The Multisystemic and Multilevel Investigation of the Expanded Therapeutic Alliance‐Psychological Functioning Relationship in Individual Therapy

Abstract

The expanded therapeutic alliance, consisting of multiple interpersonal alliance relationships, is a common factor inherent to the practice of all systemic therapies. The following study has three specific aims: (a) Bring an expanded, multisystemic emphasis to the study of the therapeutic alliance in individual therapy; (b) Understand better the session-by-session relationship between alliance and psychological functioning, including distinguishing within-person from between-person variability by using multilevel modeling techniques; and (c) Explore the role of early attachment relationships and family-of-origin experiences in moderating the alliance-psychological functioning relationship. Instead of taking only one or two alliance measurements throughout treatment like in the majority of previous research, we measured both alliance and psychological functioning continuously at each session for 296 subjects.

Therapeutic Alliance and Retention inBriefStrategicFamilyTherapy: A Mixed‐Methods Study

“…Although the retained group did not differ significantly from the nonretained group in terms of overall alliance ratings or contingent interactions, there were notable consistencies between the qualitative and quantitative aspects of the study. These consistencies support the validity of the results, which reflect the alliance literature in general (Fife et al., ; Karam et al., ; Sparks, ) and the SOFTA‐o literature specifically (Beck et al., ; Friedlander, Escudero, Horvath et al., , 2008Friedlander et al., ). Moreover, the consistent results have important implications for therapists working with challenging families.…”

“…'s () multisite effectiveness trial of Brief Strategic Family Therapy (BSFT). The importance of alliance building in first sessions is well understood as necessary for setting the stage for change in family therapy (Karam, Ko, Pinsof, Mroczek, & Sprenkle, ; Sparks, ).…”

A 20‐Year Review of Common Factors Research in Marriage and Family Therapy: A Mixed Methods Content Analysis

“…MFT programs place model-specific training front and center in their curriculum. Common factors proponents propose that MFTs may be best served by integrating common factors training into the curriculum of graduate programs as part of the training students receive in specific MFT models (D'Aniello & Fife, 2017;Fife, 2016;D'Aniello et al, 2018;Karam et al, 2015). (D'Aniello & Fife, 2017) and (Fife et al, 2019) conducted two empirical studies focused on the role of common factors in MFT training and found favorable perceptions from faculty and students.…”

“…Of 31 participants, 28 (90%) directors of accredited MFT/counseling programs indicated that their students receive some form of training in common factors, and they reported overall positive student responses to the training. Karam et al (2015) highlight specific training in common factors implemented at the University of Louisville where a unique capstone project allows students to specifically assess their theory preference based on common factors, The Family Institute at Northwestern University where students are able to measure their performance in different categories of change using an online computer graph system known as STIC, Purdue University where the science that supports common factors is studied extensively, Alliant International University, Sacramento Campus which requires a common factors course as part of basic core curriculum, and Michigan State University's doctoral program that studies common factors in greater depth. Author (2019) interviewed students about their experience of common factors training and found that students reported overwhelmingly positive experiences of being trained in common factors; developed a more sophisticated understanding of the relationship between common factors, models, and change process; and said it provided increased guidance in how to structure their clinical work.…”

Attachment Change in the Beginning Stages of Therapy: Examining Change Trajectories for Avoidance and Anxiety

“…Specifically, Parish and Eagle () identified empirical evidence that “therapy relationships… [contain] every feature of attachment identified in the theoretical literature with the sole exception… [of] protesting separation from the therapists” (Parish & Eagle, , p. 280). This therapist‐centered (TC) attachment process emphasizes the importance of the therapeutic alliance to provide a healing context that is created through connection with an understanding and validating therapist who is engaged and responsive (Karam, Ko, Pinsof, Mroczek, & Sprenkle, ).…”