L’impasse thérapeutique consiste en la stagnation de la progression du patient vers ses objectifs. Cette impasse peut se résoudre et permettre au patient de vivre une expérience transformatrice. Toutefois, l’impasse qui ne se résout pas peut engendrer des conséquences négatives chez le patient et le thérapeute. Dans le cadre de cette étude, nous avons voulu comprendre quel rôle le psychothérapeute pouvait jouer dans le fait que l’impasse se résolve ou non. Trente participants ayant entre 25 et 41 ans et pratiquant la psychothérapie ont été recrutés afin de participer à l’étude. Ils ont participé à une rencontre d’environ deux heures, où ils ont pris part à une entrevue semi-structurée, lors de laquelle on leur a demandé de parler de leur ressenti en lien avec deux impasses thérapeutiques vécues, une de ces impasses s’étant résolue et l’autre ne s’étant pas résolue. Ils ont ensuite rempli des questionnaires évoquant leur expérience de l’impasse sur le coup de son apparition: l’Inventaire d’alliance de travail, une échelle mesurant l’intensité du contre-transfert, l’Inventaire d’anxiété situationnelle, le Questionnaire sur le contre-transfert, une échelle mesurant l’intensité de l’impasse thérapeutique, ainsi qu’une échelle mesurant le niveau de fonctionnement du patient. Ensuite, une autre section d’entrevue semi-structurée a été effectuée afin de recueillir le vécu actuel des participants en lien avec cette même impasse. Les sections d’entrevue ont été analysées à partir de la GÉVA, instrument mesurant le niveau de mentalisation des affects de façon séparée pour chacun d’eux. Les niveaux de mentalisation de l’hostilité, de l’impuissance, de la culpabilité, de la tristesse et de l’anxiété ont été mesurés. Notre première hypothèse, soit que le niveau de mentalisation serait plus élevé dans la situation d’impasse résolue que non-résolue n’a pas été corroborée et c’est l’inverse qui s’est produit pour l’affect de tristesse. La deuxième hypothèse, qui supposait que le niveau de mentalisation serait plus élevé au moment de l’expérimentation qu’au moment de l’impasse, a été corroborée pour les affects d’hostilité et de peur, alors que la tristesse et la culpabilité ont plutôt présenté des résultats inverses. La troisième hypothèse, qui proposait que la récupération du niveau de mentalisation entre le moment de l’impasse et le moment présent serait plus important dans le cas de l’impasse résolue a été confirmée pour l’affect d’hostilité. La quatrième hypothèse, voulant que le contre-transfert serait de nature plus négative dans le cas de l’impasse non-résolue a pour sa part été entièrement corroborée. La cinquième hypothèse, proposant que le niveau de mentalisation présenterait un lien positif avec l’alliance, a été corroborée uniquement dans les cas où l’alliance était bonne. Finalement, la sixième hypothèse, postulant que le niveau de mentalisation et le contre-transfert auraient un lien négatif, a été confirmée dans le cas de l’impasse résolue. Pour conclure, nous constatons que le lien entre l’avènement d’un défi émotionnel et le niveau de mentalisation n’est pas unidirectionnel. Il arrive qu’un défi émotionnel surcharge le thérapeute, qui présente alors une difficulté à mentaliser, alors qu’à d’autres moments, le défi le stimule plutôt à mentaliser davantage. Il s’agit pour le thérapeute de rester à l’affût de sa réaction lors d’un défi émotionnel, afin de tenter de maintenir un niveau de mentalisation suffisant. De plus, nous remarquons que les patients présentant un trouble de la personnalité du cluster C sont davantage représentés lors des impasses non-résolues. Ainsi, il conviendrait de se montrer prudent face à ce type de patient lorsqu’une impasse thérapeutique survient. Finalement, les situations où l’alliance thérapeutique est faible paraissent à risque, puisqu’il semble alors que des facteurs tels que les propres conflits psychiques du thérapeute puissent alors entrer en lien avec son niveau de mentalisation, ce qui pourrait diminuer ce dernier et mener à des impasses non-résolues. Il s’agit donc pour le thérapeute de tenter en tout temps d’améliorer une alliance thérapeutique qui serait faible.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

The basic idea of the diploma thesis is to analyze the functionality of alliances in the global economic environment. Thesis specializes on the particular type of alliance - airline alliance. It is structurally divided into three separated chapters. The first chapter follows the basic determinants of the alliances functioning, their structure, composition and typology. Its aim is to explain the most important factors necessary for understanding the main meaning of the chapters. It focuses on the main advantages and disadvantages of the companies involved in alliances. The second chapter focuses on the implementation of alliances in airline industry. It monitors their historical development, legislative and regulatory environment in which the alliances were established and exist. It focuses on mapping the European and American area. The third chapter compares advantages and disadvantages of large and small members of Star Alliance within the European, American and Asian market. It compares them on the level of regional comparison, and then based on comparative fundamental and technical analyses.

Magister Artium - MA (Psychology) / The state of postgraduate studies in South Africa has come under renewed enquiry in recent years as concern is placed on the inconsistency between postgraduate enrolment and graduation rates. The discrepancy between the enrolment and completion rates is attributable to a range of factors. Literature identified the supervisory relationship as an important and significant factor in predicting completion. The establishment of a good working alliance in the beginning of the thesis process has been identified as a crucial task. As a result, it is useful to gain insight into how students set about establishing working relationships with new supervisors and how they rate the quality thereof. The present study was conducted with Psychology Masters students who were in their first semester of the first enrolment in the Community and Health Sciences faculty at the University of the Western Cape. Attachment theory provided the theoretical framework for the study as it posits that the quality of current relationships are a function of early relationship experiences. Thus students were thought to draw on earlier experiences when setting about establishing new relationships such as the supervisory relationship. The study was exploratory and descriptive in nature. Semi-structured interviews were conducted with eleven eligible participants who have been selected purposively. Transcriptions have been subjected to a Thematic Analysis. Ethics clearance has been requested from and granted by the Senate Research Committee and all relevant ethics principles such as, confidentiality, anonymity, voluntary participation and informed consent, have been adhered to. Findings indicated that supervision was a central component for graduate completion, underscoring the importance of early supervisory sessions to form a strong working alliance. Furthermore, the findings indicated that the supervisor's role in providing the expertise and support largely contributed to the success of establishing strong and productive supervisory relationships. Participants perceived strong supervisory relationships as necessary to foster completion of higher degree requirements. The development of a new supervisory relationship activated relational patterns for students that underscored the importance of recognizing the supervisory relationship as a relationship.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / INTRODUCTION: Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention rates and poor outcome in treatment studies. One explanation for patient drop-out is weak treatment alliances, which are also associated with poor outcome. This study investigates a novel treatment for AN, Alliance Focused Treatment (AFT), which attends to ruptures in the alliance as well as interpersonal difficulties and emotional avoidance commonly associated with AN. Group analyses are presented along with one detailed case. METHOD: Seven women with AN-spectrum illnesses were randomized to receive both AFT and Behavioral Change Treatment (BCT) using a replicated single case A-B-C-B design. Participants began with a Baseline Phase (A) and then received the experimental treatment (AFT) and the comparison treatment (BCT) in alternating fashion. This design allowed each participant to provide comparison (control) data for each treatment. "Time" (session number) was used as a covariate in analyses. Each treatment phase was four weeks long, with twice-weekly sessions. Participants recorded daily kilocalorie intake and post-session treatment alliance. Generalized Estimating Equations were used to examine differences in kilocalorie intake and treatment alliance between phases and within participants. Graphs of slopes of kilocalorie and alliance change for each participant, in each phase, facilitated observation of treatment effects. RESULTS: Six participants completed treatment. Significant overall increases in kilocalorie intake were observed only in BCT relative to a baseline period when controlling for time, however, both AFT and BCT showed interactions with time indicating kilocalorie intake increased in both conditions. No significant differences between active treatments in kilocalorie intake were observed. Participants rated global working alliance significantly higher in BCT, while they rated the task dimension of alliance significantly higher in AFT. Global patient-rated treatment alliance was significantly associated with kilocalorie intake, and the relationship between global alliance and kilocalorie intake became stronger over time. Participants rated ruptures in 39% of sessions and frequently reported discussion of the rupture as a component of its resolution. DISCUSSION: This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN. / 2031-01-02

Because of its political and philosophical launching ground (Arredondo & Perez, 2006), cultural competence did not begin as an empirical research program, and as a result, there remains disagreement about how to define and measure cultural competence. Although the application of cultural competence remains unclear to some psychologists (Fuertes et al., 2006), it is now common knowledge that the therapeutic alliance is a statistically and clinically significant contributor to effective therapy. This pilot study merges two prominent bodies of literature, cultural competence and therapeutic alliance, with the underlying assumption that a culturally competent counselor will be able to provide effective service through the therapeutic relationship (Pope-Davis et al., 2002). This pilot study was designed to provide information about the relationship between therapists' self-reports and their observed behaviors regarding cultural competence (CC), examine how therapists' CC facilitates the formation of working alliances, and examine the role of CC in predicting parent-child discrepancy in alliance. Participants were family therapists and family members involved in a multi-site clinical trial study (Parent Study) evaluating Brief Strategic Family Therapy (BSFT™; Szapocznik, Hervis, & Schwartz, 2003). A total of 14 therapists from 8 community treatment programs from across the country were included in the rating portion of the study. The Parent Study included African American and Hispanic families with adolescents ages 12-17, mostly referred from the juvenile justice system. Scores from Roysircar's Multicultural Counseling Inventory (MCI; 1994) and Cultural Diversity Observer Rating Scale (CDORS; 2005) were compared. Observed therapeutic alliance was evaluated using the Vanderbilt Therapeutic Alliance Scale-Revised. The associations were evaluated with 3 multilevel univariate linear models using HLM software. Since 6 of 14 therapists (43%) completed the MCI, the pilot study was completed without self-reported competence as a predictor of therapeutic alliance (only CDORS was used). The results of this study failed to provide support for the hypothesized relationships between cultural competence and therapeutic alliance. These results are discussed in light of the methodological limitations of this study and suggestions are made to improve future investigations in this area.

Abstract The purpose of this study is to use Analytical Hierarchy Process (AHP) to find out success factors of small and medium-sized enterprises (SMEs) R&D alliances and relative importance of these factors, and then to get the key successful factors (KSFs) to discuss why these KSFs have important influence on SMEs R&D alliances. AHP and case study are used in this research. Through literature review, the researcher develops 4 criteria and 16 successful factors which are arranged in hierarchical structure chart. Next, case study is used to make this chart reflect better the conditions of Taiwanese SMEs R&D alliances. Finally, to find out the KSFs, AHP is used to design the questionnaire and do questionnaire survey. The results of this study are: 1. The relative importance of the 4 criteria is: business strategy (0.386), the mechanism of R&D alliance management (0.283), partners¡¦ relationship (0.207), and government policy (0.124). 2. The 6 KSFs are: identifying market demand (0.137), clearly defining roles and responsibilities (0.101), establishing mechanism of communication and mutual trust (0.091), using complementary resources and technology (0.079), routinely assessing and adjusting (0.074), and emphasizing the degree of commitment (0.074).

Analyzing the current state of the United States' alliances with both Japan and South Korea underscores the failure of the traditional alliance theory concepts, realism, liberalism, and constructivism, to adequately describe their continuation. Introducing a concept termed the stability theory to alliance theory explains the current trajectories of the US-Japan and US-South Korea alliances. Stability theory is an extension of the conception of the three aforementioned theories and hedging, and is based in part upon the inherent inertia resisting change, in a long-standing alliance. In setting the stage for the introduction of stability theory, the past, present, and future of the alliances come into play, illustrating how this new theory picks up where others fall off.

This is the first known occupational therapy (OT) study to examine the emergent patterns of the client-therapist working alliance during the course of a community-based OT intervention. The experiences of both the adult client and OT in each of four dyads are explored and described as they relate to the evolution of the alliance over time and the impacting contextual factors. These experiences were considered alongside the therapy outcomes. Mixed methods, including quantitative scales and interviews, were used in this multiple-case study situated within a pragmatism paradigm. Individual case and cross case analyses were conducted leading to the identification of eleven cross case themes. These findings suggest that the interpersonal relationship between a client and OT develops with the goal of becoming a safe harbour for the clients. The strengthening interpersonal bond appears to create an impetus within the client to engage in therapeutic activities. This enticed engagement results in the client’s performance of novel activity purposefully selected by the OT as bearing personal meaning for the client. The clients’ engagement often results in enhanced insight into their abilities and meaningful functional gains. This success appears to reinforce and energize both the momentum toward the collaboratively-established therapy goals, as well as provides a positive feedback mechanism into the working alliance. The OT’s training, philosophy and skill, client’s attributes, and environmental influences (both physical and social) all appear to have potential implications upon the working alliance’s development and/or the therapeutic achievements. Further research will be needed to confirm or disconfirm these findings and may include further study with variable client populations (e.g., different ages, different conditions), the role of humour in the therapeutic process, the impact of client’s degree of social isolation on the alliance, as well therapists’ disparate levels of use-of-self and the related impacts upon the alliance.

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