The first sessions of psychotherapy: A qualitative meta-analysis of alliance formation processes.

Abstract

Although the effect of the therapeutic alliance on psychotherapy outcome is well documented in the research literature, less is known about how the alliance is developed during the first sessions of therapy. This qualitative meta-analysis aimed to summarize and reanalyze the existing qualitative research literature on alliance-formation processes from the perspectives of therapists and clients. Research articles were obtained through systematic searches in the following databases: PsycINFO, MEDLINE, and Web of Science. Initially, 1,006 nonduplicate articles were screened, resulting in 15 articles that explored early alliance-formation processes from the perspectives of therapists and clients. These articles were analyzed using an existing framework of meta-analyzing qualitative research. Nine articles that studied the client perspective revealed 5 overarching metathemes: (1) meeting a competent and warm therapist;(2) being understood as a whole person; (3) feeling appreciated, tolerated, and supported; (4) gaining new strength and hope for the future; and (5) overcoming initial fears and apprehension about psychotherapy. Seven articles that studied the therapist perspective revealed 6 overarching metathemes: (1) balancing technical interventions and interpersonal warmth; (2) showing a genuine desire to understand; (3) openly supporting client agency; (4) adjusting to create a sense of safety; (5) paying attention to body language; and (6) providing helpful experiences during the first session. As the first of its kind, this meta-analysis of the dual perspectives of therapists and clients shows thematic commonalities and divergences in how alliance development is experienced. Clinical implications of how alliance development can be promoted in clinical practice are discussed.

Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy

“…Which experiences were relevant for therapy (theme three) and how can one find a way of working with personal issues, while at the same time not being too critical or disloyal to loved ones (theme four). These results underscore how coming to a therapy process is connected to apprehension and a need to discover what the social rules of the situation are, a point recently emphasized in a qualitative meta-analysis of clients' experiences with starting therapy from an alliance formation perspective (Lavik et al, 2018).…”

‘Nobody else can lead your life’: What adolescents need from psychotherapists in change processes

“…Our findings suggest that the relationship may serve as a foundation underpinning client participation. Similarly, a recent meta‐analysis of all qualitative alliance formation studies, from both patient and therapist perspective, underscores how supporting agency from the therapist perspective, and gaining hope and strength through feeling accepted from the patient perspective, are important micro‐processes in developing a productive working alliance (Lavik, Frøysa, Brattebø, McLeod & Moltu, ). Our findings suggests that mental health services need to be tailored to the individual needs and preferences of young service users, and that attention to symptoms and distress needs to be balanced with a relational orientation.…”

People Engaging Each Other: A Dual-Perspective Study of Interpersonal Processes in Useful Therapy

“…In a recent meta-analysis of qualitative studies of alliance formation from client and therapist perspectives, Lavik et al (2018a) concluded that clients express needs for therapists who are competent professionally to provide problem-solving strengths and hope, while also helping in overcoming initial fears and apprehension with personal warmth and tolerance. Therapists in this meta-analysis emphasized that they worked continuously to combine technical interventions with interpersonal warmth.…”