The Development of Therapeutic Alliance During Psychological Assessment: Patient and Therapist Perspectives Across Treatment

Abstract

We examined the impact of patient- and therapist-rated alliance developed during psychological assessment on the subsequent alliance measured early and late in formal psychotherapy. We hypothesized that a working alliance developed during psychological assessment conducted from a collaborative therapeutic model of assessment (TMA; Finn & Tonsager, 1992, 1997; Fischer, 1994) between the patient and therapist would carry into formal psychotherapy. We also hypothesized that alliance for those patients receiving a TMA would be significantly greater than patients receiving psychological testing as usual. To test this hypothesis, we administered the Combined Alliance Short Form-Patient Version (Hatcher & Barends, 1996) and the Combined Alliance Short Form-Therapist Version (Hatcher, 1999) to a sample of outpatients and their therapists at the end of the assessment feedback session, early, and late in psychotherapy. The hypotheses were supported as alliance scales rated at the assessment feedback session demonstrated positive and significant relationships with alliance throughout formal psychotherapy and in relation to a control group. The clinical utility and research implications of these findings are discussed.

Therapeutic Assessment with couples

“…Ackerman, Hilsenroth, Baity, and Blagys (2000) found that when clients at a community clinic took part in a collaborative assessment prior to beginning formal psychotherapy, they were much less likely to ultimately terminate therapy against medical advice than clients who participated in a more traditional, information gathering model of assessment. In addition, the results presented in Ackerman et al's (2000) article, as well as later results from the same study (Hilsenroth, Peters, & Ackerman, 2004), indicated collaborative assessment may be associated with higher levels of client-therapist alliance during subsequent psychotherapy when compared with alliance levels reported by clients who received traditional assessment. Similarly, Hanson, Claiborn, and Kerr (1997) found that college students participating in a brief "interactive" (collaborative) assessment were more likely to rate their sessions "deep" and their counselors as expert, trustworthy, and attractive, than students participating in an assessment that involved unilateral feedback from the assessor.…”

“…To date, all of the empirical research on collaborative and Therapeutic Assessment has focused on individual (Ackerman et al, 2000;Finn & Tonsager, 1992;Hilsenroth et al, 2004;Newman & Greenway, 1997) and family clients (Smith et al, 2009;Tharinger et al, 2009;Tharinger, Finn, Wilkinson, & Schaber, 2007). However, an accumulating body of case material suggests collaborative and Therapeutic Assessment techniques may also be useful for psychologists working with couples, either as a precursor or supplement to traditional couples therapy (Butcher, 1990;Dorr, 1981;Finn, 2007;Richman & Davidoff, 1971).…”

“…In studies of college students seeking services at counseling centers, TA has been associated with decreased psychological symptomatology, increased self-esteem, and an increased sense of hopefulness (Finn & Tonsager, 1992;Newman & Greenway, 1997). Other researchers have found that clients who participate in TA before beginning a course of psychotherapy are likely to be more committed to therapy and experience a stronger alliance to the therapist than clients who participate in more traditional assessments (Ackerman, Hilsenroth, Baity, & Blagys, 2000;Hilsenroth, Peters, & Ackerman, 2004). In addition, preliminary studies of TA as a therapeutic intervention for children and families have found TA to be associated with decreased psychological symptomatology in children and improved family functioning (Smith, Wolf, Handler, and Nash, 2009;Tharinger, Finn, Gentry, Fowler, et al, 2009).…”

Early change in maladaptive defence style and development of the therapeutic alliance

“…Early alliance can be determined either at a single session or as a developing process (Hilsenroth, Peters, & Ackerman, 2004).…”

Avaliação psicológica como fator protetor à interrupção de tratamento na psicoterapia psicanalítica de crianças: dados empíricos

“…Hilsenroth, Peters and Ackerman (2004) examined a sample of outpatients and their therapists at the end of the assessment feedback session, early, and late in psychotherapy, aiming at verifying the impact of patient-and-therapist-rated alliance developed during psychological assessment on the subsequent alliance measured early and late in formal psychotherapy. They found that a working alliance developed during psychological assessment between the patient and therapist would carry into formal psychotherapy.…”