The therapeutic alliance–A conceptual analysis

The role and function of the therapeutic alliance in psychotherapy has increasingly been the focus of clinicians' and researchers' interests over the last decade. Alliance concepts have, however, been criticized for lack of conceptual clarity. The paper presents a generic model as a heuristic means for clarifying the conceptual meaning of the therapeutic alliance. The model distinguishes between the personal relationship aspect, and the collaborative, task-related aspect of the alliance, with therapist, patient, and common contributions to each of these aspects. The model is compared to other alliance conceptualizations, and its implications for alliance theory and research are discussed. A content analysis of four widely used alliance scales in relation to the model shows the scales to represent conceptually different, yet overlapping constructs. It is argued that the componential nature of the therapeutic alliance will render difficult any interpretation of findings regarding the relationship between alliance and outcome in traditional process-outcome research. More complex research strategies guided by theory are called for, if the therapeutic alliance should remain a vital field of research.     

Taking Relationship Seriously in Psychotherapy: Radical Relationality

Psychologists who have historically focused on relationships have tended to underestimate the radical nature of human relationship. A “serious” or an ontological relationality would change the nature of psychotherapy. We describe this change in a discussion of two approaches to relationship, weak and strong relationality. We argue that weak relationality, the general conception of relationship in mainstream psychology, does not ultimately take even the therapeutic relationship seriously. We then discuss and illustrate ten practical implications that a strong relationality would have for psychotherapy.

Therapeutic change in adolescents sexual offenders

IntroductionA number of studies have shown that the treatment of adolescents who have engaged in sexually abusive behavior (AESABs) reduces their risk of sexual recidivism. However, few studies have examined the internal processes leading to these results.ObjectiveThe purpose of our research was to determine whether the treatment of AESABs (n = 43) influences the following factors related to sexual offending: deficient social skills, social isolation, ineffective coping strategies, and cognitive distortions. The impact of motivation for change and trauma symptoms on therapeutic progress was also examined.MethodPre/post-treatment analyses were completed.ResultsThe results of our pre/post-treatment analyses indicate significant changes in social isolation, coping strategies and cognitive distortions, and a significant reduction of trauma symptoms. Only social skills remained deficient. The data on motivation were not sufficient to establish whether motivation was linked to the progress of the subjects.DiscussionOur study highlights the importance of interventions targeting the acquisition of social skills in AESABs. Trauma is also an important factor to consider in the assessment of therapeutic progress, despite not being directly related to sexually abusive behaviour. The limits of the study highlight the importance of establishing an a priori program evaluation framework.     

Les représentations mentales de l’enfant chez les parents : situation,illustrations et réflexions sur les catalyseurs de changements en évaluation thérapeutique de l’enfant

Therapeutic assessment of the child (TA-C) is a model of psychological assessment that allows for collaborative work with parents and child on their reasons for consultation, a collaboration that breaks away from a traditional double separation (parent/assessor, and assessor/therapist) in child assessment. This paper, grounded in a contemporary psychodynamic viewpoint, presents clinical illustrations to support a conceptualization of change processes in TA-C. It is argued that, in order to revitalize empathy in parents, work focusing on the parents’ mental representation of their child is central. We propose a hierarchy of assessment/therapeutic goals that allows for a better distinction between TA-C and standard assessment in work with children.     

Human pelvis motions when walking and when riding a therapeutic horse

A prevailing rationale for equine assisted therapies is that the motion of a horse can provide sensory stimulus and movement patterns that mimic those of natural human activities such as walking. The purpose of this study was to quantitatively measure and compare human pelvis motions when walking to those when riding a horse. Six able-bodied children (inexperienced riders, 8–12 years old) participated in over-ground trials of self-paced walking and leader-paced riding on four different horses. Five kinematic measures were extracted from three-dimensional pelvis motion data: anteroposterior, superoinferior, and mediolateral translations, list angle about the anteroposterior axis, and twist angle about the superoinferior axis. There was generally as much or more variability in motion range observed between riding on the different horses as between riding and walking. Pelvis trajectories exhibited many similar features between walking and riding, including distorted lemniscate patterns in the transverse and frontal planes. In the sagittal plane the pelvis trajectory during walking exhibited a somewhat circular pattern whereas during riding it exhibited a more diagonal pattern. This study shows that riding on a horse can generate movement patterns in the human pelvis that emulate many, but not all, characteristics of those during natural walking.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

A Dyadic Analysis of the Between‐ and Within‐System Alliances on Distress

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). This study examines the relationship between the therapeutic alliance and distress using the couple rather than the individual as the unit of analysis. One hundred and seventy‐three couples receiving treatment for relational distress at two university clinics participated in this study. The actor–partner interdependence model was used to analyze the relationship of each partner's between‐ and within‐system alliance scores and distress at session four. Results provide support for actor effects on relational distress for both male and female partners and for actor effects on psychological distress for female partners. Limited support was found for partner effects on distress. Furthermore, results indicate that the alliance between partners is a stronger predictor of improvement in early sessions in comparison with the alliance between the individual and the therapist.     

Love in Action: An Integrative Approach to Last Chance Couple Therapy

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce—who often describe this therapy as their “last chance.” In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high‐conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three “primary colors” of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language‐based and action‐based practices, suggesting that meaning is held and expressed as much through interaction or “relational motion” as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action‐based interventions in early stages of therapy, by engaging couples in “experiments in possibility.” Typical action approaches are described. An extended vignette follows.