Working Alliance

Meaning in life is generally not considered to be one of the most central
aspects of person-centered and experiential therapies. However, Carl
Rogers described how clients found purpose in life by going through
a process that helped them to connect to their inner experiencing. This
process was evoked by an empathic, accepting, and genuine therapeutic relationship and resulted in positive therapy outcome. Recently,
scholars have also stressed the importance of the therapeutic alliance
to foster meaning-making processes in therapy. Meaning in life is also
related to well-being. Therefore, the aim of this study is to test whether
meaning in life would mediate between therapeutic alliance and therapy outcome in person-centered and experiential psychotherapies.
Our sample consisted of 96 outpatients nested within 23 therapists.
Using multilevel modeling, we found that meaning in life indeed
mediates between the therapeutic relationship and therapy outcome.
This suggests that meaning in life might actually be at the very core of
person-centered and experiential therapies, and therefore deserves the
attention of clinicians as well as theorists. Our results support the idea
that the therapeutic bond might foster meaning(-making processes) in
therapy, leading to better therapy outcome. However, this idea should
be explored further using longitudinal methods.

Behovet for og ønsket om systemrettet rådgivning ser ut til å øke, men innenfor PPtjenesten jobber PP-rådgivere likevel mest individuelt. Vi ville undersøke hvorvidt PPrådgivere ønsket mer systemrettet arbeid i samarbeid med skoler og barnehager. Vi satte fokus på noen av de spesifikke deltemaene som inngår i PP-rådgiveres opplevelse av å jobbe systemrettet med ansatte i barnehager og skoler. I undersøkelsen var disse deltemaene arbeidsalliansen, PP-rådgivernes opplevde kompetanse og støtte, samt opplevelser av samarbeidet med ansatte i skoler og barnehager.

Ved å benyttet et forklarende sekvensielt blandet metodedesign der kvalitative intervjuer brukes til å utdype resultatene fra en kvantitativ spørreskjemaundersøkelse, har vi tatt utgangspunkt i problemstilling: Hvordan oppfatter PP-rådgivere det å jobbe systemrettet i samarbeid med skoler og barnehager? I spørreundersøkelsen deltok 157 PP-rådgivere (21 menn og 136 kvinner) med erfaringen fra 0.5 til 35 år. I den semistrukturerte intervjuundersøkelsen deltok fem kvinnelige PP-rådgivere som hadde erfaring med å jobbe systemrettet fra 8 til 12 år.

Resultatene viste at PP-rådgiverne ønsket å jobbe mer systemrettet, men de også uttrykte et ønske om å beholde et visst fokus på individrettet arbeid. Selv om det var ulike måter å forstå systemarbeid på, hadde informantene i intervjuene en felles forståelse av at systemarbeid handlet om et gruppenivå heller enn arbeid med enkeltbarn. I sin forståelse av arbeidsalliansen la PP-rådgiverne vekt på å skape felles mål for å oppnå et godt samarbeid, og tillit ble ansett som viktig i samarbeidet med skoler og barnehage. Til slutt fant vi en sammenheng mellom vektlegging av arbeidsallianse og opplevd kompetanse og opplevd støtte i spørreundersøkelsen. Både opplevd kompetanse og opplevd støtte predikerte hver for seg en sterkere vektlegging av arbeidsalliansen. Intervjuene støttet også oppunder en slik forståelse. Funnene om at økt kompetanse på og støtte for å drive systemrettet arbeid bidro til en økt vektlegging av arbeidsalliansen, noe som kunne tyde på hvor viktig arbeidsalliansen ser ut til å være hvis man skal lykkes med systemarbeid.

Resultatene fra dette prosjektet kan danne bakgrunn for videre forskning på følgende områder: 1) relasjonskompetanse i systemrettet arbeid med fokus på arbeidsalliansen mellom PP-tjenesten og skoler og barnehager; 2) hvordan opplevd kompetanse og opplevd støtte fra ledelse og kolleger i PP-tjenesten henger sammen med økt vektlegging av arbeidsalliansen og 3) holdninger til og forståelsen av systemrettet arbeid hos ansatte i barnehager og skoler for å kunne få et mer helhetlig bilde.

El objetivo del presente trabajo es analizar la alianza terapéutica (acuerdo en tareas, objetivos y vínculo positivo) desde la perspectiva del paciente y del terapeuta a lo largo de un tratamiento de 15 sesiones y conocer cómo el estilo de apego influye en la forma de alianza terapéutica. Se propone la realización de un estudio exploratorio, descriptivo, mixto, tomando una muestra de 20 personas de 18 a 45 años con pacientes en tratamiento psicológico en el Hospital de Clínicas José de San Martín. Para evaluar el desarrollo de la alianza terapéutica, en cada paciente y en su terapeuta, se les administrará el Inventario de Alianza de Trabajo (Working Alliance Inventory - Horvath y Greenberg,1896) en las sesiones 3, 8, 15. Para evaluar el estilo de apego, se les administrará a los pacientes la Escala de Apego Adulto (Adult Attachment Scale - Collins y Read,1990) en la sesión 1. Siendo la alianza terapéutica el indicador más robusto en el inicio, sostenimiento y finalización del tratamiento y predictor de éxito del mismo (Del Re et.al, 2012, Hartmann et al., 2014) resulta esperable que el vínculo terapéutico y el acuerdo en tareas y objetivos incrementarán en el curso de la terapia siendo superior en las sesiones 8 y 15 frente a la primera toma en la sesión 3.

The purpose of the present work is to analyze the therapeutic alliance (agreement in tasks, objectives and positive bond) from the perspective of the patient and the therapist throughout a treatment of 15 sessions and to know how the attachment style influences the form of alliance therapy. It is proposed to carry out an exploratory, descriptive, mixed study, taking a sample of 20 people between 18 and 45 years old with patients undergoing psychological treatment at the Hospital de Clínicas José de San Martín. To evaluate the development of the therapeutic alliance, in each patient and in their therapist, the Working Alliance Inventory (Horvath and Greenberg, 1896) will be administered in sessions 3, 8, 15. To evaluate the style of attachment, patients will be administered the Adult Attachment Scale (Collins and Read, 1990) in session 1. The therapeutic alliance being the most robust indicator in the beginning, maintenance and termination of treatment and a predictor of success of the same (Del Re et.al, 2012, Hartmann et al., 2014) it is expected that the therapeutic bond and the agreement on tasks and objectives will increase during the course of therapy, being higher in sessions 8 and 15 compared to first take in session 3.

We investigated 185 therapist self-disclosure events in 16 cases of open-ended psychodynamic/interpersonal psychotherapy. One disclosure occurred approximately every other session, with the most frequent type being disclosure of facts. Therapists initiated 73%, and focus returned to the client following 93%, of disclosure events. Disclosures of feelings and insight were judged to be more intimate and higher in quality than were disclosures of facts. Overall disclosure occurrence was positively related to client-rated working alliance and feelings disclosure occurrence was positively related to client-rated real relationship. Factual disclosure occurrence was negatively related to working alliance and real relationship. Results suggest that disclosure is multifaceted, nuanced, and complex. Implications for practice, training, and research are discussed.

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Abstract
The aim of this qualitative study is to contribute to empirical knowledge about compulsive hoarding behavior for social workers, educators, psychoeducators and other professionals involved with hoarders in order to improve services offered to these people. We tried to know how users of CSSS, who received social services for compulsive hoarding behavior, perceive and assess interventions conducted by social professionals. Semi-structured interviews were conducted with six users of Centre de santé et de services sociaux of Quebec City area (CSSS Alphonse- Desjardins, Portneuf, Québec-Nord and Vieille-Capitale). They also answered the French version of the questionnaire Working Alliance Inventory – Short Version (WAI-SR). Focus group were conducted with eleven professional implicated with hoarders to complete and contextualize data. Results: Compulsive hoarding disorder is a life condition before being a psychiatric condition, and that hoarding behaviors are part of the perception that the users have of themselves, of their priorities, objectives and conditions in which they want to live. Users also have predominantly a favorable opinion about social services in CSSS, which can be linked at a good recognition of the problem. Finally, both users and social professionals perceived a lack of resources in the Quebec City area to answer the specifics needs of people with problems inherent to their compulsive hoarding behaviors.

Contemporary trends in science policy and social theory
challenge the concept of doctoral supervision as ‘professional
practice’. The concept compares supervision with the work
of other professionals regarding a specific working alliance.
Supervisors and novices engage in a relationship to create
and solve an intellectual crisis. The dynamics of the crisis,
paradoxes of the situation and technical uncertainties of
non-standardised problem solving are typical features of
all professional practices. However, worldwide trends in
doctoral education such as the improvement of completion
rates, the creation of formal organisations and programs
as well as the overall ‘projectification’ of the Ph.D. process
tend to ignore the unpredictability of doctoral research and
supervision. In consequence, social theory discusses trends
towards increasing formal control, disciplinary differentiation
and particularities in doctoral supervision as an ongoing ‘deprofessionalisation’
of a shared professional practice. To defend
and specify the concept of professional practice for doctoral
supervision, I draw on a comparative study of supervision
practices in two disciplinary fields (physics and social sciences)
and different organisational contexts in the German academic
system. I argue that the creation of independent researchers
and new knowledge constitute a specific interaction between
supervisors and novices beyond disciplinary and organisational
differences. Autonomy and dependence, self-learning and
guidance, production and solution of intellectual crisis and
conflicting role patterns create an inherent tension in supervision
practice that cannot be resolved by formal structures and is
therefore best described as professional practice.

In the current study, the aim was to measure the effects of Young schema domains, Young maladaptive coping styles, and Young parenting styles on working alliance among supervisors, therapists, and the clients. Participants were eight supervisors (clinical psychology doctorate students), twelve therapists (clinical psychology master students), and four clients (applicants to AYNA Psychotherapy Unit). In order to measure working alliance, two types of measurement based on qualitative (open ended questions and relational circles (developed by the researcher) and quantitative (Working alliance inventory/supervisor-therapist and therapist-client forms) methods were used. According to results, a relationship between Young schemas, parent styles, and coping styles and working alliance was found among supervisors, therapists, and clients. Associations were discussed in line with Schema Theory.

Keywords: Schema Theory, Working Alliance, Supervision, Psychotherapy

La psicoterapia no se puede concebir al margen del establecimiento de una relacion interpersonal entre cliente y terapeuta. Entre los componentes de la relacion terapeutica, la alianza es el que ha recibido mas atencion por parte de la investigacion. En este articulo se describen brevemente algunas de las aportaciones mas significativas de las principales orientaciones teoricas en cuanto a la vision de la alianza terapeutica y se revisan las investigaciones principales que han tenido a la alianza como protagonista. La relacion significativa entre la alianza terapeutica y los resultados de la terapia asi como la interaccion entre terapeuta y paciente como variable influyente en el desarrollo de la alianza son algunos de los aspectos que se destacan.

Rezensionen 387 da sich ihr (aufgrund des Primats des Stilbegriffs und der Prämisse der Identität von Wissen und Wissenschaft) Methodenfragen selbst als Stilfragen darstellen, die nur zur Wiederholung der Pluralität der lebenspraktischen Perspektiven oder zu weiteren wissenssoziologischen Untersuchungen von "Weltanschauungen" führen.

Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist-client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The concept of a working alliance as a key ingredient within therapeutic processes has been emphasized by many community mental health researchers and practitioners. However, few studies have provided insights into the dimensions and operationalization of the con-cept. To address this gap, the authors analyzed data on the working alliance derived from two qualitative data sets: (a) interviews conducted with 33 users of community mental health services, family members, and service providers; and (b) content extracted from a systematic review of 48 articles in the area of community mental health services. Three superordinate themes emerged: Building and negotiating trust, I’m on your side, and Tools and strategies. The authors discuss implications for community mental health practice.

Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist-client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Meaning in life is generally not considered to be one of the most central aspects of person-centered and experiential therapies. However, Carl Rogers described how clients found purpose in life by going through a process that helped them to connect to their inner experiencing. This process was evoked by an empathic, accepting, and genuine therapeutic relationship and resulted in positive therapy outcome. Recently, scholars have also stressed the importance of the therapeutic alliance to foster meaning-making processes in therapy. Meaning in life is also related to well-being. Therefore, the aim of this study is to test whether meaning in life would mediate between therapeutic alliance and therapy outcome in person-centered and experiential psychotherapies. Our sample consisted of 96 outpatients nested within 23 therapists. Using multilevel modeling, we found that meaning in life indeed mediates between the therapeutic relationship and therapy outcome. This suggests that meaning in life might actually be at the very core of person-centered and experiential therapies, and therefore deserves the attention of clinicians as well as theorists. Our results support the idea that the therapeutic bond might foster meaning(-making processes) in therapy, leading to better therapy outcome. However, this idea should be explored further using longitudinal methods.

The present study examined the association between treatment fidelity during therapist initial training and subsequent treatment outcome of Parent Management Training-Oregon model (PMTO) in The Netherlands. Clinically referred children (N = 86) aged 4 to 11 years and their parents received PMTO and were assessed at four time points: at baseline, and after 6, 12, and 18 months. Difference scores between baseline and follow-up assessments of externalizing behavior problems, parenting practices, and parental psychopathology and parents' overall ratings of working alliance, were correlated with treatment fidelity scores measured prior to the intervention. Furthermore, differences in therapists' fidelity scores between treatment completers and drop-outs were examined. Results showed that higher fidelity scores of PMTO therapists during initial training were associated with larger improvements in externalizing behavior, parenting practices, and parental psychopathology, especially after 18 months. In addition, parents who completed the treatment had a significantly more adherent therapist than families who dropped out. However, the correlations between treatment fidelity and working alliance were non-significant. These findings indicate that therapists' high adherence to the PMTO treatment principles during initial training decreases the chance of treatment drop-out and positively affects the longterm effectiveness of PMTO.

Objective: Although the working alliance-outcome association is well-established for adults, the working alliance has accounted for 1% of the variance in adolescent therapy outcomes. How the working alliance unfolds in therapy and is modeled in therapy studies may substantially affect how much variance is attributed to the working alliance. Method: The sample included 2,990 military youth who were treated by 98 therapists and attended at least 8 therapy sessions. The average age was 14.91 years (SD 􏰁 1.79). Each session, clients completed the Outcome Rating Scale as a measure of psychological well-being/ distress and the Session Rating Scale as a measure of working alliance. We utilized 3 models to examine the working alliance-outcome association in therapy: (a) mono-method model (i.e., 1 rating of working alliance correlated with outcomes), (b) aggregate-assessment model (i.e., multiple sessions aggregated and correlated with outcomes), and (c) change-based model (i.e., changes in working alliance scores correlated with outcomes). Results: Findings supported the change-based model. The amount of variance explained in youth outcomes via growth in working alliance scores in the change-based model was approximately 9.8%, which suggests that a key mechanism of client-perceived change for adolescents in therapy may be the continual development of the working alliance over the course of treatment. Conclusions: The monitoring of and continual promotion of the working alliance among military youth in the early phases of therapy may help therapists improve treatment outcomes.