Therapeutic Alliance as a Measurable Psychotherapy Skill

Summers, Richard F.

doi:10.1176/appi.ap.27.3.160

Cited by 94 publications

(53 citation statements)

References 32 publications

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“…Therapeutic alliance is a relatively new concept that integrates patient, caregiver, and clinician factors into a measurable construct (11). The conceptual support for such a measure is linked to a variety of observations, including the positive effects of the patient-clinician relationship on decision-making quality, health outcomes, as well as on treatment response (27)(28)(29)(30)(31)(32). Therefore, a number of factors relevant to these relationships are aggregated in a single measure-which has not previously been studied in an ICU population.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Huff¹,

Nadig²,

Ford³

et al. 2015

Annals ATS

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Rationale: Therapeutic alliance is a novel measure of the multifaceted caregiver-clinician relationship and a promising intervention target for improving patient-centered outcomes. However, therapeutic alliance has not been studied in an intensive care unit (ICU) setting.Objectives: To explore the relationships among caregiver-reported therapeutic alliance and psychological distress as well as patient, caregiver, and ICU clinician factors. Methods:In this cross-sectional study, we enrolled consecutive patient caregivers of mechanically ventilated patients discharged from all ICUs at Duke University and the Medical University of South Carolina Hospitals between December 2013 and August 2014. Measurements and Main Results:Caregivers completed an in-person, hospital-based interview that included measures of therapeutic alliance with the ICU physicians (Human Connection Scale) as well as patient centeredness of care; symptoms of depression, anxiety, and post-traumatic stress; decisional conflict; and quality of communication. We performed a multivariate regression to characterize associations between Human Connection Scale scores and key variables. A total of 56 caregivers were included in these exploratory analyses. Patients were largely disabled (47%) and Medicare insured (53%). Caregivers were highly educated and generally had high therapeutic alliance (median, 55; interquartile range, 48-58) with the ICU clinicians. Therapeutic alliance was strongly correlated with patient centeredness (r = 0.78) and poorly correlated with psychological distress (r , 0.2). Stepwise multivariate modeling revealed that higher therapeutic alliance was associated with fewer baseline patient comorbidities as well as caregiver report of greater trust in the ICU team, better quality of communication, and less decisional conflict (all P , 0.012).Conclusions: Therapeutic alliance encompasses measures of trust, communication, and cooperation, which are intuitive to forming a good working relationship. Therapeutic alliance among ICU caregivers is strongly associated with both modifiable and nonmodifiable factors. Our exploratory study highlights new intervention targets that may inform strategies for improving the quality of the caregiver-clinician interaction.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Huff¹,

Nadig²,

Ford³

et al. 2015

Annals ATS

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“…pediatrician has to accommodate their communication style, both verbal and nonverbal, to that of culturally different patients); improving the understanding of change process (e.g., the therapist understands the patient's readiness to make change, appreciates barriers to change, moves with the patient from being uninterested to change-to unaware or unwilling to make a change-to considering a change to deciding and preparing to make a change as well as help them anticipate relapse); focusing on the here and now (e.g., the therapist focuses on current problem solving with the patient); making connections (e.g. therapist helps to practice the newly acquired skill in real life); and finally manipulating the environment (e.g., at the end of therapy help change school if the school has the social group involved in similar conduct symptoms); Limit setting (e.g., saying no to bringing a friend or leaving the session at will) and finally therapy termination (e.g., slowly weaning off the therapeutic relationship) [8][9][10][11][12][13].…”

Section: Shamanism Naturopathymentioning

confidence: 99%

Priority Mental Health Disorders of Children and Adolescents in Primary-care Pediatric Settings in India 3: Psychotherapy and Other Non-pharmacological Interventions

Russell

Kaur

et al. 2011

Indian J Pediatr

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The pediatrician is a primary column of support for children and adolescents with a myriad of mental health problems in low-mental health care resource countries like India. While majority of mental health consultations happen in primary-care, and only 10% are referred successfully for specialised help, there is a clear role for pediatrician psychotherapists in primary care. The primary-care pediatricians should be aware of the indications for psychotherapy, the various approaches that could be used in primary-care settings, the structure and the process of the psychotherapeutic technique involved, the suggested specific techniques for the Priority Mental Health Disorders and the evidence available to support their use as well as the developmental modifications that are required based on the cognitive development of the child or adolescent.

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“…En efecto en el año 1999, la División 29 de la APA (Psicoterapia) estableció una comisión para identificar, operacionalizar y diseminar información sobre la relación terapéutica con apoyo empírico, estudiando la asociación entre resultados y aspectos de la relación y la alianza terapéutica (Norcross, 2001, American Psychological Association, 2006. Según Martin, Garske y Davis (2000) el incremento en la investigación acerca de la alianza se debe a la relación constante que se encuentra entre la calidad de la alianza y los resultados terapéuticos, una relación que se mantiene a pesar de las diferentes orientaciones teóricas y maneras disímiles de evaluar la alianza entre investigadores (Fenton, Cecero, Nich, Frankforter y Carroll, 2001;Horvath y Symonds, 1991;Luborsky, 1994;Martin, Garske y Davis, 2000;Summers y Barber, 2003). Ciertamente, Marmar, Gaston, Gallagher y Thompson (1989) postulan que la alianza predice de manera significativa los resultados de modalidades diferentes de psicoterapia y, a la vez, se ha encontrado que esta relación se mantiene en el tratamiento de problemas psicológicos variados (Fenton et al, 2001).…”

Section: Introductionunclassified

Adaptación del cuestionario de alianza de ayuda revisado versión paciente (HAQ-II-P) para la población de cordobeses

2013

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ResumenLa Psicología Basada en la Evidencia resultaría incompleta si no indagara el rol de la relación terapéutica. No obstante la ausencia de instrumentos adaptados obstaculiza el desarrollo de estudios empíricos en el contexto local. Este trabajo tuvo por objetivo principal adaptar la versión para pacientes del Cuestionario de Alianza de Ayuda Revisado (HAq-II). A su vez, como objetivo adicional se efectuó una comparación de tres modelos teóricos de alianza terapéutica. De esta manera, luego de traducir los ítems y evaluar la equivalencia mediante un panel de expertos se administró el HAq-II a una muestra de 119 participantes que se encontraban en tratamiento psicoterapéutico breve. Los resultados del análisis factorial confirmatorio sugieren un modelo subyacente de dos dimensiones: vinculo positivo con el terapeuta (α = .70) y acuerdo con los objetivos y tareas (α = .71). Cabe destacar que dicho modelo integra coherentemente las teorías propuestas por Luborsky y Bordin. Palabras Clave. Alianza Terapéutica, Análisis Factorial Confirmatorio, Psicología Basada en la Evidencia. AbstractEvidence-Based Psychology would be incomplete if the role of the therapeutic relationship was not investigated. However, the absence of adapted instruments impedes the development of empirical studies in the local context. The principal objective of this work was to adapt the patient version of the Revised Helping Alliance Questionnaire (HAq-II). As an additional objective a comparison of three theoretical models of therapeutic alliance was carried out. After translating the items and evaluating their equivalency via a panel of experts, the HAq-II was administered to a sample of 119 participants undergoing brief psychotherapy. The results of the confirmatory factorial analysis suggest an underlying model of two dimensions: positive bond with the therapist (α = .70) and goal and task agreement (α = .71). It should be noted that this model fits coherently with the theories proposed by Luborsky and Bordin. Key Words. Therapeutic Alliance, Confirmatory Factorial Analysis, Evidence-Based Psychology.Correspondencia: 15 Ardilaun Road, London, N5 2QR, Inglaterra. León 1955, Barrio Maipú Córdoba, Argentina. Cp: 5000. Email: hanne.conn@gmail. com leomedpsico@gmail.com, lsmoretti@gmail.com.insatisfacción corporal, creencias y consumo de cigarrillos IntroducciónNo es posible concebir la psicoterapia sin tener en cuenta el establecimiento de una relación interpersonal entre el cliente y el terapeuta (Corbella y Botella, 2003). En efecto independientemente del modelo teórico de base las diferentes tradiciones psicoterapéuticas acuerdan en mayor o menor medida en que el establecimiento de una relación positiva y de colaboración con el paciente resulta indispensable para alcanzar el éxito psicoterapéutico. Si bien los inicios del estudio de la relación terapéutica se inician con Freud, tanto el movimiento humanista como la vertiente cognitiva enfatizaron la importancia de esta relación. De esta manera Roger señaló que ser empático, congruente y ac...

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Therapeutic Alliance as a Measurable Psychotherapy Skill

Cited by 94 publications

References 32 publications

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Priority Mental Health Disorders of Children and Adolescents in Primary-care Pediatric Settings in India 3: Psychotherapy and Other Non-pharmacological Interventions

Adaptación del cuestionario de alianza de ayuda revisado versión paciente (HAQ-II-P) para la población de cordobeses

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