The role of evidence-based therapy relationships on treatment outcome for adults with trauma: A systematic review

Ellis, Amy E.; Simiola, Vanessa; Brown, Laura S.; Courtois, Christine A.; Cook, Joan M.

doi:10.1080/15299732.2017.1329771

Cited by 24 publications

(22 citation statements)

References 51 publications

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“…Higher working alliance at the start of treatment, as rated by both patients and therapists after session 1, was associated with greater symptom improvement, measured by symptom scores at the end of treatment, controlled for baseline scores. This extends the earlier findings of Brady et al (18), who found that patients reporting a stronger working alliance were more likely to respond well to CT-PTSD, and replicates the findings of numerous other studies which have found a positive association between working alliance and therapy outcome, including in PTSD treatment (15). Although the effect sizes in our study were of small to medium size, they are in line with those of other studies in a range of different disorders (1,3,15).…”

Section: Discussionsupporting

confidence: 92%

“…This extends the earlier findings of Brady et al (18), who found that patients reporting a stronger working alliance were more likely to respond well to CT-PTSD, and replicates the findings of numerous other studies which have found a positive association between working alliance and therapy outcome, including in PTSD treatment (15). Although the effect sizes in our study were of small to medium size, they are in line with those of other studies in a range of different disorders (1,3,15). These results support the importance of establishing a good working relationship with patients in trauma-focused psychological therapies for PTSD, which is associated with treatment outcomes, although other processes such as reduction of negative appraisals also play a role (43).…”

Section: Discussionsupporting

confidence: 89%

“…A number of studies have shown that a good working alliance predicts better treatment outcome in patients with PTSD [see (15) for a review]. However, most of these studies have used a pooled or single point measure of working alliance and have not examined the relationship in the opposite direction (i.e., symptom change influencing alliance).…”

Section: Introductionmentioning

confidence: 99%

“…There may be reason to argue that the working alliance is particularly important in treatment for PTSD [e.g., (15)]. CT-PTSD, and most other evidence-based treatments, are traumafocused, relying on the disclosure of intensely personal and painful experiences.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Working Alliance and Symptom Improvement in Cognitive Therapy for Posttraumatic Stress Disorder

et al. 2021

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Background: Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings.Objective: To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavioral treatment for posttraumatic stress disorder (PTSD).Methods: Ratings of working alliance were made by both the patient and therapist after sessions 1, 3, and 5 of a course of Cognitive Therapy for PTSD (CT-PTSD). Autoregressive, cross-lagged panel models were used to examine whether working alliance predicted PTSD symptom severity at the next assessment point and vice versa. Linear regressions tested the relationship between alliance and treatment outcome.Results: Both patients' and therapists' working alliance ratings after session 1 predicted PTSD symptom scores at the end of treatment, controlling for baseline scores. At each assessment point, higher therapist working alliance was associated with lower PTSD symptoms. Crossed-lagged associations were found for therapist-rated alliance, but not for patient-rated alliance: higher therapists' alliance ratings predicted lower PTSD symptom scores at the next assessment point. Similarly, lower PTSD symptoms predicted higher therapist working alliance ratings at the next assessment point. Ruminative thinking was negatively related to therapists' alliance ratings.Conclusions: Working alliance at the start of treatment predicted treatment outcome in patients receiving CT-PTSD and may be an important factor in setting the necessary conditions for effective treatment. For therapists, there was a reciprocal relationship between working alliance and PTSD symptom change in their patients during treatment, suggesting that their alliance ratings predicted symptom change, but were also influenced by patients' symptom change.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Relationship Between Working Alliance and Symptom Improvement in Cognitive Therapy for Posttraumatic Stress Disorder

et al. 2021

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“…The therapeutic relationship has been conceptualised and investigated across a broad range of therapeutic approaches and contexts (Orlinsky et al, 2004). Empirically, the quality of the therapeutic relationship has been positively associated with treatment outcomes across a range of therapeutic styles, presenting problems and treatment settings, including (Barnao, Ward, & Casey, 2016;Ellis, Simiola, Brown, Courtois, & Cook, 2017;Hewitt & Coffey, 2005;Horvath, Re, Flückiger, & Symonds, 2011;Meier et al, 2005) improved outcomes for domestic violence treatment (Taft & Murphy, 2007), sexual offending treatment (Beech & Hamilton-Giachritsis, 2005) and the prison population (Huffman, 2013). Given that there is a general consensus that the therapeutic relationship plays a crucial role in treatment outcomes across the psychological and counselling literatures, it is curious then, that it has received such little theoretical and empirical attention in the field of forensic treatment.…”

Section: Therapeutic Relationshipmentioning

confidence: 99%

A Model Of Engagement For Correctional Practice

Gannaway¹

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<p>Despite recent advances in correctional rehabilitation, rates of treatment attrition remain high and low efficacy rates suggest improvements in treatment development and delivery are needed. Treatment engagement is an important concept which remains poorly understood. In order to enhance understanding and facilitate higher levels of engagement in treatment, robust theoretical models need to be developed. In light of this, two key questions need to be answered; (1) what is engagement? And (2) what are the underlying causal mechanisms which facilitate or hinder engagement? I explore the contributions of current conceptualisations and models of correctional treatment engagement. I explain how evolutionary psychology, agency, norms and the therapeutic alliance can contribute to our theoretical understanding. These concepts are then integrated to form the Model of Engagement for Correctional Practice. Engagement is conceptualised as a set of adaptive, goal-directed behaviours occurring as a result of the dynamic interactions between contextual, psychological and social processes. I argue that these factors influence the nature of the therapeutic alliance and subsequently participant engagement. The model is then evaluated in terms of critical features required for a robust theory of engagement. I then suggest some practice principles and guidelines to demonstrate how this model can be applied to enhance treatment engagement.</p>

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Therapeutic alliance in psychological therapy for posttraumatic stress disorder: A systematic review and meta‐analysis

Howard

Berry

Haddock

2021

Clin Psychology and Psychoth

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Background Therapeutic alliance is a key element of successful therapy. Despite being particularly relevant in people with posttraumatic stress disorder (PTSD), due to fear, mistrust and avoidance, there has not yet been a comprehensive systematic review of therapeutic alliance in this population. This review explored (a) variables which may predict alliance and (b) whether alliance predicts PTSD outcomes. Method Following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines, the review identified 34 eligible studies. Studies were subjected to a quality assessment. Predictors of alliance were considered in a narrative synthesis. Twelve studies were entered into a meta‐analysis of the association between therapeutic alliance and PTSD outcomes. Results There was some evidence for individual variables including attachment, coping styles and psychophysiological variables predicting the alliance. Therapy variables did not predict alliance. The therapeutic alliance was found to significantly predict PTSD outcomes, with an aggregated effect size of r = −.34, across both in‐person and remote therapies. Limitations Included studies were restricted to peer‐reviewed, English language studies. Quality of included studies was mostly rated weak to moderate, primarily reflecting issues with selection bias in this area of research. Conclusions This is the first review to demonstrate that therapeutic alliance is a consistent predictor of PTSD outcomes, in both in‐person and remote therapies, and the effect appears at least as strong as in other populations. This is of relevance to clinicians working with traumatized populations. The review identified a need for further research to determine variables predicting alliance in therapy for PTSD.

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The role of evidence-based therapy relationships on treatment outcome for adults with trauma: A systematic review

Cited by 24 publications

References 51 publications

The Relationship Between Working Alliance and Symptom Improvement in Cognitive Therapy for Posttraumatic Stress Disorder

The Relationship Between Working Alliance and Symptom Improvement in Cognitive Therapy for Posttraumatic Stress Disorder

A Model Of Engagement For Correctional Practice

Therapeutic alliance in psychological therapy for posttraumatic stress disorder: A systematic review and meta‐analysis

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