Background With a lack of experimental designs that explore which therapeutic style is helpful for which patient, the aim of this study was to test the feasibility of experimentally varying the therapeutic style under realistic conditions and to investigate how this affects alliance ratings by clients and counselors. Methods We defined two manualized therapeutic styles (neutral/distant relational style vs. high affiliation relational style) based on the interpersonal circumplex. In a randomized two-group design, 64 healthy university students (70% female, Mage = 23.78, SDage = 2.81) received a single psychological counseling session on interpersonal conflicts by one of four counselors and in one of the two styles. We checked the manipulation success using observer-rated degree of affiliation and ratings of counselors’ interpersonal behavior with the Interpersonal Message Inventory (IMI-R). A series of linear regression models analyzed whether the style predicted working alliance, assessed via the Working Alliance Inventory (WAI). Results In accordance with the hypotheses, significant differences in the rated degree of affiliation (p ≤ .001) and IMI-R ratings (p ≤ .001 in friendly, p = .003 in hostile dimension) were found between the two groups. Overall, alliance ratings were high across groups and raters (WAI overall scores ranging from 3.76 to 4.07). The style did not predict clients’ alliance ratings. Conclusion The experimental variation of the therapeutic style proved feasible under realistic conditions with high overall alliance ratings. The novel experimental design may provide a basis for further research.
Abstract. In light of ongoing demographic changes, it is essential to tailor psychotherapeutic approaches and interventions to the specific needs and characteristics of older adults. An interpersonal skills group (ISG) for older adults consisting of modified Cognitive Behavioral Analysis System of Psychotherapy (CBASP) elements (Situational Analysis, Kiesler Circle Training) was integrated into the treatment schedule of an inpatient setting in routine clinical care. Feasibility and outcome were evaluated in a pilot study including 13 older patients ( Mage = 77.3, range 66–87 years) diagnosed with a major depressive disorder. Results indicate very good feasibility as well as a significant reduction of depressive symptoms in self-report measures and observer rating at discharge ( d = 1.00 to d = 5.62). No significant changes were observed in interpersonal distress, whereas significant changes in the Emotion Regulation Questionnaire (ERQ reappraisal: p < .001) and the Impact Message Inventory (IMI: p = .002 to p < .001) were reported and discussed. However, the results in the observer rating are likely to have been overestimated through a nonblinded rater. Further studies should examine the efficacy of age-tailored CBASP programs for older adults in large randomized controlled trials.
Im Zuge der Anfänge der Verhaltenstherapie (VT) und der “kognitiven Wende” wurde der aktiven Beziehungsgestaltung und damit verbundenen Faktoren zunächst nur zweitrangig Beachtung geschenkt, obwohl die Bedeutung der Beziehung zwischen Therapeut und Patient auch in der VT bereits relativ früh erkannt wurde. Seitdem hat sich die VT substanziell weiterentwickelt. Insbesondere die aktive Gestaltung der therapeutischen Beziehung in Abhängigkeit verschiedener Variablen ist mittlerweile fester Bestandteil einer jeden VT. In dieser Übersichtsarbeit werden Konzepte der Beziehungsgestaltung dargestellt, welche der VT zugerechnet und im Rahmen der Ausbildung im deutschsprachigen Raum gelehrt werden. Fokussiert wird auf folgende drei Ansatzpunkte: Die Ausrichtung der Beziehung an (1) Therapiephasen, (2) Bedürfnissen, Motiven und Erwartungen sowie (3) frühen traumatisierenden Beziehungserfahrungen. Die aktuelle Studienlage legt nahe, dass pauschalisierte Handlungsempfehlungen zur aktiven Gestaltung der therapeutischen Beziehung zu kurz greifen. Ausgehend von der individuellen Problematik des einzelnen Patienten wird die Realisierung der therapeutischen Beziehung im Sinne einer differentiellen Beziehungsgestaltung beschrieben und diskutiert.
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