Agency and alliance as change factors in psychotherapy.

Huber, Julia; Jennissen, Simone; Nikendei, Christoph; Schauenburg, Henning; Dinger, Ulrike

doi:10.1037/ccp0000628

Cited by 17 publications

(26 citation statements)

References 62 publications

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“…Therapeutic agency has been found to be related to lower psychological distress, lower depression scores, and better therapy outcomes even when controlling for baseline distress (Huber et al, 2019). Furthermore, positive changes in agency predicted subsequent symptom improvement in patients (n = 386) in psychodynamic outpatient psychotherapy (Huber et al, 2021).…”

Section: Continuity With Prior Empirical Researchmentioning

confidence: 97%

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

Gorlin

Békés

2021

Front. Psychol.

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To address the need for conceptual and clinical consensus within the field, psychotherapy research has increasingly focused on identifying common principles of change. While the field contends that this approach is atheoretical, we argue that principles of change cannot be fully understood or applied without the context of some theoretical framework. This article develops such a framework by identifying and explicating two theoretical assumptions that are implicitly shared by multiple therapeutic approaches: (1) that increasing agency is a fundamental aim of psychotherapy, and (2) that therapists enhance clients' agency by increasing their awareness. Building on the largely disparate empirical literatures demonstrating the importance of client agency and awareness to successful therapeutic outcomes, we provide a theoretical account of the highly iterative and synergistic meta-process by which these two factors jointly produce change. Explicit identification and empirical investigation of this Agency via Awareness psychotherapy meta-process, we argue, could facilitate scientific and clinical progress within the field. The hypothesized meta-process is discussed in relation to existing integrative models of therapeutic change, and its manifestations in the theory and practice of major therapeutic orientations are reviewed and illustrated. We discuss how this framework can facilitate psychotherapy research by providing a common language and conceptual foundation for wide-ranging therapeutic approaches, constructs, and findings. Finally, by raising clinicians' awareness of the implicit assumptions underlying their therapeutic work, we suggest that the Agency via Awareness framework can increase their agency over when and how they apply these assumptions in therapy to maximize client improvement.

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Section: Continuity With Prior Empirical Researchmentioning

confidence: 97%

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

Gorlin

Békés

2021

Front. Psychol.

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“…In a psychometric study on the WAI-SR [59], the average WAI-SR score for in-person outpatient therapy in their sample of 88 patients was reported as 3.8 (SD = 0.63). More recently, in a previous study on a 20-session treatment of an in-person outpatient sample (N= 386), in which therapeutic agency was also assessed, the average WAI-SR ranged from 3.65 to 3.88 (SD ranging from 0.70-0.77) depending on the phase of treatment [56]. Although no studies reporting on the patient-reported WAI-SR in online therapy during COVID appear to have been published, therapist-reported WAI-SRT scores during online therapy during COVID suggest similar ratings of the working alliance (M = 4.09, SD = 0.48; [60].…”

Section: Methodsmentioning

confidence: 99%

“…It is thought that a low sense of agency may exacerbate relationship difficulties, also within the therapist-patient dyad [52]. Patients' sense of agency may manifest within psychotherapy sessions as their contribution to the therapy process, openness, expressiveness, cooperativeness, autonomy, contribution to the therapeutic bond, active collaboration, and interactive collaboration with the therapist [54], and has been associated with a stronger working alliance [49,55,56].…”

Section: Patients' Experiences Of the Collaborative Process In Therapymentioning

confidence: 99%

“…This intentional influence over the psychotherapy change (i.e., 'therapeutic agency') has been proposed as the single most important determinant of therapy outcome [54]. Recently, several empirical studies have indeed found therapeutic agency to be associated with the working alliance [49,56], lower psychological distress, lower depression levels, and better therapy outcomes even when controlling for baseline distress [57]. Moreover, increases in therapeutic agency over the course of psychotherapy have shown to predict subsequent symptom improvement [56].…”

Section: Patients' Experiences Of the Collaborative Process In Therapymentioning

confidence: 99%

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COVID-19 Related Traumatic Distress in Psychotherapy Patients during the Pandemic: The Role of Attachment, Working Alliance, and Therapeutic Agency

2021

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The early months of the COVID-19 pandemic have been a challenging time for many psychotherapy patients. To understand why certain patients were more resilient, we examined the role of patients’ attachment anxiety and attachment avoidance, as well as collaborative therapy experiences (perceived working alliance and therapeutic agency) in their online sessions on their COVID-related traumatic distress over a three-month period. A total of 466 patients in online psychotherapy completed a survey during the first weeks of the pandemic, and 121 of those completed a follow-up survey three months later. Lower distress at follow-up was predicted by patients’ lower attachment anxiety and higher therapeutic agency in their online sessions after controlling for baseline distress and time of survey completion. Higher working alliance predicted less distress at follow-up only for patients with high attachment anxiety. For patients with low attachment avoidance (i.e., more securely attached), higher therapeutic agency predicted less distress. These findings suggest that patients’ attachment anxiety and therapeutic agency may play significant roles also in online therapy during COVID-19 in patient’s experienced traumatic distress, and that working alliance and therapeutic agency may be differentially important for patients with different levels of attachment anxiety and avoidance.

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“…Es interessiert nicht mehr nur, dass die therapeutische Beziehung eine offensichtlich wichtige Komponente jeder Therapie ist. Sondern es wird gefragt, wie die Kausalitäten sind, welches die Wirkmechanismen sind und was wir für die Gestaltung der therapeutischen Beziehung lernen können [38].…”

Section: Therapie(prozess)forschungunclassified