Allianser och interventioner En studie av hur familjer upplevt en öppenvårdsinsats och hur behandlingseffekt kvarstår Sammanfattning I Sverige utreds årligen uppskattningsvis 100 000 barn av socialtjänstens individ- och famil-jeomsorg och antalet strukturerade öppenvårdprogram har i det närmaste fördubblats sedan 1999. Många av dessa insatser har kommit att ersätta den traditionella institutionsvården. I och med ökningen av att antalet unga som numera hamnar i strukturerade öppenvårdsprogram behövs mer kunskap om såväl innehåll som resultat. Denna studies syfte är att undersöka och belysa en öppenvårdsverksamhets, i en mellansvensk kommun, innehåll d.v.s. vilka föränd-ringar som familjerna kan beskriva har skett samt om positiva förändringar kvarstår efter be-handling. Studien är av kvalitativ karaktär och resultaten bygger på intervjuer med familjer som deltagit i den aktuella behandlingen. Studiens tolkningsram belyser förutsättningar vilka ligger till grund för framgångsrik behandling. Viktiga inslag såsom terapeutisk allians och generella behandlingsprinciper vilka tar upp interventioner riktade mot avgörande risk- och skyddsfaktorer belyses. Resultatet visar att öppenvårdsverksamhetens behandlingsfaktorer intensitet och tillgänglighet har varit verksamma för att uppnå förändringar. Flertalet positiva förändringar har bestått efter behandlingens avslut. Resultatet antyder på att verksamheten skulle vinna på att bättre informera om behandlingens innehåll innan familjer tar ställning till att delta i behandling eller ej. Resultatet visar att arbetsplaner och målbeskrivningar skulle kunna göras tydligare för att bättre nå behandlingsresultat. Studiens resultat indikerar också betydelsen av att interventioner inom skolsituationen har betydelse för positiva förändringar. Ytterligare visar resultatet att flertalet familjer beskriver en mycket god terapeutisk allians och dess betydelse för uppnådd förändring. / Alliance and interventions A study of how families have experienced open care treatment and the lasting effects of treatment. Abstract In Sweden approximately 100,000 cases involving children are investigated annually by the social services office for individual and family services. The number of registered cases in the open care service programs has almost doubled since 1999, replacing traditional institutional care. As a result of the increase in the number of children, more knowledge is needed con-cerning the underlying issues and results from the open care service program. The purpose of this study is to investigate and clarify the open care service program of a medium-sized Swe-dish county, to explain changes that have take place as described by the families themselves and which positive changes remain after treatment. The study’s analysis sheds light on which premises should exist for positive treatment. Important elements such as therapeutic care al-liance and general treatment programs and which interventions directed towards conclusive risk and protective factors are addressed. Results show that factors such as intensity and avail-ability of open care service programs treatment are instrumental in reaching changes and that the majority of changes have persisted after concluded treatment. Results suggest that open care service programs could benefit by better informing about treatment’s before families decide on participating in treatment or not. Also results indicate that action plans and descrip-tion of objectives could be made more explicit to better attain therapeutic results. Results also show that the majority of families describe a favorable therapeutic alliance and their signific-ance to viable change. Results also corroborate the importance of intervention in the school environment on attaining positive effects.

Thesis (Ph.D.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Department of Psychiatry. Title from pdf file main screen (viewed on February 17, 2010). Includes bibliographical references.

The present study investigated three pretreatment therapist characteristics (professional burnout, counseling self-efficacy, and gender role orientation) in relation to the therapeutic alliance within the context of youth treatment. It was hypothesized that the emotional exhaustion and depersonalization dimensions of burnout would be negatively associated with the alliance, while the personal accomplishment dimension of burnout and counseling self-efficacy would be positively associated with the alliance. In addition, it was hypothesized that androgynous therapists would have superior alliances, relative to stereotypically masculine or feminine therapists. Participants were 42 pairs of therapists and youth clients. Prior to intake, therapists completed the Maslach Burnout Inventory -- Human Services Survey (MBI), a modified version of the Counselor Self-Efficacy Scale (CSES-M), and the Bem Sex-Role Inventory (BSRI). Clients and therapists completed parallel versions of the Child Therapy Bond Scale (CTBS) following the third session. As hypothesized, results indicated that depersonalization and personal accomplishment were significantly related, in the expected directions, to therapist ratings of the alliance. Other hypotheses were not supported. Future research directions and potential implications of these findings for professional training, service delivery, and quality management in mental health organizations are discussed.

The working alliance has been defined as a collaborative agreement between therapist and client on the goals and tasks of therapy, together with a bond of mutual trust (Bordin, 1979). The link between a strong working alliance and positive therapy outcomes has received widespread empirical support (Horvath & Symonds, 1991; Horvath & Luborsky, 1993). In light of this robust finding, Duncan and Miller (2000) suggest that, to increase their effectiveness, therapists may attend to and work within "the client's theory of change." These findings and suggestions typically concern the adult client willingly attending therapy. This study investigated how they might apply to juvenile delinquents. The goal of the current study was to examine the relationship between working alliance and treatment outcomes with delinquent youth. In addition, it aimed to investigate an element of the working alliance suggested to be of particular importance to these youth, their perception that the treatment process "fits" their own theory of change. Given its impact on treatment of mandated clients, readiness for change was also examined for its relationship with working alliance and treatment outcomes. One hundred and fourteen incarcerated youth were asked to complete a series of surveys at baseline, 2-month, and 4-month follow-up. The relationship between the predictor variables (working alliance, readiness for change, treatment fit with change theory) and criterion variables (staff-rated treatment progress, rule violations, and predicted post-detention success) were examined with multiple regression. Results demonstrated that youths' baseline ratings of treatment fit with change theory predicted self-reported treatment progress 4 months later, even when controlling for readiness for change. Treatment fit with change theory was related to the working alliance in this sample, and was a better predictor of self-reported treatment gains than the working alliance. Results suggest that treatment fit with change theory may be a productive way to conceptualize the alliance construct in work with incarcerated youth. Qualitative data on theories of change was elicited from participants and content analyzed for themes. Contributions to the developing field of desistence theory and implications for clinical practice are discussed. / text

Therapeutic alliance and its relationship to client nonverbal behavior, specifically facial expressions, were examined. Therapist interpretation of the client nonverbal behavior, or affect, influences the therapeutic alliance and process. Based on a sample of clients from a graduate school therapy training facility, results suggest therapist training in facial expressions, and how they relate to client emotion, improve the therapeutic alliance between therapist and client. After a micro-expression training for therapists, clients reported higher life functioning on the Outcome Rating Scale (ORS) and an improved therapeutic alliance on the Session Rating Scale (SRS). Overall, these findings support the benefit of incorporating micro-expression training into therapy instruction.

This quantitative study investigated the effect of client self-disclosure on the physiological arousal of the therapist and subsequent ratings of the therapeutic alliance, session smoothness, and session depth. Three therapists and 10 clients participated in a 40-minute videotaped therapy session while being attached to sensors that measured heart rate and skin conductance. The participants completed self-report questionnaires designed to assess the therapeutic alliance and session smoothness and depth immediately following the therapy session. The videotaped therapy sessions were later transcribed and coded by two independent coders for the occurrence of client self-disclosure. Correlation analyses were utilized to determine whether or not a relationship existed between client self-disclosure and the physiological arousal of the therapist. No significant relationships were found to exist between client self-disclosure and the physiological arousal of the therapist. Positive correlations were found to exist between the occurrence of client self-disclosure and the physiological arousal of the therapist as well as between the occurrence of client self-disclosure and the therapeutic alliance. The physiological arousal of the therapist was also found to be positively correlated with the strength of the therapeutic alliance.

This is a study of treatment alliance between staff and juvenile delinquent boys in institutional treatment under the Swedish Board of Institutions (SiS). The aim of this study is twofold. First, the purpose is to explore alliance phenomena in correctional institutions for young delinquents in their qualitative, rather than quantitative, aspects. Second, the study aims to explore possible preconditions - obstacles and possibilities - for the development of a genuine treatment alliance between staff and youth. In a case-within-cases design, eight boys in two institutions were followed throughout their treatments. Through participant observations, interviews, and on the basis of their case files I collected data from both the youths and the staff at different points of time during the treatment. Information from the three data sources was used for the purpose of triangulation and mutual validation. The main findings indicate the existence of two kinds of alliance processes, one a genuine alliance and the other a sham alliance one. The genuine alliance appears to be a rare occurrence at these institutions. On the contrary, close examination reveals that a high level of institutional adjustment on the part of a boy in custody often reflects mere sham alliance. The sham alliance builds upon a strong tacit mutual agreement between the boy and the staff to establish a non-change relation. The stronger the staff-youth agreement about this kind of relation, the stronger the sham alliance. Sham alliance serves the common avoidance of conflicting emotions (at unconscious and conscious levels) and contributes to momentary symptomatic relief. Equally important, sham alliance generates an atmosphere of calm and peace on the ward. Among several factors, one of the most significant obstacles to the development of genuine alliance is the fact that the boy is admitted to the institution not on his own will but typically strongly against it. Factors that promote the development of a genuine alliance within a correctional institution are discussed finally.

A concept known as the therapeutic alliance has been shown to be a robust predictor of counselling outcome. However, the specific counsellor behaviours that relate to the alliance have not been clearly identified, and few prior attempts to identify these variables have been based on client-derived conceptualizations of the alliance. 51 adult clients participated in a cross-sectional study of the relationship between 15 client-identified counsellor behaviours and the strength of the therapeutic alliance. Results indicated that 11 of the 15 behaviours were moderately to strongly correlated with the strength of the alliance, and that two behaviours (i.e., making positive comments about the client and greeting the client with a smile) significantly predicted the strength of the alliance. The findings support the hypothesis that client-identified behaviours are related to and predict alliance; however, some discrepancy remains between the present results and prior research. Implications are discussed and future research is suggested.

This study examined interpersonal predictors of early therapeutic alliance in a cognitive-behavioral treatment study for adolescents with anxiety and/or depressive disorders. Client, therapist, and observer rated measures of alliance were obtained from the third session of treatment in a sample of twenty-seven adolescents. Results indicate that alliance ratings across the three perspectives are significantly associated with one another, but that pretreatment interpersonal variables were differentially associated with varying informant perspectives. Adolescents’ perceptions of their relationships to their caregivers positively related to their perceptions of the therapeutic alliance, such that adolescents with more positive representations of relationships with their attachment figures were more likely to endorse stronger working alliances early in treatment. Adolescent-reported symptom severity at pretreatment predicted observer ratings of alliance, such that adolescents who indicated greater symptoms at pretreatment were rated as having stronger early alliances with their therapists by independent observers. Adolescent perceptions of social support also predicted observer ratings of alliance. Therapists perceived having weaker alliances with adolescents showing clinically significant depression, as compared to adolescents diagnosed with anxiety disorders alone. Future research is needed to examine whether identification of relevant interpersonal factors can help improve therapeutic engagement and outcomes for the psychosocial treatment of adolescents with anxiety and depressive disorders.

Thesis (Ph. D.)--Ohio State University, 2008. / Title from first page of PDF file. Includes bibliographical references (p. 172-185).