Examining state and trait alliance in group therapy: A within-person and between-person actor–partner interdependence model.

Abstract

Objective: Session-to-session fluctuations in alliance (i.e., state-like alliance) have been found to predict subsequent treatment outcome, especially in treatments in which working through ruptures and repairs in alliance is conceptualized as a main mechanism of change. Despite these advancements in the alliance literature, to our knowledge, no study has directly examined the roles of the state-like and trait-like alliance in group therapy. Method: Data for this study were provided by 61 patients hospitalized in a psychiatric day care unit in Israel. Patients participated in a dynamic therapy group and an occupational therapy group simultaneously. We used the actor-partner interdependence model (APIM) to examine actor and partner state-like and trait-like alliance on an individual member's outcome. Results: Within the dynamic therapy group, results failed to provide evidence of actor or partner state-like alliance effects; however, results did indicate a significant actor trait-like alliance effect. In addition, there was a significant interaction between actor statelike alliance and partner trait-like alliance in predicting an individual member's outcome in the dynamic therapy group. Within the occupational therapy group, results indicated a significant actor trait-like alliance effect. In addition, there was a significant interaction between actor state-like alliance and partner trait-like alliance in predicting an individual member's outcome in the occupational therapy group. Similarly, in the occupational group, there was an interaction effect between partner state-like alliance and partner trait-like alliance in predicting an individual member's outcome. Conclusions: Findings from this study demonstrate how other group members' trait-like and state-like alliance (i.e., partner effects) may influence the treatment progress of individual members. Highlights and Implications• This study provides evidence of the complex relationship between alliance and outcome in rolling inpatient therapy groups.• Findings of this study suggest that the other group members' ability to form alliances in general significantly effects the relationship between an individual member's alliance rating and treatment progress overall, and in a given session. This finding provides evidence of the importance of the group context, or the other group members, on process-outcome relationships for an individual group member.This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

How getting in sync is curative: Insights gained from research in psychotherapy.

“…Testing the same individual in several types of interactions and relationships (e.g., romantic partner, best friend, manager, child or parent, friendly stranger, unfriendly stranger) and in different settings (e.g., face-to-face treatment vs. telepsychotherapy) can crystalize individual-specific signatures using methods like round robin (Kenny, 1994(Kenny, , 2019. Although in traditional psychotherapy settings, most patients are treated by a single therapist, other unique settings exist (Kivlighan et al, 2022). Moreover, even in traditional settings, patients tend to interact with multiple professionals who engage therapeutically with them: diagnosticians, therapists, evaluators, case managers, and others, and the different interactions can serve to crystalize the patients' trait-like tendencies (Moggia et al, 2023).…”

State and trait characteristics of attachment as predictors of outcome in inpatient psychotherapy.

“…Recent methodological considerations underlined the importance of disentangling stable, traitlike differences in patients’ ability to form a strong working relationship with their therapist from statelike improvements of the alliance throughout treatment, that might reflect a mechanism of therapeutic change (Zilcha-Mano, 2017). Subsequent studies demonstrated that not only trait differences in alliances, but also statelike improvements of the alliance throughout treatment affect individual patient’s outcomes (Kivlighan et al, 2022; Zilcha-Mano, 2017; Zilcha-Mano & Fisher, 2022).…”

Quantifying synchronization in groups with three or more members using SyncCalc: The driver-empath model of group dynamics.

“…What we have learned so far is that individuals who have stronger alliances with the therapist, measured by questionnaires at the end of each session, experience better outcomes if the groups' average alliance with the therapist is also strong (Kivlighan et al, 2022). From the vantage point of synchrony research, we have learned that movement synchrony in the client-therapist dyad signals better results from individual sessions and in the longer term (Ramseyer & Tschacher, 2016) so long as the therapist was leading the client and not the other way around (Ramseyer, 2020).…”

“…In another example, Kivlighan et al (2022) studied self-reports of alliances with the group leader among adult psychiatric participants in two types of group therapy. They investigated the specific effects of transient (“state-like”) alliances that might be observed in particular sessions and (“trait-like”) alliances that persist across sessions.…”