Clinical consensus strategies to repair ruptures in the therapeutic alliance.

Eubanks, Catherine F.; Burckell, Lisa A.; Goldfried, Marvin R.

doi:10.1037/int0000097

Cited by 48 publications

(42 citation statements)

References 31 publications

(41 reference statements)

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“…Understanding negative effects is essential because it allows clients to make informed decisions about the risks and benefits of ICBT, helps researchers continuously improve the design and delivery of ICBT, and ensures clients do not experience unnecessary harm or distress (Crawford et al, 2016; Rozental et al, 2018; Scott and Young, 2016). Moreover, from the clinician perspective, understanding negative effects puts therapists in a position to respond to and address negative effects in treatment, which could ultimately serve to bolster outcomes and the therapeutic alliance, similar to how past researchers have found that therapist response to an alliance rupture can be beneficial to outcomes in therapy (Eubanks et al, 2018).…”

Section: Introductionmentioning

confidence: 74%

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails

Gullickson

Hadjistavropoulos

Dear

et al. 2019

Internet Interventions

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Internet-delivered cognitive behaviour therapy (ICBT) is an efficacious form of treatment for anxiety and depression, yet it is still possible for clients to experience negative effects associated with treatment. In the ICBT literature, the term negative effects is broadly used to refer to all potentially adverse or unwanted events or experiences that are perceived as undesirable by the client and may or may not be associated with long-term symptoms or distress. Previous ICBT studies have asked clients to retrospectively describe negative effects at post-treatment; however, no research has examined the content of clients' emails to their therapist to see whether clients are reporting negative effects as they arise. In the current study, 96 clients (80 completers; 16 non-completers) were randomly selected from a published ICBT trial and directed content analysis was used to examine client emails for mention of negative effects. In addition, correlational analyses were used to examine the relationship between negative effects and: 1) demographic characteristics; 2) treatment engagement; 3) treatment satisfaction; 4) working alliance; and 5) symptom outcomes among completers. The results indicated that 61.5% of clients experienced at least one negative effect during treatment, although total number of negative effects was not significantly correlated with client demographic characteristics, lessons completed, working alliance, treatment satisfaction, or symptom outcomes. Among completers, technical difficulties, implementation problems, and negative emotional states were the most commonly reported negative effects, whereas dropout was the most commonly reported negative effect by non-completers. Negative effects that have been identified in previous research, such as symptom deterioration, novel symptoms, and severe adverse events, were not identified in client emails. The high incidence of negative effects in the current study suggests there may be value in systematically monitoring client emails for negative effects throughout treatment as a supplement to retrospective post-treatment reports. This will give therapists the opportunity to intervene as negative effects occur and potentially mitigate any impact they have on treatment outcomes. Future research, both qualitative and quantitative, is needed to gain a more nuanced understanding of negative effects associated with ICBT.

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Section: Introductionmentioning

confidence: 74%

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails

Gullickson

Hadjistavropoulos

Dear

et al. 2019

Internet Interventions

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“…Precisely, ruptures manifest themselves through phases of lack of coordination characterized by non-cooperative behaviors between participants, while repairs through coordination phases identified by cooperative behaviors; both of them are expressed through verbal and non-verbal communication (Colli and Lingiardi, 2009;Morán et al, 2016;Colli et al, 2017). The therapist's capacity to acknowledge and manage these moments could lead the therapy to positive changes or negative results (Eubanks et al, 2018). Therefore, the intersubjective negotiation in the therapeutic relationship involves a reciprocal regulation process that can itself be a mechanism of therapeutic change Muran, 2003, 2006;Martinez Guzman et al, 2014): shifts in the collaboration and coordination levels can be considered fundamental keys of change (Colli and Lingiardi, 2009;Lingiardi et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…As Hardy and Llewelyn (2015) point out, over the years, the study of the dynamics underlying the therapeutic relationship has involved the use of different methodologies (e.g., individual case studies, qualitative or quantitative analysis, naturalistic studies) and different analysis techniques (e.g., standardized methods, hermeneutics approaches, speech analysis) to provide empirical evidence aimed at explaining the role of factors that foster clinical change (e.g., Elliott et al, 2009;Eubanks et al, 2018;Smink et al, 2019). However, in recent decades, psychotherapy research has been moving toward an integrated approach of qualitative and quantitative methods, the mixed methods approach (Creswell and Plano Clark, 2017), to have a fuller picture of the ecological context of the therapeutic interaction supported by objective measures (Gelo et al, 2012;Bartholomew and Lockard, 2018).…”

Section: Introductionmentioning

confidence: 99%

The Action of Verbal and Non-verbal Communication in the Therapeutic Alliance Construction: A Mixed Methods Approach to Assess the Initial Interactions With Depressed Patients

2020

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In psychodynamic psychotherapy, verbal (structures and intents) and non-verbal (voice and interruptions) dimensions of communication intertwine conveying information and determining the mutual regulation between therapist and patient through conversational sequences. The communication components interplay is the foundation for building the therapeutic alliance, a relational dimension that predicts a psychotherapy outcome and change, influenced by patient-therapist exchanges from the initial stages of their encounter. Depressed patients present specific verbal and non-verbal communication and show difficulties in developing and maintaining the therapeutic alliance. Based on the reviewed literature, the main aim of this study was to analyze how the action of specific communicative modes, implemented by the therapist and depressed patients, affect the reciprocal construction of the early therapeutic alliance by each participant during the mutual regulation processes. We employed a mixed methods approach based on a systematic observation of communication and alliance ruptures and repairs within the audio recordings and verbatim transcripts of 20 psychotherapy sessions (6,232 speaking turns) with seven depressed patients. The observational design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified because we developed a comprehensive procedure that integrates an ad hoc indirect observation system (the Communicative Modes Analysis System in Psychotherapy), analyzing verbal and non-verbal communication, and an observational tool with deductive categories (the Collaborative Interactions Scale-Revised), assessing the therapeutic alliance construction. Once we confirmed the intra-and inter-observer reliability for the ad hoc system and the inter-rater reliability for the tool with deductive (or theoretical) categories, we performed descriptive statistics (to describe quantitatively communicative modes and alliance Del Giacco et al. Communication Acts on Therapeutic Alliance ruptures and repairs), lag sequential analysis (to detect stable patterns in communication-alliance interactions), and polar coordinate analysis (to identify significant relationships between communicative modes and alliance ruptures and repairs). Results confirm that the therapist's verbal (asking and exploring) and non-verbal (elaborating and cooperatively interrupting) modes and the depressed patients' verbal (asserting and exploring) and non-verbal (expressing emotions and cooperatively interrupting) modes determine stable patterns and significant associations with collaborative behaviors connected to the reciprocal construction of alliance by each participant. All this may provide professionals with useful information to increase the psychotherapy effectiveness with depressed patients.

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“…Finally, these results suggest certain clinical implications. Although it is true that each patient's internal representations are unique due to being subjective, identifying the predominant ones in each personality style can be a useful clinical strategy for therapists, but not only to characterize the personality styles of their patients in terms of their overriding RD: in addition, they can be used as verbal markers indicating change, stuck or rupture moments experienced during the session (Eubanks, Burckell, & Goldfried, 2018;Valdés et al, 2016). The greater proportion of RD associated with romantic partners as relational objects during stuck episodes may point to the presence of internal representations connected with this meaningful other, which are problematic, and which persistently recur throughout the therapy.…”

Section: Discussionmentioning

confidence: 99%

Conflictual relational demands of anaclitic and introjective depressive women

Valdés¹,

Alamo

Reinel

2019

RevPsicología

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The depression is associated with typical ways of relating to and handling conflict with others. This study empirically examined the most frequent relational demands of female depressive patients, depending on their personality configuration and the characteristics of relevant segments within the session: change and stuck episodes. Ten psychotherapies (n = 230 sessions) were observed in order to identify, delimit and code relevant episodes within session (24 change episodes and 26 stuck episodes) using the CCRT-LU-S Category System (Albani et al., 2002), to determine patients’ relational demands. The results showed that introjective patients verbalized more relational demands on themselves as a relational object, and therefore more demands with a subject-subject direction. These patients expressed their needs and wishes centered on questioning themselves, to the detriment of generating significant interpersonal relationships. Furthermore, it was possible to predict a greater presence of relational demands referred to contents about “loving” during the change episodes, confirming that the most frequent themes in patients’ discourse were a strong wish to feel happy, despite their experiences of helplessness. These findings highlight the need for a more dimensional view of depression that takes into account patients’ personality configurations and their association with little and big outcomes.

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Clinical consensus strategies to repair ruptures in the therapeutic alliance.

Abstract: The findings are consistent with the growing literature on the value of using certain alliance-focused interventions during a rupture. The findings point to the importance of therapists' awareness of the state of the alliance so that they can identify when ruptures are occurring.

Cited by 48 publications

References 31 publications

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails

The Action of Verbal and Non-verbal Communication in the Therapeutic Alliance Construction: A Mixed Methods Approach to Assess the Initial Interactions With Depressed Patients

Conflictual relational demands of anaclitic and introjective depressive women

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