Association of patients’ pre-therapy strengths and alliance in outpatient psychotherapy: A multilevel growth curve analysis

Schürmann-Vengels, Jan; Appelbaum, Sebastian; Apel, Marie-Kristin; Trimpop, Leonie; Muermans, Michaela Martha; Ostermann, Thomas; Teismann, Tobias; Willutzki, Ulrike

doi:10.1080/10503307.2022.2146543

Cited by 7 publications

(5 citation statements)

References 61 publications

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“…We can speculate that feedback on trust/respect may have initiated discussion of the topic, or prompted therapists to say or do things that fostered trust/ respect, leading to a subsequent stabilization or increase in trust/ respect levels over time rather than a decline, as was evident in the control group. In addition, potentially relevant to understanding the relation between trust/respect and the related concept of the alliance is that research has generally found that the alliance improves rather than decreases (on average) across the duration of treatments investigated here (Schürmann-Vengels et al, 2022). Future research should explore such trends in trust/respect and alliance in various treatment populations to further explore whether the decline in trust-respect found here for the control condition reveals a noteworthy difference between trust/respect and the alliance, or whether such declines do occur in certain settings/ populations.…”

Section: Discussionmentioning

confidence: 93%

Randomized controlled trial evaluating feedback to community-based therapists based on patient reports of trust and respect.

Gibbons¹,

Duong²,

Zoupou³

et al. 2023

Journal of Consulting and Clinical Psychology

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Objective: Patient trust/respect toward their therapists may be an important component of patient–therapist relationships. This randomized controlled trial evaluated the impact of providing weekly feedback to therapists regarding patient ratings of trust/respect toward their therapist. Method: Adult patients seeking mental health treatment at four community clinics (two community mental health centers and two community-based intensive treatment programs) were randomized to either having their primary therapist receive weekly symptom feedback-only or symptoms plus trust/respect feedback. Data were collected both prior to and during COVID-19. The primary outcome measure was a measure of functioning obtained weekly at baseline and the subsequent 11 weeks, with the primary analysis focusing on patients who received any treatment. Secondary outcomes included measures of symptoms and trust/respect. Results: Among 233 consented patients, 185 had a postbaseline assessment and were analyzed for the primary and secondary outcomes (median age of 30 years; 5.4% Asian, 12.4% Hispanic, 17.8% Black, 67.0% White, 4.3% more than 1 race, and 5.4% unknown; 64.4% female). On the Patient-Reported Outcomes Measurement Information System Social Roles and Activities scale (primary outcome), the trust/respect plus symptom feedback group had significantly greater improvements over time than the symptom alone feedback group (p = .0006, effect size d = .22). Secondary outcome measures of symptoms and trust/respect also showed statistically significant greater improvement for the trust/respect feedback group. Conclusions: In this trial, trust/respect feedback to therapists was associated with significantly greater improvements in treatment outcomes. Evaluation of the mechanisms of such improvements is needed.

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Section: Discussionmentioning

confidence: 93%

Randomized controlled trial evaluating feedback to community-based therapists based on patient reports of trust and respect.

Gibbons¹,

Duong²,

Zoupou³

et al. 2023

Journal of Consulting and Clinical Psychology

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“…However, our results are consistent with findings showing that early phase alliance agreement predicted improved symptoms over the course of treatment (e.g., Marmarosh & Kivlighan, 2012), and there is evidence that the influence of greater agreement on symptom improvement remains stable throughout early to later treatment phases (Jennissen et al, 2020). In addition, Schürmann‐Vengels et al (2023) found a positive association between initial levels of character strengths and the alliance, and a nonsignificant association between strengths and the alliance over time. Combining their approach with our analytic strategy introduces possible future research that models cross‐lagged associations between virtues and the alliance over time.…”

Section: Discussionmentioning

confidence: 99%

“…We then used the estimates produced by the regression model to conduct tests of the four slopes for the response surface analysis (Schönbrodt et al, 2022). Existing applications of response surface analysis involving alliance correspondence have not used logistic regression, and so our application is exploratory.…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…Active conditioning refers to creating a therapeutic alliance that encourages clients to apply their character strengths (Goodman et al, 2022), whereas sphere of action suggests that the application of virtues involves discerning the fit between virtue and context (Bloomfield, 2022). Schürmann‐Vengels et al (2023) recently established an empirical link between character strengths and working alliance, showing a positive association at time 1, whereas there was no association between initial strengths and change in the alliance over time.…”

Section: Introductionmentioning

confidence: 99%

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A practice‐based study of relational virtues and alliance correspondence in psychodynamic psychotherapy

Jankowski,

Sandage,

Captari

et al. 2024

J Clin Psychol

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ObjectiveTreatment outcome monitoring typically emphasizes pathology. In contrast, we responded to the need to establish psychodynamic psychotherapy as evidence‐based by modeling changes in gratitude and forgiveness.MethodWe utilized a practice‐based research design involving non‐manualized outpatient treatment. We employed a longitudinal mixture modeling approach to evaluate treatment effectiveness. We did so by testing the theorized role for relational virtues (i.e., gratitude, forgiveness) as signs of progress in psychodynamic treatment, with relational virtues referring to the application of character strengths to specific situations. We modeled clients' self‐reported level on the virtues as a joint process over five time points, and examined the influence of early treatment alliance correspondence on patterns of change using a sample of outpatient clients (N = 185; Mage = 40.12; 60% female; 74.1% White).ResultsA 3‐class solution best fit the data, with one class exhibiting growth in gratitude and forgiveness, improved symptoms, and a greater likelihood of symptom improvement relative to well‐being gains. Alliance correspondence predicted the classes of change patterns, with greater similarity between clinicians' and clients' perceptions about the alliance predicting greater likelihood of belonging to the subgroup showing highest levels of virtues and well‐being, lowest symptoms, and improved well‐being.ConclusionClinical implications involve monitoring gratitude and forgiveness as signs of progress and navigating the dialectic between implicit alliance processes and explicit virtue interventions. The former involves nurturing a strong alliance and repairing ruptures, whereas the latter involves direct in‐session conversation and/or the practice of virtue interventions in and/or outside of session.

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“…In the years that followed, various studies investigated or reported the relationship between pretreatment interpersonal problems and the therapeutic alliance in clinical samples. A negative correlation was found in patients with depression (Altenstein-Yamanaka et al, 2017; Constantino et al, 2017; Gómez Penedo et al, 2020; Renner et al, 2012), bulimia nervosa (Constantino & Smith-Hansen, 2008), social anxiety disorder (Willutzki et al, 2009), posttraumatic stress disorder (Lawson et al, 2020), schizophrenia (Johansen et al, 2013), and studies with a heterogenous sample (Schürmann-Vengels et al, 2023; Zimmermann et al, 2021). However, there are also studies that found no (Missirlian et al, 2005) or a positive correlation (Millstein et al, 2015) between interpersonal problems at therapy baseline and therapeutic alliance.…”

Section: Study Aimsmentioning

confidence: 99%

The relationship between interpersonal problems and therapeutic alliance in psychotherapy: A three-level mixed-effects meta-analysis.

Iovoli,

Flückiger,

Gómez Penedo

et al. 2024

Psychotherapy

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Psychotherapy is an interpersonal process of collaboration toward specified treatment goals. The therapeutic alliance is well established as an important factor of psychotherapeutic change. However, the experience of distress in social interactions, commonly referred to as interpersonal problems, might be interfering with the collaborative process during psychotherapy. This study systematically reviews the literature and obtains an estimate of the relationship between pretreatment interpersonal problems and the quality of the therapeutic alliance. Overall, 27 studies with 48 correlation coefficients were included in the final analysis. Due to the nested structure of the data, a three-level meta-analytic approach with a restricted maximum likelihood estimator was applied. Alliance assessment phase, alliance rater, alliance measure instrument, and treatment type were tested as potential moderators. Heterogeneity and publication bias test were performed. The meta-analysis showed a small, but significant negative relationship between interpersonal problems at the beginning of psychotherapy and subsequent therapeutic alliance (r = −.12, SE = .02, 95% CI [−.16, −.08], p < .001, d = −.27). Only alliance assessment phase accounted for significant variability. There were no indications for a substantial publication bias. Interpersonal problems of patients before psychotherapy are a robust predictor for lower therapeutic alliance quality, albeit a small effect size. Consequently, patients who experience interpersonal problems may face greater challenges in developing a strong alliance with their therapists, especially in early stages of the treatment.

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Association of patients’ pre-therapy strengths and alliance in outpatient psychotherapy: A multilevel growth curve analysis

Cited by 7 publications

References 61 publications

Randomized controlled trial evaluating feedback to community-based therapists based on patient reports of trust and respect.

Randomized controlled trial evaluating feedback to community-based therapists based on patient reports of trust and respect.

A practice‐based study of relational virtues and alliance correspondence in psychodynamic psychotherapy

The relationship between interpersonal problems and therapeutic alliance in psychotherapy: A three-level mixed-effects meta-analysis.

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