Instrumental variable analyses for causal inference: Application to multilevel analyses of the alliance–outcome relation

Crits‐Christoph, Paul; Gallop, Robert; Gaines, Averi N.; Rieger, Agnes; Gibbons, Mary Beth Connolly

doi:10.1080/10503307.2018.1544724

Cited by 29 publications

(28 citation statements)

References 80 publications

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“…These results con rm the robust positive relationship between alliance and outcome across alliance and outcome measures, cultures, patient characteristics, treatment approach, and the perspective of the assessor. This nding has also been con rmed applying instrumental variable analyses (24). Although the therapeutic relationship has a long tradition in child and adolescent psychotherapy dating back to Anna Freud (25), there is a scarcity of research on the alliance-outcome relationship in child and adolescent psychotherapy (26).…”

Section: The Role Of Common Factors and The Therapeutic Alliancementioning

confidence: 74%

Improving Treatment Outcomes for Adolescents with Borderline Personality Disorder Through a Socioecological Approach

Sharp

Kongerslev

et al. 2022

Preprint

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Background: There is a dearth of studies evaluating treatment efficacy for adolescents diagnosed with borderline personality disorder. The few available randomized controlled trials that have been conducted show modest results and treatments appear to have equivalent effects. The current paper draws on (a) the lessons learnt from the last 50 years of psychotherapy research in general and (b) recent advances in mentalization-based understanding of why treatment works, which together point to the importance of following a socioecological approach in the treatment of personality problems in adolescence – a developmental period that insists on a treatment approach that goes beyond the therapist-client dyad. Case presentation: Here, we describe such an approach, and offer a clinical case example with a young 17-year old girl diagnosed with borderline personality disorder, to illustrate what a shift toward a more socioecological approach would entail. Conclusions: The clinical impact of the socioecological approach and the potential benefits as illustrated in the current case illustration, offers a framework that justifies and allows for the expansion of service delivery for youth with borderline personality disorder beyond dyadic therapist-client work.

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Section: The Role Of Common Factors and The Therapeutic Alliancementioning

confidence: 74%

Improving Treatment Outcomes for Adolescents with Borderline Personality Disorder Through a Socioecological Approach

Sharp

Kongerslev

et al. 2022

Preprint

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“…Another method that has recently begun making inroads in psychological research is Instrumental Variable (IV) regression (e.g. Bollmann et al, 2019;Crits-Christoph et al, 2020;Maydeu-Olivares et al, 2020). IV regression uses information from variables that are not included in the focal structural equations but are used as instruments to "purify" the endogenous regressors of their relationships with omitted confounders.…”

Section: A Brief Conceptual Overviewmentioning

confidence: 99%

Using copulas to enable causal inference from nonexperimental data: Tutorial and simulation studies.

Falkenström¹,

Park²,

McIntosh³

2023

Psychological Methods

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Causal inference in psychological research is typically hampered by unobserved confounding. A copula-based method can be used to statistically control for this problem without the need for instruments or covariates, given relatively lenient distributional assumptions on independent variables and error terms. The current study aims to: (1) provide a user-friendly introduction to the copula method for psychology researchers; and (2) examine the degree of non-normality in the independent variables required for satisfactory performance. A Monte Carlo simulation study was used to assess the behavior of the copula method under various combinations of conditions (sample size, skewness of independent variables, effect size, and magnitude of confounding). In addition, an applied example from research on the effects of parental rearing on adult personality and life satisfaction was used to illustrate the method. Simulations revealed that the copula method performed better at higher levels of skewness in the independent variables, and that the impacts of lower skewness can be offset to some extent by larger sample size. When skewness and/or sample size is too small, the copula method is biased towards the uncorrected model. In the applied example, parental rejection/punishment predicted less adaptive personality and life satisfaction, with no evidence of confounding. For parental control/overprotection, there was evidence that confounding attenuated the estimated relationship with personality/life satisfaction.Copula adjustment is a promising method for handling unobserved confounding. The discussion focuses on how to proceed when assumptions are not quite met, and outlines potential avenues for future research.

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“…The working alliance is considered to be an important determinant of psychotherapy success (28,29) because it builds a framework for various methods and strategies used by psychotherapists. It builds communication between the psychotherapist and the stable part of patient's personality, helping the latter to remain in the process of change despite the fluctuating level of subjective discomfort or perceived difficulties in functioning.…”

Section: Therapeutic Alliance and Psychotherapy Outcomesmentioning

confidence: 99%

The Strength of Alliance in Individual Psychotherapy and Patient's Wellbeing: The Relationships of the Therapeutic Alliance to Psychological Wellbeing, Satisfaction With Life, and Flourishing in Adult Patients Attending Individual Psychotherapy

Prusiński

2022

Front. Psychiatry

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ObjectivesThe central aim of the research was to verify and determine the strength of the relationships of therapeutic alliance to wellbeing, life satisfaction, and flourishing in patients attending individual psychotherapy. The relationships were assessed based on different sources of information about the quality of the working alliance: patient's evaluation and patient's and psychotherapist's joint evaluations.DesignThe author applied Bordin's pantheoretical model of alliance and two different conceptions of wellbeing, operationalized as hedonistic and eudaimonic.MethodsThe 411 participants included 252 patients and 159 psychotherapists. To test the hypotheses, 16 joint and separate models of structural relations were built and analyzed empirically using SEM. Correlations were analyzed between alliance factors and those of wellbeing, satisfaction, and flourishing.ResultsThe actual impact of working alliance quality on psychological wellbeing proved to be stronger compared to the relations between alliance and satisfaction or flourishing. The results of analyses revealed low, though usually positive and significant, correlations between the dimensions of alliance and those of wellbeing, life satisfaction, and flourishing.ConclusionsThe empirical data and the strategy of analyses brought the expected results, confirming that patient's and psychotherapist's perception of a strong therapeutic alliance is crucial for the optimization of patient's functioning and wellbeing. It turns out that the therapeutic alliance is, above all, a factor of wellbeing understood more deeply than merely as current pleasure. The study also showed that no factor isolated from other components of alliance increased the quality of patient's mental functioning more than others.

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Instrumental variable analyses for causal inference: Application to multilevel analyses of the alliance–outcome relation

Cited by 29 publications

References 80 publications

Improving Treatment Outcomes for Adolescents with Borderline Personality Disorder Through a Socioecological Approach

Improving Treatment Outcomes for Adolescents with Borderline Personality Disorder Through a Socioecological Approach

Using copulas to enable causal inference from nonexperimental data: Tutorial and simulation studies.

The Strength of Alliance in Individual Psychotherapy and Patient's Wellbeing: The Relationships of the Therapeutic Alliance to Psychological Wellbeing, Satisfaction With Life, and Flourishing in Adult Patients Attending Individual Psychotherapy

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