The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis.

Flückiger, Christoph; Rubel, Julian; Re, A. C. Del; Horvath, Adam O.; Wampold, Bruce E.; Crits‐Christoph, Paul; Atzil-Slonim, Dana; Compare, Angelo; Falkenström, Fredrik; Ekeblad, Annika; Errázuriz, Paula; Fisher, Hadar; Hoffart, Asle; Huppert, Jonathan D.; Kivity, Yogev; Kumar, Manasi; Lutz, Wolfgang; Muran, J. Christopher; Strunk, Daniel R.; Tasca, Giorgio A.; Vîslă, Andreea; Voderholzer, Ulrich; Webb, Christian A.; Xu, Hui; Zilcha‐Mano, Sigal; Barber, Jacques P.

doi:10.1037/ccp0000594

Cited by 138 publications

(149 citation statements)

References 108 publications

(182 reference statements)

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“…This should be examined further. There are examples of constructs measured in therapy being influenced by the phrasing of the items or by already experienced symptom relief although it seems clear that important constructs, such as the alliance, are not simply an epiphenomenon of symptom reduction (e.g., Flückiger et al, 2020;Mooney et al, 2014;Zilcha-Mano et al, 2014). However, in this study the measures were examined from week one of treatment, meaning that the likelihood of the scores being confounded with progress in treatment, is likely reduced.…”

Section: Limitations and Further Researchmentioning

confidence: 95%

It's the therapist and the treatment: The structure of common therapeutic relationship factors

Finsrud

Nissen‐Lie

Vrabel

et al. 2021

Psychotherapy Research

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Prior research has established that common therapeutic relationship factors are potent predictors of change in psychotherapy, but such factors are typically studied one at a time and their underlying structure when studied simultaneously is not clear. We assembled empirically validated relationship factors (e.g., therapist empathy; patient expectations; agreement about goals) into a single instrument and subjected it to factor analysis. Method: The instrument was applied to patients (N = 332) undergoing intensive psychotherapy of different types for depressive disorders, anxiety disorders, eating disorders, and childhood trauma in an inpatient specialized mental health setting. In order to examine the psychometric properties of the scale, we used half the sample (N=164) to conduct exploratory factor analysis (EFA) and parallel analysis before we tested the solution using exploratory structural equation modeling (ESEM) on the second half of the sample (N=168). Measurement invariance analysis was conducted to examine the stability of the factor structure. Results: The analysis yielded two factors, which were termed 1. "Confidence in the therapist" and 2. "Confidence in the treatment." Discussion: When assessed simultaneously, patients differentiate between their evaluation of the therapist and of the treatment. The results indicate that there is substantial overlap among previously established relationship factors. Trial registration: ClinicalTrials.gov identifier: NCT03503981.

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Section: Limitations and Further Researchmentioning

confidence: 95%

It's the therapist and the treatment: The structure of common therapeutic relationship factors

Finsrud

Nissen‐Lie

Vrabel

et al. 2021

Psychotherapy Research

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“…Largely due to Bordin's (1979) transtheoretical reformulation of the alliance construct, which emphasized purposeful collaboration and affective bond, the alliance has been described as the “quintessential integrative variable” and “common factor” (Wampold & Imel, 2015; Wolfe & Goldfried, 1988) and has been the subject of multiple meta‐analyses indicating its predictive relationship to psychotherapy outcome (Horvath et al, 2011; Horvath & Symonds, 1991; Martin et al, 2000, Flückiger et al, 2018, 2020). The proliferation of this study ultimately led to a “second generation” of alliance research that aimed to study ruptures‐repair and to provide therapists “clinically‐friendly” data—namely “what to do when.” In sum, this study has demonstrated that ruptures and repairs are quite prevalent (e.g., anywhere from 30%–50% of sessions by self‐report or 30%–100% by the observer) and predictive of outcome (Eubanks et al, 2018); this generation also includes the promising benefits of alliance‐focused training (AFT) on rupture–repair (see Muran, 2019; Muran et al, 2018; to be discussed further below).…”

Section: Why Study Ruptures?mentioning

confidence: 99%

One more time with less jargon: An introduction to “Rupture Repair in Practice”

2021

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In this introduction to this issue on Rupture–Repair in Practice, we present our understanding of alliance ruptures using common language to appeal to all theoretical orientations. Specifically, we define withdrawal movements away from another or oneself (efforts towards isolation or appeasement) and confrontation movements against another (efforts towards aggression or control). In addition to these interpersonal markers, we suggest that therapist emotional experiences can be considered as intrapersonal markers indicating rupture. We emphasize understanding ruptures as relational phenomena. Then we present various pathways toward rupture–repair, highlighting renegotiation of therapy tasks or goals and exploration of patient and therapist contributions and needs. We explain how these paths can be understood as critical change processes that can transform obstacles in treatment into opportunities. We finish with some mention of our alliance‐focused training for self‐development. This issue represents an important step towards demonstrating the transtheoretical and practical potential of rupture–repair.

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“…There are over 300 studies that have examined the alliance-outcome association, involving over 30,000 patients (53); consistently, the alliance measured early in therapy is a predictor of the outcome of therapy. There is convincing evidence that this association is not confounded by early symptom change or other factors and is important for all types of therapies (37,(53)(54)(55). Moreover, it is the therapist contribution to the alliance that is important for producing therapeutic outcomes-that is, therapists who are better able to form an alliance across a variety of patients have better outcomes than therapists whose ability to form an alliance with patients is poorer (37,(56)(57)(58)(59).…”

Section: Psychotherapymentioning

confidence: 99%

Healing in a Social Context: The Importance of Clinician and Patient Relationship

Wampold

2021

Front. Pain Res.

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When a patient presents to a health provider, the course of the disorder is composed of three effects: natural effects, specific effects, and contextual effects. Part of the contextual effect is due to the relationship between the healer and the patient. Social healing appears to be present in eusocial species and particularly well-developed in humans. Evidence for the importance of the relationship in healing is found in placebo studies, including placebo analgesics, medicine, and psychotherapy. Although the theory for how the relationship is therapeutic is not well-developed, four possible mechanisms are discussed. The implications for health care and the treatment of pain are discussed.

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The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis.

Cited by 138 publications

References 108 publications

It's the therapist and the treatment: The structure of common therapeutic relationship factors

It's the therapist and the treatment: The structure of common therapeutic relationship factors

One more time with less jargon: An introduction to “Rupture Repair in Practice”

Healing in a Social Context: The Importance of Clinician and Patient Relationship

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