Change in coordination across phases of psychotherapy and outcome: Two mechanisms for the role played by patients' contribution to the alliance.

Abstract

This article investigated the mechanisms underlying associations between patients' contribution to the alliance and outcome by examining relations between change in the alliance over the course of treatment and improvement in Short-Term Dynamic Psychotherapy (STDP) and Brief Adaptive Psychotherapy (BAP). Findings for STDP were consistent with 1 model about the role played by the alliance, according to which change in the alliance over the course of therapy is the vehicle for overall improvement. Results for BAP were consistent with the other main position proposed in the literature, which argues that a positive alliance provides the foundation for successful treatment. Discussion includes suggesting that it might prove useful in future research to group therapy approaches in terms of these 2 models and that this idea may explain 2 apparently contradictory sets of findings from previous studies on relations between change in the alliance and outcome.

Patient coordination style during the first session of therapy: relationship with early alliance, patient's characteristics and outcomes

“…Surprisingly we did not replicate the findings from Westerman et al [16] concerning the relation between PCS and outcome. This may be explained by differences concerning the treatment and the sample.…”

“…The validity studies of Westerman et al [10,16] showed acceptable interrater reliability (r ranging from 0.68 to 0.93) and good internal consistency (α ranging from 0.63 to 0.98). Coordination measured at intake interview was predictive of outcome (r = 0.60) for a 10-session brief action-oriented therapy.…”

“…Patients characterised by low quality of object relations [18], hostiledominant problems [19], problems in social adjustment and defensiveness [20], tend to develop weak alliance. The influence of psychopathology showed mixed results [21].Westerman et al [16] showed that outpatients were better coordinated than inpatients, PCS explaining 21% of variance.…”

“…Therefore, PCS was considered as a behavioural measure of patient's contribution to alliance. PCS evolves in a curvilinear trajectory in Brief Treatment [15] and is related with outcome in various brief therapeutic approaches [10,16].…”

Elaboração da versão em português do Psychotherapy Process Q-Set

“…De fato, diversas pesquisas têm demonstrado que a aliança terapêutica é um importante preditor de resultados terapêuticos em diferentes psicoterapias [31][32][33] . Não há ainda, no entanto, estudos suficientes para esclarecer como tais fatores, específicos ou comuns, contribuem para a mudança em psicoterapia 34 .…”