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A relação entre os mecanismos de defesa e a qualidade da aliança terapêutica em psicoterapia de orientação analítica de adultos : um estudo exploratório; The relation between defense mechanisms and the quality of therapeutic alliance in analytic psychotherapy

Gomes, Fernando Grilo
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Dissertação Formato: application/pdf
POR
Relevância na Pesquisa
66.65%
Introdução: O estabelecimento de uma aliança terapêutica de boa qualidade em uma psicoterapia psicanalítica é fundamental para o processo terapêutico. Este estudo avaliou a influência do nível de funcionamento defensivo do paciente na qualidade da aliança terapêutica estabelecida durante a psicoterapia. Método: Pacientes em psicoterapia psicanalítica e seus respectivos terapeutas responderam ao Helping Alliance Questionary (HAq II). Os sintomas dos pacientes foram avaliados através do Symptom Checklist- 90-R (SCL 90), e seu o nível defensivo através da Escala de Funcionamento Defensivo do DSM-IV-TR. Resultados: Não houve associação entre o estabelecimento de uma aliança terapêutica de boa qualidade e o nível defensivo do paciente. No entanto houve diferença significativa quando a versão do terapeuta foi comparada com a respondida pelo paciente: os pacientes estabeleceram uma aliança terapêutica de melhor qualidade em relação a seus terapeutas do que o inverso. Discussão: O fato da aliança terapêutica de boa qualidade ter se estabelecido independentemente do nível defensivo do paciente sugere que o treinamento e as características pessoais dos terapeutas podem levar a uma capacidade de conectar-se com o paciente...

A relação entre os mecanismos de defesa e a qualidade da aliança terapêutica em psicoterapia de orientação analítica; The relationship between defense mechanisms and the quality of therapeutic alliance in analytic psychotherapy

Gomes, Fernando Grilo; Ceitlin, Lucia Helena Freitas; Hauck, Simone; Terra, Luciana
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
POR
Relevância na Pesquisa
66.66%
Introdução: O estabelecimento de uma aliança terapêutica de boa qualidade em uma psicoterapia psicanalítica é fundamental para o processo terapêutico. Este estudo avaliou a influência do nível de funcionamento defensivo do paciente na qualidade da aliança terapêutica estabelecida durante a psicoterapia. Método: Para avaliação da qualidade da aliança estabelecida, pacientes em psicoterapia psicanalítica e seus respectivos terapeutas responderam ao Helping Alliance Questionnaire (versão paciente e versão terapeuta, respectivamente). O nível defensivo foi inferido através da Escala de Funcionamento Defensivo proposta no Manual de Diagnóstico e Estatística das Perturbações Mentais, quarta edição, texto revisado. Resultados: Não houve associação entre o estabelecimento de uma aliança terapêutica de boa qualidade e o nível defensivo do paciente. No entanto, houve diferença significativa quando a versão do terapeuta foi comparada com a respondida pelo paciente: os pacientes estabeleceram uma aliança terapêutica de melhor qualidade em relação a seus terapeutas do que o inverso. Conclusão: O fato de a aliança terapêutica de boa qualidade ter se estabelecido independentemente do nível defensivo do paciente sugere que o treinamento e as características pessoais do terapeuta podem levar a uma capacidade de conectar-se com o paciente...

The development of the therapeutic alliance : rupture processes and the role of the therapist´s experiencet

Coutinho, Joana
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Tese de Doutorado
Publicado em 17/12/2010 ENG
Relevância na Pesquisa
46.66%
Tese de doutoramento em Psicologia (área de conhecimento de Psicologia Clínica); Ruptures in the Therapeutic Alliance are the main theme of this dissertation, organizing all the studies that compose it. According to Safran and Muran (2000) ruptures may be defined “as tension or breakdown in the collaborative relationship between the therapist and patient”. Ruptures may occur when the therapist participates in maladaptive interpersonal cycles similar to those that occur in the patient’s other relationships (Safran & Segal, 1990), thus they may contribute to understand the processes that maintain the client´s generalized representations of self-other interactions. The concept of alliance ruptures that we adopted in this work, proposed by Safran and Muran, was strongly influenced by the Interpersonal Approach to Psychotherapy (Benjamim, 1990; Mitchell, 1993), according to which almost all human behaviors have an interpersonal meaning. As we argue in the first paper of this thesis, within this perspective, the individual´s internal models about the self and the world are structured from the interpersonal experiences he or she lives across life. The alliance is seen as the result of a process of mutual regulation between the therapist and the client...

A aliança terapêutica e a qualidade da experiência subjetiva : do processo terapêutico à vida diária de indivíduos com diagnóstico de perturbação de ansiedade

Mourão, Joana dos Santos Pereira Ferreira
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Tese de Doutorado
Publicado em 13/06/2012 POR
Relevância na Pesquisa
46.56%
Tese de doutoramento em Psicologia (área de especialização em Psicologia Clínica); Os indivíduos com diagnóstico de perturbação de ansiedade apresentam dificuldades no relacionamento interpessoal, que se manifestam no contexto da terapia e no contexto da sua vida diária. A formação e desenvolvimento de uma relação terapêutica segura e de suporte, pode constituir-­‐se como uma oportunidade de exploração de novos modos funcionais de relacionamento interpessoal do cliente, por si apresentados na sua vida diária, indicadores de uma mudança efetiva. Este trabalho tem por objetivo geral a análise da experiência relacional de indivíduos com diagnóstico de perturbação de ansiedade, quer no contexto terapêutico, quer no da sua vida diária. Procurou-­‐se perceber mudanças nesta experiência relacional ao longo do processo terapêutico nestes dois contextos. Na investigação presente neste trabalho participaram 21 indivíduos. Foram utilizados o Inventário da Aliança Terapêutica, o Outcome Questionnaire e o Flow Questionnaire, em todas as sessões do processo terapêutico para a recolha dos dados relativos ao contexto terapêutico. No estudo da vida diária dos indivíduos...

Mudança e aliança terapêutica: Impacto da psicoterapia em jovens adultos

Alves, Luísa Cavacas
Fonte: ISPA - Instituto Universitário Publicador: ISPA - Instituto Universitário
Tipo: Dissertação de Mestrado
Publicado em //2013 POR
Relevância na Pesquisa
46.62%
Dissertação de Mestrado em Psicologia Clínica, apresentada ao ISPA - Instituto Universitário; O objetivo deste estudo pretendeu avaliar o impacto da mudança e da aliança terapêutica sobre a perspectiva de pacientes jovens-adultos, que usufruíram de psicoterapia psicodinâmica. Procuramos identificar as categorias emergentes do processo de mudança e as perceções dos pacientes patentes na aliança terapêutica. Este estudo teve por base uma análise qualitativa enquadrada na grounded theory com processamento da análise de dados através do software Atlas ti v 7.0 (2013). Os resultados empíricos contextualizaram o processo terapêutico em três domínios: Espaço Terapêutico (Dimensão Temporal e Espacial); Espaço Extra Terapêutico (Dimensão Inter e Intrapessoal); e Impacto Mudança. Todos os participantes revelaram o impacto da mudança na forma de pensar (auto-reflexão, auto (re)avaliação, consciencialização e autoconhecimento), no sentir (regulação emocional) e no agir (aceitação e autonomia). As categorias que mais se distinguiram foram a consciencialização e autoconhecimento. As perceções dos pacientes sugerem-nos uma robusta aliança terapêutica, com particular destaque para o vínculo (96%), evidenciando a dimensão relacional da aliança. A percentagem de 88% e 82%...

The early impact of therapeutic alliance in brief psychodynamic psychotherapy

Marcolino,José Alvaro Marques; Iacoponi,Eduardo
Fonte: Associação Brasileira de Psiquiatria - ABP Publicador: Associação Brasileira de Psiquiatria - ABP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2003 EN
Relevância na Pesquisa
46.62%
INTRODCTION: Therapeutic alliance is a key component of the psychotherapeutic process. This study estimated the impact of the therapeutic alliance as measured by CALPAS-P in an individual brief psychodynamic psychotherapy program. METHODS: To study the impact of the therapeutic alliance patients in psychotherapy answered to the CALPAS-P at the first and third session and to the Self-report Questionnaire (SRQ-20), to the Beck Depression Inventory (BDI) and to the Hamilton Anxiety Scale at the beginning and at the end of psychotherapy. RESULTS: The study of the impact of the therapeutic alliance in brief psychodynamic psychotherapy showed that higher TUI scores in the first session were significantly associated to the improvement on the BDI. Patients with best scores in the working alliance, measured at the third PWC session had also significant symptomatic changes. DISCUSSION: The study of the impact of the therapeutic alliance in brief psychotherapy indicated that patients who perceived that their therapists had the best capability to understand and to be involved in their issues had best results in reducing depressive symptoms and patients with higher capability to form the working alliance reached the best psychotherapy outcomes.

Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research

Ardito, Rita B.; Rabellino, Daniela
Fonte: Frontiers Research Foundation Publicador: Frontiers Research Foundation
Tipo: Artigo de Revista Científica
Publicado em 18/10/2011 EN
Relevância na Pesquisa
46.65%
This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. A summary of how the concept of alliance has evolved over time and the more popular alliance measures used in literature to assess the level of alliance are presented. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. In our opinion, with regard to the relationship between the therapeutic alliance and outcome of psychotherapy, future research should pay special attention to the comparison between patients’ and therapists’ assessments of the therapeutic alliance. This topic, along with a detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects.

Differential Effects of Interventions on the Therapeutic Alliance With Patients With Personality Disorders

Bond, Michael; Banon, Elisabeth; Grenier, Marcella
Fonte: American Psychiatric Press, Inc Publicador: American Psychiatric Press, Inc
Tipo: Artigo de Revista Científica
Publicado em //1998 EN
Relevância na Pesquisa
46.58%
The goal of this study was to examine the relationship between clearly defined therapist interventions and the therapeutic alliance with personality-disordered patients. Transcripts of one psychotherapy session for each of 5 subjects taking part in a long-term psychotherapy research project were rated for therapist interventions and therapeutic alliance to determine if specific interventions were followed by enhanced or diminished therapeutic work. Transference interpretations were followed by a deterioration in the therapeutic alliance when the alliance was weak, but by enhanced work when the alliance was solid. In patients with both strong and weak alliances, defense interpretations and supportive interventions enhanced therapeutic work without increasing defensiveness. Supportive interventions seemed to prepare the way for exploration and to repair ruptured alliances. (The Journal of Psychotherapy Practice and Research 1998; 7:301–318)

THE ROLE OF THERAPEUTIC ALLIANCE IN SUBSTANCE USE DISORDER TREATMENT FOR YOUNG ADULTS

Urbanoski, Karen A.; Kelly, John F.; Hoeppner, Bettina B.; Slaymaker, Valerie
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.52%
The therapeutic alliance is deemed to be integral to psychotherapeutic interventions, yet little is known about the nature of its role in treatment for substance use disorders (SUD), especially among young people. We investigated baseline predictors of the therapeutic alliance measured mid-treatment, and tested whether the alliance influenced during-treatment changes in key process variables (psychological distress, motivation, self-efficacy, coping skills, and commitment to AA/NA) independent of these baseline influences. Young adults in residential treatment (N=303; age 18-24) were assessed at intake, mid-treatment, and discharge. Older age and higher baseline levels of motivation, self-efficacy, coping skills, and commitment to AA/NA predicted a stronger alliance. Independent of these influences, participants who developed a stronger alliance achieved greater reductions in distress during treatment. Findings clarify a role for alliance in promoting during-treatment changes through reducing distress.

Therapeutic Alliance Between Youth and Staff in Residential Group Care: Psychometrics of the Therapeutic Alliance Quality Scale

Duppong Hurley, Kristin; Lambert, Matthew C.; Van Ryzin, Mark; Sullivan, Justin; Stevens, Amy
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.68%
Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service provider, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.

Empatia e aliança terapêutica sob a ótica dos terapeutas cognitivo-comportamentais

Araújo, Mara Lívia de
Fonte: Universidade Federal de Uberlândia Publicador: Universidade Federal de Uberlândia
Tipo: Dissertação
POR
Relevância na Pesquisa
46.58%
Na abordagem cognitivo-comportamental, a empatia é considerada uma habilidade social importante para a formação de um bom relacionamento terapêutico. Considerando a importância da empatia e da aliança entre terapeuta e cliente para o progresso do tratamento psicoterapêutico o presente estudo investigou junto aos terapeutas cognitivo-comportamentais a capacidade empática pessoal por meio do Inventário de Empatia (IE) e a qualidade da relação terapêutica por meio do Inventário Cognitivo-Comportamental para Avaliação da Aliança Terapêutica, além de identificar a definição de empatia terapêutica para esses psicólogos. Uma amostra de 30 psicoterapeutas especialistas em Terapia Cognitivo- Comportamental respondeu os dois inventários. Além disso, realizou-se uma prova de juízes para o Inventário Cognitivo-Comportamental para Avaliação da Aliança Terapêutica, elaborado neste trabalho a partir dos pressupostos teóricos desenvolvidos por J. Beck. Esta prova foi realizada com oito juízes, também psicólogos especialistas em Terapia Cognitivo- Comportamental. Os resultados mostraram que os participantes apresentaram-se como pessoalmente empáticos, principalmente nos fatores Sensibilidade Afetiva e Tomada de Perspectiva do IE. No que tange à relação terapêutica...

Facteurs associés à l’alliance thérapeutique en toxicomanie : effets modérateurs de la judiciarisation et des troubles sévères de santé mentale

Patenaude, Catherine
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
Relevância na Pesquisa
46.65%
La toxicomanie a des répercussions importantes tant pour les individus qui en souffrent que pour la société en général (MSSS, 2007). L’efficacité des traitements offerts aux toxicomanes est toutefois affaiblie par la difficulté à maintenir et à engager en traitement cette clientèle (Meier et al., 2006). Dans ce contexte, et puisque la qualité de l’alliance thérapeutique est associée aux résultats et à la persévérance en traitement (Martin et al., 2000; Meier et al., 2005a), l’alliance qui se développe entre le client et le thérapeute en cours de thérapie peut être vue comme une piste de solution prometteuse pour améliorer l’efficacité des traitements de la toxicomanie. La présente étude se propose d’identifier les facteurs associés à l’alliance thérapeutique développée par une clientèle toxicomane en traitement (n = 269). L’étude s’intéresse également à l’influence de doubles problématiques (toxico-justice, toxico-santé mentale) sur les relations existantes entre l’alliance et ces facteurs (effets modérateurs). Les liens entre l’alliance thérapeutique et différentes variables (santé mentale, consommation, satisfaction envers les services, motivation, soutien social, pressions légales) ont été examinés à l’aide d’analyses de régression hiérarchique. Les résultats indiquent que le profil de consommation évalué avant l’entrée en traitement covarie avec l’alliance thérapeutique. Les troubles cognitifs et la satisfaction envers les services sont les deux principales variables évaluées lors de la thérapie de groupe qui sont associées à l’alliance. Des effets modérateurs de la présence de problématiques associées à la toxicomanie (justice...

Adolescents agresseurs sexuels : l’alliance thérapeutique et la motivation au changement en contexte d’autorité

Cloutier, Micaël
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
Relevância na Pesquisa
46.56%
La littérature scientifique s’intéressant aux adolescents agresseurs sexuels démontre qu’il s’agit d’une population qui apparait souvent résistante au changement (Rich, 2003). Il importe ainsi d’identifier les facteurs qui favorisent ou compromettent le déroulement de l’intervention auprès de cette clientèle. L’alliance thérapeutique et la motivation au changement figurent d’ailleurs parmi ces facteurs ayant démontré leur influence positive. Toutefois, considérant le caractère dynamique de ces dernières, peu d’études ont documenté les particularités de leur développement respectif, spécialement dans un contexte d’autorité tel que celui des adolescents agresseurs sexuels. La présente recherche permet donc de mieux comprendre la contribution de caractéristiques individuelles et environnementales sur le développement de l’alliance thérapeutique et le processus de changement chez cette clientèle juvénile. Basés sur une collecte de données quantitatives auprès de 166 adolescents agresseurs sexuels suivis dans différents centres de traitement spécialisés en délinquance sexuelle au Québec, les résultats obtenus à partir d’analyses corrélationnelles et multivariées illustrent de nombreuses relations significatives entre un ensemble de caractéristiques individuelles et environnementales et le développement de l’alliance thérapeutique et de la motivation au changement. En effet...

Exploring the Therapeutic Alliance in Cognitive-Behavior Therapy with Children with Autism Spectrum Disorder: An Interpretative Phenomenological Approach

Houlding, Kerry
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
Relevância na Pesquisa
66.5%
Abstract The therapeutic alliance (TA) is the most studied process of adult psychotherapeutic change (Zack et al., 2007) and has been found to have a moderate but robust relationship with therapeutic outcome regardless of treatment modality (Horvath, 2001). The TA is loosely described as the extent to which the therapist and the participant connect emotionally and work together towards goals. Conceptualizations of the TA with children have relied on adult models, even though it is widely acknowledged that the pediatric population will rarely willingly commit to therapy, nor readily admit to any challenges that they may be experiencing (Keeley, Geffken, McNamara & Storch, 2011). For children with Autism Spectrum Disorder (ASD) the therapeutic alliance may require an even greater retheorizing considering the communicative and social difficulties of this particular population. Despite this need, research on children with ASD and the therapeutic TA is almost non-existent. In this qualitative study, transcripts from semi-structured interviews with mothers of children with ASD were analyzed using Interpretative Phenomenological Analysis (IPA). IPA closely examines how individual people make sense of their life experiences using a theme-by-theme approach. The three interviewees were mothers whose children were participants in a nine-week Cognitive Behaviour Therapy (CBT) group for obsessive-compulsive behaviours (OCB). A total of four superordinate themes were identified: (i) Centralization and disremembering the TA...

Multiple intelligences and the therapeutic alliance: incorporating multiple intelligence theory and practice into counselling

Pearson, M.
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Artigo de Revista Científica
Publicado em //2011 ENG
Relevância na Pesquisa
66.54%
How many ways do counselling clients reflect and communicate? How many ways can counsellors respond to client needs? Gardner’s theory of multiple intelligences (MI) has only recently been applied to the field of counselling. This discussion highlights the contribution MI theory and practice can make to developing the therapeutic alliance, to supporting a culture of client feedback, to enhancing counsellor flexibility, and to the overall effectiveness of therapy. The therapeutic alliance has been shown to contribute significantly to positive outcomes from counselling. Recent research highlights the positive impact from modifying treatment in response to client needs and interests. Understanding clients’ preferred intelligences enhances counsellors’ ability to tailor treatment. This article argues that counsellors and their clients could experience increases in the therapeutic alliance, in feedback and the effectiveness of the therapeutic process as a result of using MI theory and practice, offered in the form of expressive therapies. Possible new foundations for eclecticism, new directions for counsellor training and enhancement of practice are discussed.; Mark Pearson

Facteurs associés à l’alliance thérapeutique chez les patients ayant des troubles psychotiques

Cloutier, Geneviève
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Travail aux cycles supérieurs / Graduate student work
FR
Relevância na Pesquisa
46.67%
Ce rapport de stage porte sur les facteurs associés à l’alliance thérapeutique chez les patients ayant des troubles psychotiques. Une recension des écrits portant sur les facteurs liés à l’alliance thérapeutique ainsi que sur les troubles psychotiques a été réalisée. Par la suite, une description du milieu de stage, le Centre d’Hébergement l’Entre-Toit a été réalisée. La présentation de la méthodologie utilisée afin d’effectuer les cinq études de cas précède la présentation des données, l’analyse ainsi que l’interprétation de ces dernières. Suite à l’analyse des données recueillies, il appert que certaines dimensions semblent jouer un rôle plus ou moins important dans la création et le maintien de l’alliance thérapeutique. D’autre part, certaines dimensions étudiées ne permettent pas d’obtenir de résultats probants. De plus, il s’avère que les facteurs associés à l’alliance thérapeutique ne semblent pas avoir le même impact pour toutes les personnes souffrant de troubles psychotiques. À la lumière des résultats obtenus, des recommandations sont formulées afin de guider les professionnels œuvrant auprès d’une clientèle présentant des troubles psychotiques afin de mettre l’emphase sur les éléments importants...

Participants' Perceptions of Dimensions of the Therapeutic Alliance Over the Course of Therapy

Bachelor, Alexandra; Salamé, Ramzi
Fonte: American Psychiatric Press, Inc Publicador: American Psychiatric Press, Inc
Tipo: Artigo de Revista Científica
Publicado em //2000 EN
Relevância na Pesquisa
46.56%
The course of diverse dimensions of the therapeutic alliance as seen by the therapy participants was examined in two studies. In Study 1, use of the Penn Helping Alliance Method, Therapeutic Alliance Rating System, and Vanderbilt Psychotherapy Process Scale at the 3rd, 10th, and next-to-last therapy sessions revealed significant increases over time for therapists' mean scores on 5 of the 12 subscales. Consistency of participants' scores over time varied depending on rater perspective (therapist or client) and time interval. In Study 2, the Helping Alliance Questionnaire, Working Alliance Inventory, and California Psychotherapy Alliance Scales showed no significant change in participants' average alliance scores on the 9 subscales from the 5th to 10th sessions, and their same-scale ratings were in general consistent. Few differences were observed between therapists' and clients' average alliance ratings, but the relationship was generally perceived differently within dyads.

The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management

Howgego, Irene; Yellowlees, Peter; Owen, Cathy; Meldrum, Lenore; Dark, Francis
Fonte: SAGE Publications Publicador: SAGE Publications
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
56.58%
Objective: The aim of this review was to examine the level of evidence supporting the assumed link between a positive therapeutic alliance among patients and case managers and effective outcome for patients with a mental illness who are managed in community mental health services. Method: MedLine, PsychINFO and Social Sciences Index search of articles from 1986 to 2001 returned 84 articles and two texts. Inclusion criteria were the use of validated measures and relevance to psychiatry and community case management. Results: A definite correlation exists in the psychotherapy literature between the therapeutic relationship and improved outcomes, with its potential as a prognostic indicator acknowledged. Attempts to apply the concept to patients outside the field of psychotherapy have been slow, although expansion of the concept to other forms of change-inducing therapy was a current trend. Issues of definition, quantification and measurement of the relationship caused rigorous debate in the literature. Case management research demonstrating the importance of the therapeutic relationship and 'goodness-of-fit' between patients and case managers was sparse with no published Australian studies. Conclusions: The level of evidence supporting the link between the therapeutic alliance of patients with mental illness and improved outcomes although sparse is encouraging. It indicates the potential of the alliance as a predictor of outcome for patients engaged in case management services in community mental health. Research to determine the role and effectiveness of the alliance in the patient/case manager dyad is needed to define this potential. Effectiveness of clinical practice in the case management field could be enhanced if research findings confirmed the genesis and value of the alliance in case management. Focus on relationship strategies as a clinical tool gives the clinician and service provider a potential vehicle for promoting partnerships with the seriously mentally ill person in managing their illness and optimizing their strengths in the community.

Deconstructing the Therapeutic Alliance: Reflections on the Underlying Dimensions of the Concept

Krause,Mariane; Altimir,Carolina; Horvath,Adam
Fonte: Clínica y Salud Publicador: Clínica y Salud
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/11/2011 ENG
Relevância na Pesquisa
56.46%
The concept of the alliance has received increasing attention from both clinicians and researchers over the past thirty years. Yet it remains only vaguely defined, and its role and effect in therapy continues to be controversial. The goal of this paper is to clarify the meaning of the concept as it is perceived by clients and therapists, and to compare and contrast these perceptions to the notion of the alliance as it is de-facto implemented in research through the most frequently used alliance measures. Our results indicate that clients and therapists pay attention to different aspects of the relationship when they assess the quality of the alliance. The most frequently used measures share some important features but also exhibit significant differences. Some alliance measures attempt to accommodate the differences in the clients´ and therapists´ points of view but others ignore them. In general, these popular measures do not appear to be closely matched to the unique client/therapist perspectives. The impact of the substantial variations between measures and the absence of a clear distinction between the differing perspectives of clients and therapists is discussed.

The development of the therapeutic alliance and the emergence of alliance ruptures

Coutinho,Joana; Ribeiro,Eugenia; Fernandes,Catarina; Sousa,Inês; Safran,Jeremy D.
Fonte: Anales de Psicología Publicador: Anales de Psicología
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/10/2014 ENG
Relevância na Pesquisa
56.61%
Objectives: This study evaluated the development of the therapeutic alliance and the emergence of alliance ruptures, in a sample of patients with different diagnosis and different therapeutic outcome. Design: We examined the longitudinal data of 38 therapeutic dyads receiving cognitive-behavioural therapy, including dropouts as well as successful and unsuccessful cases. The sample included cases with Axis I and Axis II disorders. Method: At the end of each session, patients evaluated the alliance using the Working Alliance Inventory (WAI). Six judges trained in the observation of alliance rupture markers with an observational system of ruptures, rated 201 videotaped sessions. Longitudinal statistical models were applied to the data. Results: We found that the pattern of alliance development of successful cases was different from the unsuccessful and dropouts cases. In addition on average, patients with personality disorders began therapy with a lower WAI score that decreased over time, whereas patients with Axis-I disorders began therapy with a higher WAI score that increased over time.