Different processes for different therapies: Therapist actions, therapeutic bond, and outcome.

Ulvenes, Pål; Berggraf, Lene; Hoffart, Asle; Stiles, Tore C.; Svartberg, Martin; McCullough, Leigh; Wampold, Bruce E.

doi:10.1037/a0027895

Cited by 76 publications

(86 citation statements)

References 69 publications

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“…For example, although the therapist alliance effect on outcome was not a consistent predictor of outcome across the analyses, it may be suggested, based on previous research (Marmarosh & Kivlighan, 2012), that the agreement between patient and therapist alliances has a consistent effect on outcome. Note further that although previous studies have demonstrated the importance of alliance in different treatment conditions and orientations, including supportive treatment (Horvath et al, 2011), in some cases supportive clinical management and psychotherapy may demonstrate different processes in which alliance is related to outcome (Ulvenes et al, 2012). …”

Section: Discussionmentioning

confidence: 98%

Therapist-reported alliance: Is it really a predictor of outcome?

Zilcha‐Mano¹,

Solomonov²,

Chui³

et al. 2015

Journal of Counseling Psychology

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Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist’s report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient’s contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients’ self-reported and diagnostician-rated depressive symptoms. Overall, the findings demonstrate that the therapists’ contribution to the alliance-outcome association was explained mainly by prior symptomatic levels. However, when a time lag of several sessions was introduced between alliance and symptoms, a positive association emerged between alliance at one time point and symptomatic distress assessed several sessions later in the treatment, controlling for previous symptomatic level. The findings were similar whether or not we controlled for the patient’s perspective on the alliance. Taken together, the findings attest to the importance of improving therapists’ ability to detect deterioration in the alliance.

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Section: Discussionmentioning

confidence: 98%

Therapist-reported alliance: Is it really a predictor of outcome?

Zilcha‐Mano¹,

Solomonov²,

Chui³

et al. 2015

Journal of Counseling Psychology

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“…Although the alliance is generally considered as a common factor, it may still operate differently in distinct treatment orientations (Ulvenes et al, 2012). Some theoretical orientations place greater emphasis on alliance as an active ingredient in treatment than others (Muran & Barber, 2010).…”

mentioning

confidence: 99%

The relationship between alliance and outcome: Analysis of a two-person perspective on alliance and session outcome.

Zilcha‐Mano

Muran

Hungr

et al. 2016

Journal of Consulting and Clinical Psychology

120

129

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Objective Better alliance is known to predict better psychotherapy outcomes, but the interdependent and interactive effects of both therapist- and patient-reported alliance levels have yet to be systematically investigated. Method Using Actor-Partner Interdependence Model analysis we estimated actor, partner, and two types of interactive effects of alliance on session outcome in a sample of 241 patient-therapist dyads across 30 sessions of cognitive-behavioral and alliance-focused therapy. Results Findings suggest that the most robust predictors of session outcome are within-treatment changes in patient reports of the alliance, which predict both patient and therapist report on outcome. Within-treatment changes in therapist reports of the alliance, as well as differences between patients and between therapists in their average ratings of alliance levels across treatment, predict outcome as reported by the specific individual. Although alliance was found to be a significant predictor of outcome in both treatments, for therapist-reported alliance and outcome it had a stronger effect in alliance-focused therapy than in cognitive-behavioral therapy. Additionally, dyads with the highest pooled level of alliance from both partners fared best on session outcome. Conclusions The results are consistent with a two-person perspective on psychotherapy, demonstrating the importance of considering the interdependent and interactive nature of both patient and therapist alliance levels on session outcome.

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“…In the same vein, one can now use neuroimaging to study the effects of treatment ingredients common to different therapy models, such as levels of adherence, therapeutic alliance or emotion activation [32,33]. Combined, such neuroimaging research may help clarify the relationships of treatment variables to both short- and long-term outcomes toward elucidating what works for whom.…”

Section: Discussionmentioning

confidence: 99%

Review of Psychodynamic Psychotherapy Neuroimaging Studies

Abbass

Nowoweiski²,

Bernier³

et al. 2014

Psychother Psychosom

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The clinical efficacy of psychodynamic psychotherapy (PDT) has undergone extensive study and review. Recently, researchers have studied the effects of this treatment on brain metabolic or synaptic activity, but the collective findings have never been reviewed. The objective of this review was to describe the findings of all neuroimaging studies of any form of PDT treatment. An extensive literature search through databases along with surveying of research groups were undertaken to acquire all available published studies. Eleven series were included in the final sample, consisting of 2 randomized controlled trials, 5 controlled trials and 4 case series, altogether involving 210 people: 94 healthy controls and 116 people with mood disorders, panic disorder, somatoform disorders and borderline personality disorder. A variety of neuroimaging techniques were used to examine regional metabolic activity and synaptic neurotransmission before and after treatment. The common finding was normalization of synaptic or metabolic activity in limbic, midbrain and prefrontal regions, occurring in association with improved clinical outcomes. PDT has demonstrable effects on brain function in diverse clinical populations as evidenced by a modest group of mixed neuroimaging studies.

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Different processes for different therapies: Therapist actions, therapeutic bond, and outcome.

Cited by 76 publications

References 69 publications

Therapist-reported alliance: Is it really a predictor of outcome?

Therapist-reported alliance: Is it really a predictor of outcome?

The relationship between alliance and outcome: Analysis of a two-person perspective on alliance and session outcome.

Review of Psychodynamic Psychotherapy Neuroimaging Studies

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