Originally identified by Freud (1912, 1913), the therapeutic or working alliance between client and therapist has in the last decade been proposed as the common factor that could account for psychotherapeutic outcome regardless of the theoretical orientations and/or techniques employed by therapists. Psychotherapy researchers (Allen, Newsom, Gabbard, & Coyne, 1984; Hartley & Strupp, 1983; Horvath, 1981; Luborsky, 1976; Marziali, Marmar, & Krupnick, 1981) have developed various scales for measuring the alliance and have quite consistently demonstrated an alliance-outcome relationship. The Working Alliance Inventory (Horvath, 1981, 1982) is the first self-report instrument developed to measure the alliance construct. It is based on the theory proposed by Bordin (1975, 1979) that the alliance is the product of the synergistic combination of three highly related components -- goal mutuality, agreement regarding relevant tasks and responsibilities, and the development of personal bonds or attachments. In the present study, the Working Alliance Inventory was administered after each of the first five, the tenth, and the final sessions of 44 psychotherapy cases. It was found to be statistically significantly related to outcome by the third to fifth session on four of the six outcome measures employed. Another self-report measure, the Helping Alliance Questionnaire (Luborsky, McLellan, Woody, O'Brian, & Auerbach, 1985) was also administered at the third session, as well as measures of therapist empathy, expertness, attractiveness, and trustworthiness. The Helping Alliance Questionnaire, which is based on a clinically-derived definition of the alliance, was found to be statistically significantly related to outcome on all six of the measures employed. Speculations concerning the differential patterns of results with the two alliance measures are offered. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

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This study examines the factors that influence how patients, families, and clinicians make decisions about risk-taking and safety in brain injury rehabilitation. Despite the importance of these decisions, particularly during transitions in care, there is scant literature to help guide these care partners in ethical and clinical decision-making related to risk-taking and safety. This study suggests that there are tensions between rehabilitation and patient safety efforts. Risk-taking lies at the core of brain injury rehabilitation; however, decisions about risk-taking are also influenced by conflicting values, system pressures, and patient abilities. A relational approach to autonomy that addresses patients’ decisional and functional abilities within their social contexts is more nuanced than a liberal individualist approach to autonomy, and provides a better framework for understanding decision-making. Relational autonomy may help clinicians make decisions that better balance risk-taking and safety, decisions that are committed to the principles of respecting autonomy and advancing safety.

This study examines the factors that influence how patients, families, and clinicians make decisions about risk-taking and safety in brain injury rehabilitation. Despite the importance of these decisions, particularly during transitions in care, there is scant literature to help guide these care partners in ethical and clinical decision-making related to risk-taking and safety. This study suggests that there are tensions between rehabilitation and patient safety efforts. Risk-taking lies at the core of brain injury rehabilitation; however, decisions about risk-taking are also influenced by conflicting values, system pressures, and patient abilities. A relational approach to autonomy that addresses patients’ decisional and functional abilities within their social contexts is more nuanced than a liberal individualist approach to autonomy, and provides a better framework for understanding decision-making. Relational autonomy may help clinicians make decisions that better balance risk-taking and safety, decisions that are committed to the principles of respecting autonomy and advancing safety.

Thesis--University of Michigan. / Cover title: Adherence to hypertensive treatment regimes. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 62-76).

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