Indirect effect of patient outcome expectation on improvement through alliance quality: A meta-analysis

Constantino, Michael J.; Coyne, Alice E.; Goodwin, Brien J.; Vîslă, Andreea; Flückiger, Christoph; Muir, Heather J.; Gaines, Averi N.

doi:10.1080/10503307.2020.1851058

Cited by 30 publications

(15 citation statements)

References 45 publications

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“…We also get the impression that successful therapeutic interventions and increased insight makes the relationship stronger because the patients experience that the therapist is helping them improve. A meta-review by Constantino et al found that when patients in CBT were more optimistic about how much therapy would help them (high outcome expectation) this had a moderate effect on higher alliance quality, which had small-to-moderate effect on better post-treatment outcomes [27]. Successful interventions and increased insight in the early course of treatment could lead to increased trust in the therapists' ability to help, which can create higher outcome expectations, which again could influence post-treatment outcome.…”

Section: Discussionmentioning

confidence: 99%

The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression

Malkomsen

Røssberg

Dammen

et al. 2021

IJERPH

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Background: There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. Method: Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. Results: We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. Conclusions: Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.

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Section: Discussionmentioning

confidence: 99%

The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression

Malkomsen

Røssberg

Dammen

et al. 2021

IJERPH

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“…This combined setting may have contributed to treatment adherence, since no rTMS session was missed for the ~5 months duration of rTMS acute and continuation treatments. Importantly, treatment adherence and expectations are known to be important contributors for better outcomes in various treatment modalities (Horwitz, 1993 ; Constantino et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Future Perspectives From a Case Report of Transcranial Magnetic Stimulation, Cognitive Behavioral Therapy, and Psychopharmacological Treatment for Post-traumatic Stress Disorder

et al. 2021

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“…The instrument used in this study, the working alliance inventory (WAI; Horvath & Greenberg, 1989) is the most often used measure to investigate the relations between the alliance and treatment outcomes (Flückiger, Del Re, et al, 2018). The BP factor structure of the alliance over the course of treatment has been of continued interest to researchers and there is an ongoing debate whether WAI operationalizes a stable one, two, or three-factorial construct over the various stages of therapy (e.g., Andrusyna et al, 2001; Cirasola et al, 2020; Constantino et al, 2020; Corbière et al, 2006; Hukkelberg & Ogden, 2016; Kivlighan et al, 2016; Milot-Lapointe et al, 2020). The research using BP designs to investigate the factor structure of the WAI yielded inconsistent results.…”

Section: Longitudinal Investigations Of the Alliancementioning

confidence: 99%

“…The research using BP designs to investigate the factor structure of the WAI yielded inconsistent results. One of the likely reasons for this failure to converge is that all of the previous investigations modeled the alliance as a stable construct (e.g., Constantino et al, 2020; Falkenström et al, 2017; Flückiger, Rubel, et al, 2020; Zilcha-Mano, 2017). This constancy/stability assumption forecloses the opportunity to examine the possibility that clients’ conception of the important elements of the alliance likely evolves in later points in therapy or, indeed, that the items targeting agreements regarding goals, tasks, and the personal attachments to the therapists, are in these later stages become a proxy for a more evolved understanding of what the alliance means to clients.…”

Section: Longitudinal Investigations Of the Alliancementioning

confidence: 99%

The evolution of patients’ concept of the alliance and its relation to outcome: A dynamic latent-class structural equation modeling approach.

Flückiger¹,

Horvath²,

Brandt³

2022

Journal of Counseling Psychology

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The working alliance (WA) has been widely identified as the key concept for psychotherapy and allied health care services. The WA, measured at different phases of diverse kinds of therapies, has been shown to robustly predict posttreatment outcomes. But the way the clients' conceptualization of the alliance evolves overtime, and the relation between this kind of conceptual change and subsequent symptom improvements, has not been investigated. Dynamic Latent Class Structural Equation Models (DLC-SEM) were applied to data drawn from two randomized clinical trials of cognitive-behavioral therapy for generalized anxiety disorder (N = 57 and 80) to evaluate several potential models of the relation between the conceptual/ structural changes in patients' self-reports of the quality of the alliance and subsequent treatment outcomes. Inspection of the DLC-SEM models suggests that, overtime, between 63% and 66% of the better sessionlevel outcome clients switched from three factors (task, goal, bond) to an integrated single factor conceptualization of the therapeutic alliance. The study indicates that the majority of patients evolve their concept of the alliance overtime: The previously distinct alliance elements become integrated into a single factor construct. These findings suggest that if such overtime development is generalizable across diverse patient/treatment populations, future research ought to take these developments into account both methodologically (i.e., how alliance is measured) and in analyzing time-series data (e.g., using DLC-SEM). By modeling the patient's dynamic concept evolution, this initial study shows a potential to empirically explore prior theoretical propositions of the evolutions (or stability) of the alliance overtime. Public Significance StatementThis study provides empirical evidence that the majority of clients who indicate that their condition is improving from session to session, also evolve their conceptualization of the nature of their alliance with the therapist. In other words, most of the potentially good outcome patients see their collaborative relation to their therapist as a more integrated concept. If what was observed in this study can be generalized, it would imply that therapist also need to adjust their relational focus to accommodate such, more integrated notion of the alliance during therapy.

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Indirect effect of patient outcome expectation on improvement through alliance quality: A meta-analysis

Cited by 30 publications

References 45 publications

The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression

The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression

Future Perspectives From a Case Report of Transcranial Magnetic Stimulation, Cognitive Behavioral Therapy, and Psychopharmacological Treatment for Post-traumatic Stress Disorder

The evolution of patients’ concept of the alliance and its relation to outcome: A dynamic latent-class structural equation modeling approach.

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