Future orientation in successful therapies: Expanding the concept of goal in the working alliance

Abstract

Objective: To better understand how therapists facilitate client goal attainment in therapy, we analyzed therapists' future-oriented actions in good outcome cases in which clients recorded high ratings on goal items in the Working Alliance Inventory-Short Revised. Method: We selected clients who were within the clinical range (OQ-45.2) at pretreatment, demonstrated reliable change at the end of treatment, and recorded high WAI client goals scores early in treatment. Qualitative analyses of transcripts of the initial three sessions and client posttreatment interviews were integrated into a combined analysis to identify themes across the two separate sets of findings. Results: Therapist future-oriented activity included: (1) Picking up explicit and implicit intentions; (2) using linguistic devices, such as meta-communication, action language, and hedging; (3) using evocative interventions; and (4) nudging the client into practicing change. Core finding: Therapists aligned with clients' directionality in a forwarddriven, gradually evolving process. Conclusion: Conceptual and clinical implications are discussed.

The alliance in mental health care: conceptualization, evidence and clinical applications

“…However, it rarely happens this way. It seems that experienced therapists in highalliance and successful cases rarely explicitly discuss the very specific goals of treatment, al though they do induce a future orientation through various tech niques 6,7 . This raises the question of what is meant by goals of treatment, particularly the level of specificity of such goals.…”

Facilitating children’s in-session involvement in child and family therapies: A dynamic framework of clinical practices.

“…Adjusting intensity by, for instance, letting children set the treatment agendas or accepting that children might need to avoid eye contact is consistent with earlier studies on children’s needs and experiences in therapy (e.g., McCrea et al, 2016; Lindqvist et al, 2022). Linguistic devices, such as hedging (mitigating language, e.g., Tables 4 and 5), are also documented as part of goal-related processes in successful therapies (Oddli et al, 2021). In emotionally loaded situations, the soothing function of mitigating language can also protect practitioners and enable them to reconcile complex situations (Ruch et al, 2020).…”

Do therapists differ in their general effectiveness? Therapist effects and their determinants.

“…In-depth interview analyses have demonstrated how therapists draw on their extended repertoire of knowledge sources, involving embodied, implicit decision making and clinical intuition (Bernhardt et al, 2021;Oddli & Halvorsen, 2014;Oddli & McLeod, 2017;Råbu et al, 2021). Qualitative analyses of therapy sessions have identified how decisions evolve as therapists make use of micro-cues along with distinctive linguistic manners, to involve the patient in a meaningful interaction about relevant tasks in therapy and future goals and directions (Oddli & McLeod, 2017;Oddli et al, 2021;Oddli & Rønnestad, 2012;von der Lippe et al, 2019). These studies serve to elaborate on how therapists contribute to the working alliance and other factors associated with effective therapies, such as motivation, goals, shared decision making, and responsiveness.…”

“…One example is a line of qualitative studies of "master therapists" or "supershrinks" who are identified according to their reputation within a community of practice; that is, studies of the reputedly excellent therapists (e.g., Hansen et al, 2015;Jennings & Skovholt, 1999;Skovholt & Jennings, 2016;Skovholt & Rønnestad, 1992, 1995. Examples are qualitative analyses of good-outcome and high-alliance processes with reputable, experienced therapists (e.g., Oddli et al, 2021), comparative qualitative analyses of the processes of good-and poor-outcome cases (e.g., Hansen et al, 2015;von der Lippe et al, 2019), and therapists' strategies when facing difficult impasses (Moltu & Binder, 2011).…”