Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy.

Abstract

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed.

Colaboração terapêutica: Estudo comparativo de um caso finalizado e de um caso de desistência

“…Uma pobre qualidade da aliança terapêutica, especialmente na fase inicial da terapia, está associada a uma maior probabilidade de desistência, por parte dos clientes, dos seus processos terapêuticos (e.g., Roos & Werbart, 2013;Sharf, Primavera, & Diener, 2010). Embora a definição de desistência em psicoterapia não seja consensual, resultando em discrepâncias significativas nomeadamente no que diz respeito à avaliação da prevalência do fenómeno (e.g., Benetti & Cunha, 2008;Jung, Serralta, Nunes, & Eizirik, 2013), a maioria das definições adotadas parece centrar-se no não comparecimento do cliente à última sessão agendada, e daí em diante, sem o conhecimento e/ou o acordo do terapeuta (e.g., Jung et al, 2013).…”

The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care

“…In particular, working alliance, also referred to as therapeutic bond, alliance, or therapeutic alliance, is a collaborative relationship between patient and provider and has been associated with positive psychotherapy outcomes for a wide range of diagnoses and populations, including patient engagement and retention in treatment, (Castonguay, Constantino, & Holtforth, 2006;Sharf, 2010). It is conceptualized as a key ingredient of therapeutic relationship and a strong mediator of behavioral change by facilitating for patients and providers emotional involvement, trust, partnership, and commitment to the goals and therapeutic process (Bordin, 1979;Castonguay et al, 2006;Horvath, 1991).…”

Depression explanatory models of primary care patients and doctors: Relationship with self-stigma, communication effectiveness, and recovery

“…So -and personally I find that very reassuring that they are listening to me, that she's listening to me and that I feel she's valuing my input into the discussion. (male, age 40-54) This result aligns with previous studies on how effective communication during clinical encounters results in better treatment outcomes (Street et al, 2009) particularly for mental health conditions (Horvath et al, 2011;Sharf et al, 2010).…”

“…Good patient-doctor communication and strong therapeutic alliance are both correlated to positive treatment outcomes Street, Makoul, Arora, & Epstein, 2009). In particular, meta-studies (e.g., Horvath, Del Re, Fluckiger, & Symonds, 2011;Sharf, Primavera, & Diener, 2010) have reiterated the importance of the working relationship between patients and their doctors in determining the effectiveness of mental health treatments. In these studies, enduring therapeutic alliances were significantly linked to lowered risk of treatment discontinuation and improvement in post-intervention symptoms.…”