In here and out there: Systemic alliance and intersession processes in psychotherapy.

Abstract

The processes clients engage in between therapy sessions (referred to as intersession processes; ISPs) are empirically supported as influential factor in psychotherapy. The current study examined the impact of the therapeutic alliance-both the individual alliance and the systemic alliance-on client engagement in ISP-thoughts, ISP-actions, and client perceptions of therapy progress. Eighty-one therapy clients provided responses regarding these therapy process variables, and results revealed that higher ratings of client/therapist alliance (referred to as "self-alliance"), and higher ratings of alliance between one's social network and therapy (referred to as "other-alliance") were related to greater engagement in ISP-actions, but not ISP-thoughts. In addition, an interaction factor was supported wherein those who reported high self-alliance and high other-alliance also engaged in greater ISP-actions, but this association was not found when other-alliance was reported to be low. Clients' positive perceptions of therapy progress were associated with greater engagement in ISP-thoughts, ISP-actions, and higher ratings of self-and other-alliance. Discussion and implications are offered for how therapists may be more effective at monitoring and promoting engagement in ISPs and aligning with clients' many systems. Public Significance StatementWhat clients do between sessions has important influence on the process and outcome of psychotherapy. This article advances our understanding of the mechanisms that promote clients' therapy related thoughts and actions between sessions, while connecting the influence of the individual and systemic alliances.

The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis.

“…ited size of primary studies (k ϭ 17), which may not accurately reflect the diverse universe of psychotherapy approaches; thus, an investigation of potential differential effects across particular treatment orientations was limited. Time-specific and outside-therapy confounds, for example, intersession processes, could have impact the results (see, e.g., Hartmann, Orlinsky, & Zeeck, 2011;Kaiser & Laireiter, 2019;Quirk, Smith, & Owen, 2018;Strunk et al, 2010). Based on our decision to include data sets where the alliance and symptoms were measured from Session 1 to 7 to predict posttreatment outcome, we cannot draw conclusions regarding later phases of therapy.…”

“…There are several questions raised, but not yet answered, by this investigation: A limitation of this meta-analysis is the relatively limited size of primary studies ( k = 17), which may not accurately reflect the diverse universe of psychotherapy approaches; thus, an investigation of potential differential effects across particular treatment orientations was limited. Time-specific and outside-therapy confounds, for example, intersession processes, could have impact the results (see, e.g., Hartmann, Orlinsky, & Zeeck, 2011; Kaiser & Laireiter, 2019; Quirk, Smith, & Owen, 2018; Strunk et al, 2010).…”

What works for adolescents with borderline personality disorder: towards a developmentally informed understanding and structured treatment model

“…Consequently, recovery is partly dependent upon what and whom the patient has access to in the social world. The role of extra-therapeutic factors in therapy have long been acknowledged [57], and research shows how the alliance with the social network is more important than the patient-therapist alliance for the outcome [58]. Thus, the limited support for the efficacy of interventions aimed at BPD in adolescents, could then be understood as a result of that the fundamental structure of the current mental health systems is inadequate for the unique developmental and cultural needs of young people and that transformational change and service redesign is necessary.…”

Connecting in-session corrective emotional experiences with postsession therapeutic changes: A systematic case study.

“…Previous studies on intersession activity showed that clients recalled the therapist and the therapeutic relationship to further work on problems in daily life, to seek comfort from negative emotions, and facilitate problem solving (Geller & Farber, 1993). Similarly, Owen et al (2012) and Quirk et al (2018) found that good alliance facilitated clients' engagement in more actions to address their issues in their daily life. The present study demonstrated that in affect-focused therapies such as AEDP and EFT, such carryover effects come from positive emotions sprung out from the relational experience with the therapist.…”