The foundation for therapy is called the therapeutic alliance (1, 2). Clin. “The therapeutic alliance: its relationship to outcome in brief psychotherapy,” in Empirical Studies in Analytic Theories, ed. Marmar, C. R., Gaston, L., Gallagher, D., and Thompson, L. W. (1989a). When therapeutic alliance process fails, there is normally the emergence of imbalance with regard to the family therapy, which in turn aids to dropout of adolescents from the therapeutic process (Flicker, Turner, Waldron, Brody, and Ozechowski, 2008). The definition of the therapeutic alliance proposed by Bordin (1979) is applicable to any therapeutic approach and for this reason is defined by Horvath and Luborsky (1993) as the “pan-theoretical concept.” Bordin’s formulation underlines the collaborative relationship between patient and therapist in the common fight to overcome the patient’s suffering and self-destructive behavior. Psychol. Psychiatry 14, 325–332. Can. (1988). This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Cohesion and alliance were correlated significantly and both predicted a successful outcome, although the alliance accounted for more outcome variance. (2000). Outcome research analyses the results of the therapy, whereas process research investigates the various aspects of the therapeutic process, which can also be measured during the course of therapy regardless of outcome. Assess. Kivlighan and Shaughnessy (1995) use the hierarchical linear modeling method (an analysis technique for studying the process of change in studies where measurements are repeated) to analyses the development of the alliance in a large number of cases. This work was supported by University of Turin (Ricerca scientifica finanziata dall’Università). Consult. New York: Oxford University Press. Horwitz, L. (1974). The therapeutic alliance is a COLLABORATION between patient and therapist in which there is an agreement about the problems to be addressed, the goals to … Psychol. Psychol. Without a therapeutic alliance, CFT would be nothing more than a collection of ideas in books. Numerous rating scales have been designed to analyses and measure the therapeutic alliance, scales that have enabled us to gain a better understanding of the various aspects of the alliance and observe it from different perspectives: from that of the patient, therapist, and observer. 2009 Oct;37(5):527-40. doi: 10.1017/S1352465809990269. Bordin also suggests that the alliance will influence outcome, not because it is healing in its own right, but as an ingredient which enables the patient to accept, follow, and believe in the treatment. J. L. Cleghorn (New York: Brunner/Mazel), 92–116. Nurs. Res. This research is extensively discussed (with many references) in The Heart and Soul of Change: What Works in Therapy, Mark A. Hubble, Barry L. Du… Safran, J. D., and Muran, J. C. (1996). (2004) analyzed therapeutic alliance growth during the course of short-term treatment of depressed patients, drawn from the Second Sheffield Psychotherapy Project, who received cognitive–behavioral and psychodynamic–interpersonal therapy. This latter study compared 57 clients, diagnosed with major depression and receiving either psychodynamic–interpersonal or cognitive–behavioral therapy: the cognitive–behavioral sessions were rated as having better therapeutic alliances than the psychodynamic ones. Dialogues 11, 605–619. Luborsky, L. (1976). Clin. Alien. Strupp, H. H., and Hadley, S. W. (1979). 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. This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. 2018 Jan;74(1):5-42. doi: 10.1002/jclp.22484. J. Clin. Frank, A. F., and Gunderson, J. G. (1990). 12, 213–229. Clinical Prediction in Psychotherapy. Horvath, A. O., and Symonds, B. D. (1991). (2004), where the alliance ruptures represented opportunities for clients to learn about their problems relating to others, and repairs represented such opportunities having been taken in the here-and-now of the therapeutic relationship. Psychotherapy, 48(3), pp.237-248. September 1993; Journal of Consulting and Clinical Psychology 61(4):561-73; DOI: 10.1037//0022-006X.61.4.561. Different approaches for the evaluation of alliance coexist in group psychotherapy. Therapeutic alliances rupture as a therapy event for empirical investigation. The therapist-client relationship: an integrative system perspective. Alexander, L. B., and Luborsky, L. (1986). When I was working with children with autism, the first thing we had to establish was rapport. Research on psychotherapy integration: recommendations and conclusions from an NIMH workshop. Int. Consult. Is one assessment enough? Strong, S. R. (1968). 71, 997–1006. Clin. J. Nerv. Abstract Aims: The therapeutic alliance is a concept that has received a great deal of attention within face-to-face counselling. While Rogers stressed the therapist’s role in the relationship, other works focused on the theory of the influence of social aspects. BMC Psychiatry 9, 64. doi: 10.1186/1471-244X-9-64. Fluctuations in the alliance, especially in the middle phase, thus appear to reflect the re-emergence of the patient’s dysfunctional avoidant strategies and the task of the therapist is to recognize and resolve these conflicts. Schweiz. Therapist and therapy-related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client-rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist-rated alliance. Northvale, NJ: Jason Aronson. Unlike Kivlighan and Shaughnessy, these authors considered therapies consisting of 8 and 16 sessions, using the ARM to rate the therapeutic bond, partnership, and confidence, disclosure, and patient initiative. De Roten et al. Rogers (1951) defines what he considered to be the active components in the therapeutic relationship: empathy, congruence, and unconditional positive regard. Horvath, A. O., and Luborsky, L. (1993). No significant correlation was observed between any of the four patterns and the therapeutic outcome. 24, 240–259. Shirk, S. R., and Karver, M. (2003). “On the beginning of treatment: further recommendations on the technique of psychoanalysis,” in The Standard Edition of the Complete Psychological Works of Sigmund Freud, ed. Marziali, E., Munroe-Blum, H., and McCleary, L. (1997). “Helping alliances in psychotherapy: the groundwork for a study of their relationship to its outcome,” in Successful Psychotherapy, ed. 56, 163–173. Psychol. Comparison between first and revised version of the helping alliance questionnaire. They argue that these findings could reflect the effort in cognitive–behavioral therapy to give clients positive experiences and to emphasize positive coping strategies. Psychol. 31, 603–616. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. Kivlighan, D. M., and Shaughnessy, P. (2000). J. Couns. According to Horvath and Symonds (1991), the extent of the relationship between alliance and outcome was not a direct function of time: they find that measurements obtained during the earliest and most advanced counseling sessions were stronger predictors of outcome than those obtained during the middle phase of therapy. Safran et al. This accounts for the difficulties associated with the concept of alliance, which is built interactively, and so any assessment must also consider the mutual influence of the participants. Table 1. Consult. (2005) used the WAI to refer to relationships with other group members; it was called the Member–Member WAI. It allows the patient to follow the therapist and use his or her interpretations. (1990) conclude that the positive outcome of therapy was more closely associated with the successful resolution of ruptures in the alliance than with a linear growth pattern as the therapy proceeds. Psychol. The first phase coincides with the initial development of the alliance during the first five sessions of short-term therapy and peaks during the third session. Di Nuovo et al. By establishing a therapeutic alliance, the therapist then seeks to provide patient-centered care, in which the therapist as seen as a facilitator for the patient to achieve their goals, rather than an authority figure. Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients. It may seem a little weird, but the therapeutic alliance is what makes parenting easy for me. The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder. Howard, I., Turner, R., Olkin, R., and Mohr, D. C. (2006). (1985). The generalizability of the psychoanalytic concept of the working alliance. Northvale, NJ: Jason Aronson. O’Malley, S. S., Suh, C. S., and Strupp, H. H. (1983). Samstag, L. W., Muran, J. C., and Safran, J. D. (2004). Gaston, L., and Marmar, C. R. (1994). (2003). Among patients who completed the therapy successfully, there was an increase in the alliance rating between the first session and the session representing the 25% mark, whereas among unsuccessful patients, the alliance rating declined over the same period. 37, 155–172. According to their meta-analysis based on the results of 24 studies, Horvath and Symonds (1991) demonstrate the existence of a moderate but reliable association between good therapeutic alliance and positive therapeutic outcome. Saunders, S. M., Howard, K. I., and Orlinsky, D. E. (1989). Psychotherapy 48, 34–42. Patterns of helping alliance development and outcome. J. Couns. Psychol. Numerous studies have shown that the therapeutic alliance is one of the strongest predictors of treatment outcomes. J. Nerv. 1, 62–73. Research has shown that the quality of the relationship between the therapist and the client has a greater influence on client outcomes than the specific type of psychotherapy used by the therapist (this was first suggested by Saul Rosenzweig in 1936). (1998). Psychiatr. Valutare le psicoterapie: La ricerca italiana. Change style powered by CSL. Horvath, A. O., Marx, R. W., and Kamann, A. M. (1990). Safran, J. D., and Segal, Z. Under this complexity of adapting the alliance concept to a group context, some authors have found a solution: the systemic model of alliance according to Pinsof (1988) Pinsof and Catherall (1986). New York: Basic Books. Arch. Results obtained by evaluating alliance through WAI-Client and WAI-therapist after 3, 15, and 33 months, showed clear alliance differences between treatments, suggesting that the quality of the alliance was affected by the nature of the treatment. Psychotherapy (Chic.) Gen. Psychiatry 36, 1125–1136. A therapeutic relationship, or therapeutic alliance, refers to the close and consistent association that exists between at least two individuals: a health care professional and a … Agnew-Davies, R., Stiles, W. B., Hardy, G. E., Barkham, M., and Shapiro, D. A. Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients. The work of Strong (1968) was based on the hypothesis that if the patient is convinced of the therapist’s competence and adherence, this will give the latter the necessary influence to bring about changes in the patient. In particular, Stiles et al. (2005). Client and therapist session satisfaction over the course of psychotherapy. J. Rev. However, subsequently, Raue et al. Rev. They found that alliance and group cohesion were closely related and that both were strongly related to improved self-esteem and reduced symptomatology. Ment. Clin. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Neurol. CORE Net and ARM-5: are they worth using? According to Safran and Segal (1990), many therapies are characterized by at least one or more ruptures in the alliance during the course of treatment. J. Clin. J. Couns. Riv. 15, 9–23. Psychoanalysis is the therapeutic approach that was originally developed by Sigmund Freud. Gelso, C. J., and Carter, J. Get the latest public health information from CDC:, Get the latest research information from NIH:, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: Before examining the most influential instruments designed to measure the therapeutic alliance and their correlations with outcome, we will summarize the concept of alliance as it has evolved over time. Freud, S. (1913). The article traces the development of the concept of the therapeutic working alliance from its psychodynamic origins to current pantheoretical formulations. (2004), these results were in line with Horvath’s view of the alliance as a constructive process, rather than with the views of Gelso and Carter (1994) and Safran and Muran (1996) concerning the rupture and repair of alliances, in which change was a better predictor of stability outcomes. The importance of the ‘therapeutic alliance’ has long been recognized in psychotherapeutic theory and research, but is also increasingly researched in psychiatry. Kolden, G. G. (1991). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Programme. 47, 362–371. The working alliance: where are we and where should we go? Schema Therapy: A Practitioner’s Guide. Psychol. Strupp, H. H. (2001). The use of neutral observers or the creation of counterintuitive studies is therefore recommended. 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And transference-focused psychotherapy for borderline personality disorder: study design give clients positive experiences and to positive.