How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis

Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome. Multilevel longitudinal analysis was used to investigate the following moderators of the alliance-outcome correlation: (a) research design (RCT or other), (b) use of disorder-specific manuals, (c) specificity of outcomes, (d) cognitive and/or behavioral therapy (CBT) or other types of treatments, (e) researcher allegiance, and (f) time of alliance assessment. RCT, disorder-specific manual use, specificity of primary and secondary outcomes, and CBT did not moderate the alliance-outcome correlation. Early alliance-outcome correlations were slightly higher in studies conducted by investigators with specific interest in alliance than were those in studies conducted by researchers without such an allegiance. Over the course of therapy, these initial differences disappeared. Apart from this trend, none of the variables previously proposed as potential moderators or mediators of the alliance-outcome relation, alone or in combination, were found to have a mediating impact.     

Valuing clients' perspective and the effects on the therapeutic alliance: a randomized controlled study of an adjunctive instruction

The patterns of growth and development of the therapeutic alliance over the course of therapy have been of continued interest to psychotherapy researchers. The purpose of this study was to investigate whether a simple institutional metacommunication intervention with clients had an effect on the development of the alliance. This adjunctive instruction involved inviting therapy clients to take a proactive role in their treatment by encouraging feedback to their therapist about various aspects of the therapy process. In this randomized controlled study (N = 94), clients were assigned to 1 of 2 conditions: (a) an institutional adjunctive instruction condition in which patients were contacted by clinic personnel at the beginning of the remediation phase (Session 5) and encouraged to take a proactive role in their treatment and (b) a control condition that contained no institutional adjunctive instruction. Between-condition differences in the alliance were tested, controlling for baseline influences and the early therapeutic alliance. Clients' postsession reports from Sessions 1 to 24 indicated that the adjunctive instruction increased the alliance over the course of therapy vis-à-vis the control condition. The adjunctive instruction appeared to have fostered clients' evaluation of their therapists' interest in their welfare. The results indicate that interventions, even brief or subtle, can produce lasting benefits in the alliance when targeted at specific psychological processes. Systematic metacommunication from the institutional level appeared to reinforce clients' therapeutic alliance with their therapists in individual treatment.     

The law of categorical judgment (corrected) extended: a note on Rosner and Kochanski (2009)

Rosner and Kochanski (2009) noticed an inconsistency in the mathematical statement of the Law of Categorical Judgment and derived "the valid equation, the Law of Categorical Judgment (Corrected)" (p. 125). The purpose of this comment is to point out that the law can be corrected in many different ways, leading to substantially different equations. The different versions have different consequences for the predicted distributions of the responses and, hence, for fitting real data. Some of these consequences are unexpected and sometimes undesirable. Researchers should be aware of the different possibilities as they may lead to pronouncedly different accounts of given data.     

Psychoanalytisch begründete Ans?tze in der forensischen Psychiatrie und Psychotherapie

After many years where manualized mainly behaviour treatments dominated in forensic settings, psychodynamic therapies are gaining acceptance and are performed and evaluated more and more in forensic hospitals and in prisons. This encompasses individual, couple, family and group therapies. Individual and group analysts are starting to perform these tasks again, mostly as workers in forensic settings but also as external therapists and supervisors. All staff members are important in creating a therapeutic community based on group analytic principles. They are therefore required to build up a therapeutic attitude supported by regular external case and team supervision. Delictogenic situations occur in everyday life as well as in professional settings and are analysed mainly in group therapies, considering situations of the past and the effect on other people. Modern manualized analytical concepts, such as transference-focussed psychotherapy (TFP) and mentalization-based therapy (MBT) depthen the quality of therapeutic work of all professionals in forensic settings. The multimorbid and sometimes dangerous patients require good ethical and professional attitudes. The psychoanalytic concepts of defence and resistance, transference and countertransference are essential parts of changing internalization and corrective emotional experience, important parts of useful forensic treatments.     

Zur Theorie und Praxis psychoanalytisch begründeter station?rer Psychotherapie

In the last 50 years inpatient psychosomatic psychotherapeutic treatment in Germany has undergone a special development in which the psychoanalytical and group analytical communities were substantially involved. This development will be analyzed in a review with respect to models of the clinical application of psychoanalytical treatment principles. Particular emphasis is placed on the analysis of transference and countertransference processes in a clinical multiperson situation and the resulting necessity of group and teamwork. Only such an integrative inpatient psychotherapy concept is from a psychoanalytical perspective in a position to utilize the interactional, scene-like restaging in a multiperson relationship field and to benefit therapeutically, by which the group analytical function of the team process plays a special role. The practical aspects of two applications of the integrative model in Essen and Dortmund will be presented and the results will be discussed.     

Die Auswirkungen der Wende 1989 auf Adoleszente

The significance of adolescence for psychosocial development is a controversial theme with discussions ranging from an emphasis on the importance of early childhood to the ideas propagated by Freud that the dynamics of adolescence play an important role in the psychological development of the individual and transculturation. The course of adolescence provides a starting point for understanding the psychodynamics of patients, which is often given insufficient consideration. Today, it can repeatedly be seen that patients in their mid-thirties are coming for treatment: patients who experienced their adolescence during the period of political upheaval in Germany. For a variety of reasons this proves to have been a vulnerable life phase, above all for East Germans. Puberty and adolescence comprise developmental tasks whose completion in a crisis situation, such as represented by the political change in East Germany with the reunification process, suffered considerably. Accordingly, the consequences of this conflict-laden coping process can be revealed during later therapy in transference and central relationship conflicts. The adolescents made considerable efforts to adapt to the new conditions, however, without adolescent altercations with GDR parents and conditions having taken place in sufficient measure. The treatment of a female patient is presented for whom the political change during adolescence proved to be a critical life event. Her narcissistic deficits together with her fragile identity were exacerbated as a result of the social upheavals. It is demonstrated how this ??critical life event?? was intertwined with her earlier psychological structure, the problems of adolescence and her search for identity during the course of psychoanalysis.