Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

PurposeThe purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.MethodsStudent clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.ResultsResults suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.ConclusionClinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients’ perspective regarding TA status.     

L’alliance thérapeutique triadique dans une psychothérapie avec un interprète : un concept en quête de validation

The relevance of the use of an interpreter when receiving an allophone patient seems to be more and more accepted among clinicians. However, the influence of this third person on the therapeutic process, and particularly on the establishment of the therapeutic alliance, has received scarce attention so far. The presence of an interpreter inevitably modifies the therapeutic process and makes it more complex. It requires some adjustments of the physical and material setting. It also influences practical arrangements and the very nature of interactions, as well as their content. General concepts about the intercultural approach will first be presented. Subsequently, the issue of the establishment of a triadic therapeutic alliance during a couple and family therapy or mother infant consultations will be discussed from an interactionnist and systemic perspective. The application of these models to a better understanding of patient-therapist-interpreter alliance and its specific components and dimensions will be discussed. Finally, research directions and some clinical considerations to optimize the conduct of a consultation or a psychotherapy with an interpreter will be stressed.     

Therapists’ self-reported chronic strategies of disconnection in everyday life and in counselling and psychotherapy: an exploratory study

The aim of this study was to explore how therapists believe they may relationally disconnect from other people and their clients, with an overall objective of developing methods for enhancing relational depth in counselling and psychotherapy. Participants were 168 trainee and practicing therapists, who listed their chronic strategies of disconnections (CSoDs) in everyday relationships, and then rated the presence of these CSoDs in their therapeutic work. Thirty-nine categories of self-reported everyday CSoDs emerged, organised into seven domains. Most prevalent were behavioural, passive and intrapsychic strategies. Over half of the CSoDs were rated as being present in therapy to a minimal extent, most commonly passive CSoDs, disingenuous CSoDs and humour. Male therapists, and trainee therapists, were most likely to identify their CSoDs as present in therapy.     

On Revolutionizing the Theory and Practice of Psychotherapy

The original concepts psychological hurt and therapeutic catharsis are proposed as the basis for a revolutionary change in the theory and practice of psychotherapy. Psychological hurt, understood as any residual interference with psychological functioning from an adverse event(s), is proposed as the irreducible cause of any such difficulty. Therapeutic catharsis is proposed as the optimal healing process for psychological hurt. Such a transformational view of the theory and practice of psychotherapy is deemed as necessary because of the lack of unequivocal answers to the following fundamental questions: What causes psychological problems? What resolves them in the most optimal way?     

Building an Expanded Therapeutic Alliance: A Task Analysis with Families Trapped in Parental-Adolescent Conflict

Parental-adolescent conflict is part of the normal developmental cycle of families, but when it occurs in a dysfunctional way, it is associated with the appearance of various harmful conditions for the family system and for the adolescent in particular. Family therapy is one of the main options for psychotherapeutic intervention in these cases and has ample evidence of its effectiveness. The success of this intervention is conditioned to the construction of an adequate therapeutic alliance with the family, but the process of this task has not been clarified yet. The present study is a task analysis, the purpose of which was to create a heuristic model of how an expanded alliance may be built in these kinds of cases. The model was revised and improved from the intensive analysis of six cases. The resulting model can be a useful guide for family therapists in that it describes the specific client and therapist behaviors involved in balancing the alliance, as well as the potential obstacles and suggested ways to resolve them.     

Psychologie sociale de la santé et compétences psychosociales en éducation thérapeutique : des enjeux pour la recherche et pour la pratique

The article presents the theoretical-methodological contributions of Social Health Psychology on the evaluation and reinforcement of psychosocial skills in the context of therapeutic patient education. This is illustrated by a synthesis of the results of several empirical researches in the field of pediatric diabetes. This synthesis shows that psychosocial skills are part of a system of actions and interpretations shaped by therapeutic and relational issues as well as social symbolism. Several practical implications emerge from these results for more effective work on the psychosocial skills of patients. The article concludes with the interest of a “psychosocial clinic” which draws on the viewpoint of Social Health Psychology to evaluate, analyze and intervene on the psychosocial determinants of health behaviours.