Revisiting Bordin's Theory on the Therapeutic Alliance: Implications for Family Therapy

Because of the belief that relationships are a major contributor to problems as well as the avenue for bringing about change, the alliance between therapists and clients is important in family therapy. Writings and ideas on the therapeutic alliance from psychoanalytic theory were used by Edward Bordin to develop a working theory in 1979, and later adapted to the field of family therapy. However, the adaptation did not account for many variables unique and important to family therapy. This article describes the therapeutic alliance and the necessity of creating a theory of therapeutic alliance that accounts for family therapy concepts. Future ideas for scholarship are presented.     

Influence of Therapist Behaviors on Therapeutic Alliance

A number of recent studies have investigated the relationship between therapist and client gender and conversation in marriage and family therapy. There has also been recent empirical investigation of therapeutic alliance and its influence on therapy outcome in marriage and family therapy. However, there has been limited investigation of the influence of interactional patterns on therapeutic alliance. It seems probable that therapy conversation (which seems to be influenced by gender) will influence therapeutic alliance and subsequent outcome.     

The Play Relationship and the Therapeutic Alliance

Abstract

This article examines the function of play in normal development and within the treatment relationship in both child and adult psychotherapy. Noting its developmental function and the natural role that play has as a mode of communication with children, the author emphasizes the centrality of play in the construction of the therapeutic alliance. The therapeutic alliance is characterized here as a libidinal attachment, a new object relationship through which developmental experiences involving play may be revivified and, ultimately, may lead to the forging of more enduring and successful adaptations. Two detailed clinical vignettes furnish illustrations of the ways in which play themes and scenarios develop in therapy, and how their association to the therapeutic alliance and transference relationship may be understood and interpreted.     

The Perceived Relative Strength of the Therapeutic Alliance

ABSTRACT

The association between the perceived relative strength of the therapeutic alliance in couples therapy and psychotherapeutic outcome was investigated. The perceived relative strength of the couples therapeutic alliance was classified into three categories: a balancedalliance (an individual perceives his/her own alliance and the partner's alliance as approximately equal in strength), a positively biasedor blessedalliance (an individual perceives his/her alliance as stronger than the perception of the partner's alliance) and a negatively biasedor just biasedalliance (an individual perceives his/her alliance as weaker than the perception of the partner's alliance). The impact of a consensus or non-consensus within each partner about the perceived relative strength of the alliance on outcome was also investigated. The Alliance Inventory for Couples was used as a measure of the alliance and outcome was assessed with the Family Environment Scale and the Marital Satisfaction Scale. No statistically reliable relation was found between perceived relative strength of the alliance and improved outcome. Consensus was also not predictive of outcome. These findings failed to confirm previous theoretical propositions and empirical research. Possible reasons for discrepancies between the current findings and previous research are provided. The distinction between perceived strength and strength based upon independent self-report measures; and the designation of biased, blessed and balanced alliances merit future research.     

Pretreatment Correlates of the Therapeutic Alliance in the Chronically Depressed

We examined the relationship between patient characteristics and the working alliance in a multisite trial for chronic depression. Patients treated with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), alone (n = 169) or combined with nefazodone (n = 198), completed the Working Alliance Inventory during the 2nd week of treatment. Within the CBASP alone group, a history of drug abuse/dependence, lower peak social adjustment over the past five years, and lower current social adjustment predicted a significantly poorer alliance. Within the combination group, male gender and a distancing coping style predicted a significantly poorer alliance. Results should be interpreted with caution since they did not replicate across treatment groups, and the number of significant findings were not much greater than chance expectations.     

Alliance Ratings as a Part of Trainee Evaluations Within Family Therapy Training

Client-reported therapeutic alliance scores were examined as a measure of improvement in therapeutic skills across master's-level marriage and family therapy (MFT) training. The results indicate significant correlations between alliance ratings and training variables, with the number of cumulative clinical hours identified as a significant predictor of alliance ratings according to a regression analysis. Trainees lacking the expected number of clinical contact hours in each level of training were found to be more likely to receive consistently marginal alliance ratings. Additionally, alliance ratings were especially useful in identifying trainees who were functioning at minimal levels of competency.     

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.     

Consultation with the Z Family's Technology Business: A Weekend Retreat

Family business consultation is an expanding enterprise and constitutes an interesting area of practice for psychologists drawn from industrial/organizational psychology, clinical psychology, and family psychology. This paper provides a clinical case example of a weekend retreat established as the forum for consultation to a family owned business that was experiencing a good deal of dissension between family and non-family management team members.     

Effects of Couples' Perceptions of Genogram Construction on Therapeutic Alliance and Session Impact: A Growth Curve Analysis

The purpose of this study was to examine how the construction of a therapist-administered genogram (TAGE) versus a self-administered genogram (SAGE) would affect therapeutic alliance and session character in couples therapy across time. Eight student marriage and family therapists conducting therapy with 17 couples administered a TAGE, SAGE, or control treatment intervention in the second therapy session. Measurements were taken following the first five sessions. Results of a growth curve analysis showed no significant differences in couple members' growth curves based on their participation in one of the three treatment groups. Recommendations for clinicians and future genogram researchers are provided.of the Marriage and Family Therapy program at     

Influence of Therapist and Client Behaviors on Therapy Alliance

This study considers the combined effect of therapist behaviors and couples interaction dynamics on therapeutic alliance because it seems to be a significant predictor of successful therapy outcomes. We measured therapeutic alliance using the Working Alliance Inventory, Observer Version (WAI-O), which includes three subscales: goals, tasks, and bond. We investigated the combined effect of therapist behaviors and couples interactions on therapeutic alliance. There were three significant findings: (1) the models better predicted therapeutic alliance for men clients than women clients; (2) combined consideration of partner behaviors and therapist behaviors provided the stronger prediction of therapeutic alliance; and (3) different variables predicted alliance for women clients versus men clients.     

A Two-Systems Approach to the Treatment of a Disturbed Adolescent

Abstract

This article is based upon die rich conceptual and technical framework for understanding and treating sadomasochistic psycho-pathology presented by the Novicks (this volume). Specifically, the Novicks' “two-systems” approach to self-regulation is applied to the treatment of a disturbed adolescent boy. Examples of “open” and “closed” functioning are presented as well as the role of underlying defensive omnipotent beliefs and fantasies. The clinical utility of this model, the pivotal role of the therapeutic alliance, and the significance of clinical work with the family through all stages of the treatment process are illustrated.     

Developing the Working Alliance in Marital Therapy; A Psychodynamic Perspective

A good working alliance in marital therapy is one in which the partners are actively collaborating with their therapist to work through conflicts. The therapist begins to develop the alliance by setting the frame of therapy and helping the couple understand the guidelines of treatment. The partners gradually identify with and emulate the therapist's working style and use of self as a reflective instrument. The working alliance can be weakened by empathic failures and strengthened by increased feelings of trust in the therapist and the process of treatment This paper looks at the development of the working alliance in marital therapy from a psychodynamic perspective. A clinical illustration is included.     

Therapeutic alliance and progress in couple therapy: multiple perspectives

Therapeutic alliance research in couple therapy using multiple perspectives and longitudinal data has been sparse. This study used structural equation modelling to explore relationships between changes in alliance and in progress from clients' and therapists' perspective in a fairly large sample of couples (N=195) during the initial stage of therapy at an on‐campus training clinic. Self‐rated alliance was measured after sessions 2 through 4 with the Working Alliance Inventory. There was very little change in alliance over the early sessions of therapy, and changes in alliance did not always account for changes in relationship satisfaction. Husbands' perceptions of satisfaction and alliance seem to play an important role in the dynamics of the therapeutic process. Findings suggest a reciprocal relationship between perceptions of alliance and progress in therapy when combining perceptions of therapists and couple clients. Clinical implications and future research are discussed.     

Disclosure of Divorce Plans to Children: What the Children Have to Say

Divorce has become a common experience for children. One part of the process that children of divorcing parents experience is the time when they are informed of their parents' approaching separation or divorce. In this study, 20 adults from eight families who had experienced the divorce of their parents when they were younger were interviewed using a guided interview format. At least two siblings from each family except one was interviewed. Qualitative analyses of data revealed interesting themes around the questions of how the participants were told about the impending separation or divorce, who told them, whether or not siblings were present, how they reacted to the news, and how they would have preferred being told.     

高龄老年高血压患者的降压治疗策略

80岁以上高龄老年高血压患者的降压治疗随着人口老龄化而越来越受关注。评估高龄高血压患者降压治疗的获益与风险,在循证医学基础上进行个体化治疗,依据全身情况和耐受程度调整血压控制水平,慎重选择药物,平稳缓慢降压,将使高龄高血压患者最大程度受益。     

The Value of Research Methods in Psychotherapy Research: A Reply to the Commentary of Dr Norton

Norton's commentary on our article has prompted us to think further about the purpose of psychotherapy research. We agree with his suggestion that researchers have much work to do to understand when and for whom interventions are most efficacious. We hope that our field will make progress in this regard. In this reply, we further describe why we believe careful attention to research methods, such as those highlighted in our article, is key to making progress in psychotherapy research.     

Planning, motivation, and evaluation in orientation to the future: A latent structure analysis

The paper presents a model of orientation to the future in terms of three processes; motivation, planning, and evaluation. To test this model a total of 154 11-, 15- and 18-year-old adolescents were interviewed about their goals and hopes for the future. Seven observed variables were estimated and a model including three latent constructs was tested using the LISREL VI computer program. The planning construct consisted of the amount of knowledge, the complexity of plans and their level of realization. The evaluation construct included internality, estimation of the likelihood that the goals would be realized and an overall emotional evaluation of the future. The motivation construct consisted of one observed variable, extension. Confirmatory factor analysis showed that the model fitted the data, thus providing support for the theoretical model.     

Narrative Process Coding System in Marital and Family Therapy: An Intensive Case Analysis of the Formation of a Therapeutic System

The aim of this study is to investigate whether the method (Narrative Processes Coding System) for studying the narrative sequences of individual psychotherapy developed by Angus and Hardtke (1994) can be applied in a family therapeutic process. According to the results narrative process coding system adds new dimensions and gives new depth in the narrative understanding of family therapeutic process. In micro-analytic interactional level it shows the complicated interactions between narration, plot, and narrative process type.