressful life events and greater therapist emphasis on addressing patient resistances. As further hypothesized, scores reflecting negative contribution to the alliance were positively associated with greater therapist emphasis on addressing resistances. Alliance ratings were largely independent of pretreatment symptomatology. These findings build toward the construct validity of the CALTARS.The therapeutic alliance has increasingly been the focus of both clinical and research interest in the study of the change process in psychotherapy (Hartley & Strupp, 1983;Luborsky, Crits-Christoph, Alexander, Margolis, & Cohen, 1983). Recent reviews of empirical studies (Frieswyk et al., 1986;Hartley, 1985;Orlinsky & Howard, 1986) support the view that alliance measures are robust predictors of outcome in diverse psychotherapies (Marmar, Gaston, Gallagher, & Thompson, in press;Rush, 1985;Wilson & Evans, 1977). Despite the growing body of evidence supporting the importance of the alliance as a predictor of psychotherapy outcome, there has been less emphasis on identifying and validating the specific components of this complex construct. This leaves considerable uncertainty as to precisely what alliance scales purport to measure.The California Therapeutic Alliance Rating System, CAL-TARS, in contrast to earlier measures of the alliance, places greater emphasis on the affective and attitudinal aspect of the alliance as opposed to specific therapeutic interventions (Marmar, Horowitz, Weiss, & Marziali, 1986). The need for more systematic research on the construct validity of this alliance measure motivated the present study. We identified pretreatment, process, and outcome variables for which a clear pat-

The early impact of therapeutic alliance in brief psychodynamic psychotherapy

“…It assesses the patients' capability of observing their reactions, of working actively with the therapist's remarks and to solve problems. According to this concept a higher capability of patients to establish the working alliance has produced the most significant outcomes in this study, what has been already observed by other authors 59 who reported a significant correlation between the working alliance (PWC) and the improvement in the symptomatology.…”

The role of the early therapeutic alliance in predicting drug treatment dropout

“…A potential confounding effect of a process variable not assessed in the study was suggested by Marmar and colleagues (Marmar et al, 1986;Marmar et al, 1989). A client's discontent with their early treatment progress might be reflected in poorer client alliance ratings more indicative of the dissatisfaction than of the relationship.…”

Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression.

“…It appears that the B-L RI assesses primarily the first of Gaston's dimensions, whereas the VTAS assesses primarily the other dimensions. However, there is disagreement about the extent to which these dimensions of the therapeutic relationship can be empirically discriminated (e.g., Hartley & Strupp, 1983;Hatcher & Barends, 1996;Marmar, Weiss, & Gaston, 1989).…”