Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 55-59).

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.

L'aidant naturel d'un proche souffrant de schizophrénie qui suit une thérapie familiale perçoit certains éléments liés au processus à l'œuvre. Le but de cette étude est de recueillir des éléments susceptibles d'être communs à plusieurs prises en charge familiales. Il s'agit d'apporter des hypothèses de travail sur un domaine inexploré, et d'envisager un lien entre les exposés des aidants naturels et les concepts pratiques. Après avoir parcouru les références théoriques sur la thérapie familiale et sur les aidants naturels, une analyse thématique du contenu de cinq entretiens a été réalisée. Il s'agit d'entretiens ouverts afin de récolter un plus grand nombre d'hypothèses de travail. Les suivis des aidants sont hétérogènes par la durée et le type de suivi familial. Les résultats permettent de relever 29 thèmes. Parmi ceux-ci, deux semblent de premier ordre: la communication intrafamiliale et le positionnement. Ces thèmes semblent liés entre eux ainsi qu'à d'autres. Cela laisse penser qu'ils sont élaborés par les aidants comme occupant une place centrale dans le travail effectué avec les praticiens en psychothérapie familiale. Le moment spécifique de l’avènement du trouble est une période de grande détresse pour la famille. Celle-ci manifeste des attentes en termes de soutien, et d’accompagnement de la part des professionnels. Si elles sont négligées, la création de l’alliance thérapeutique peut être mise à mal, et entraver la prise en charge. Par ailleurs, il semble que perception circulaire et linéaire coexistent dans la représentation du problème que se fait le praticien. Cette étude propose des hypothèses qui demandent à être vérifiées par des recherches ultérieures. / Caregivers dealing with a family member with schizophrenia and undergoing a family therapy feel some effects related to the process. This research aims to identify perceived family features likely to be common to the various family care programs. Thus, this study has to do with working hypotheses based on a still unexplored field of psychology, and also, to seek a link between stories of caregivers and practical concepts. Having gone through references on family therapy and caregivers, a thematic analysis of five interviews has been carried out. Follow-up of caregivers is heterogeneous in terms of duration and type of family supervision. The interviews were open in order to collect a larger number of working hypotheses. The results can take up 29 topics. Among these, two of them seem to be high-order issues: intrafamilial communication and family status. These subjects appear to be connected to each other and to other areas. This suggests that both of them are elaborated by caregivers as a strong emphasis in the work of the family therapist. At the specific time when the disorder occurs, it's a period of extreme distress for all the family members. So that the family expresses expectations in counseling and support from professionals. If the demands are neglected, building the therapeutic alliance may be harmed and can, therefore, hinder the psychological management of patients with schizophrenia. Moreover, it appears that circular and linear perceptions co-exist in the problem representation of practitioners. This study proposes hypotheses that require subsequent verification during further research.

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, apesar do grau de comprometimento do seu funcionamento psíquico. / Backgroud: The establishment of a therapeutic alliance of good quality in analytic psychotherapy is crucial for the process an results. This study evaluated the relashionship between level of defense mechanisms and the quality of the therapeutic alliance established during the psychotherapy. Methods: Patients in psychotherapy and their respective therapists answered the Helping Alliance Questionnaire (HAq II – patient version and HAQ II therapist version respectively). The symptoms were accessed by means of SCL-90, and the level of defenses through the Defensive Style Questionnaire of DSM-IV-TR. Results: There were no association between the quality of the therapeutic alliance and the patient level of defense mechanisms in this sample. On the other hand, it was found a significant difference when the HAqII answered by patients and therapist versions were compared: patients established a stronger therapeutic alliance in relation to their therapists. Discussion: The independence of levels of defense mechanisms used by the patients in relation to the quality of the established therapeutic alliance leads to the idea that training and personal characteristics of the therapists may lead to the development of an ability to connect well with patients in spite of their psychic functioning.

Si l’efficacité des psychothérapies semble maintenant faire consensus, la recherche vient aujourd’hui interroger directement le processus psychothérapeutique. Notre travail s’inscrit dans cette démarche et se fonde sur l’étude de l’interaction verbale issue d’une psychothérapie émergente, la psychothérapie EMDR, Eyes Movement Desensitization and Reprocessing. La traduction française est désensibilisation et retraitement par les mouvements oculaires. Ce dispositif thérapeutique s’avère prometteur dans le champ du soin psychique, et est principalement identifié parmi les pratiques psychothérapeutiques comme étant celle où le thérapeute exerce une action physique sur son patient et ce, au moyen de stimulations bilatérales alternées (notamment par le biais de mouvements oculaires). L’EMDR bénéficie dans le champ de la recherche majoritairement d’études s’intéressant aux effets physiologiques en lien principalement avec les mouvements des yeux pendant le traitement. Or, en vertu du fait que l’EMDR s’agence aussi autour d’un protocole verbal, nous nous inscrivons dans le champ des études qui considèrent que la psychothérapie est avant tout un « événement de parole » (Labov et Fanshel, 1977). Ainsi, en nous appuyant sur l’étude du langage, à la fois tel qu’il est prévu par le protocole et tel qu’il est dispensé par le thérapeute en séance, nous venons compléter ces travaux en nous plaçant à un niveau de description clinique, à hauteur du sujet. Dans une première partie, nous nous situons sur le plan théorique, nous éclairons les phases 3 et 4, prototypes du protocole EMDR à la lumière de théories issues du champ de la pragmatique mais aussi à la lumière des théories issues de la psychanalyse. Dans une seconde partie de recherche empirique, nous examinons un corpus constitué de trois suivis psychothérapeutiques filmés et retranscrits. En nous inscrivant dans le réel de la pratique telle qu’elle se donne à entendre, nous mettons en œuvre une méthodologie d’analyse exploratoire et qualitative issue du paradigme de la pragmatique. Pour ce faire, nous nous référons aux travaux menés au sein de l’analyse linguistico-pragmatique des interventions du thérapeute et de la Logique Interlocutoire. Nous dégageons certaines caractéristiques de la matrice langagière qui viennent souligner son importance, son rôle et ses effets dans l’instauration d’un processus de changement qui apparaît bénéfique pour le patient / As the efficiency of psychotherapies is now widely recognized, research questions the psychotherapeutic process. In this vein, we review and study the verbal interactions resulting from an emerging psychotherapy, the Eyes Movement Desensitization and Reprocessing (EMDR) psychotherapy. This therapy is very promising in the field of psychic care. It is a psychotherapeutic practice in which the therapist exercises a physical action on his patient by means of alternating bilateral stimulations – notably by ocular movements. Thus far, research on EMDR has primarily examined the physiological effects related mainly to eye movements during treatment. Because EMDR also has a verbal protocol, we review it in the framework of studies that consider psychotherapy as a "speech event" above all (Labov and Fanshel, 1977). Based on a study of language, both as provided for in the protocol and as used by the therapist in session, we attempt to pursue these works by placing ourselves at a level of clinical description, at the level of the subject. In a first part, we follow a theoretical approach, and review phases 3 and 4 and prototypes of the EMDR protocol, in light of theories in the field of pragmatics and theories stemming from psychoanalysis. In a second part of empirical research, we examine a corpus consisting of three psychotherapeutic follow-ups, which have been filmed and transcribed. By placing ourselves into the reality of the practice, as it is commonly understood, we implement a methodology of exploratory and qualitative analysis emerging from the paradigm of pragmatics. To do this, we refer to the works carried out within the linguistic-pragmatic analysis of the interventions of the therapist as well as to interlocutory logic. We highlight some characteristics of the language matrix that demonstrate its importance, its role and its effects in the implementation of a process of change that appears to be beneficial for the patient

Abstract Extensive research has been conducted out on the construct of therapeutic alliance. With the growing emphasis on evidence-based practice in psychology it is vital that measures used in both clinical and research settings are empirically well-suited for the population under investigation. However, many measurement issues related to the reliability and validity of the alliance construct remain unaddressed or unresolved. Two studies were designed to add to the scientific evidence on the therapeutic alliance by establishing empirical evidence of the psychometric properties of this construct’s most commonly used measures, with the intention of identifying the most psychometrically sound alliance measures. This was first done by systematically reviewing the literature to identify studies that used the most commonly used alliance measures. Next, key psychometric properties of each measure (internal reliability and predictive validity) were reviewed to determine if the alliance was assessed in the context of individual adult psychotherapy. In the first study, I conducted a reliability generalization analysis to (a) estimate the average reliability coefficient of each alliance measure identified in the systematic review and (b) examine the potential influence that study characteristics may have had on the reliability estimates. Six different alliance measures were included (Agnew Relationship Measure, California Psychotherapy Alliance Scales, Counselor Rating Form, Penn Alliance Scales, Therapeutic Bond Scale, Working Alliance Inventory), in various formats and rater versions, resulting in a total of 17 alliance measure variants for this first analysis. In the second study, I conducted a validity generalization analysis using only those studies from the first study that were identified as containing outcome data. The purpose of this study was to synthesize the alliance-outcome effect sizes that have been reported for the most commonly used therapeutic alliance measures and to assess the potential impact study characteristics may have on those effect sizes. Five different alliance measures (California Psychotherapy Alliance Scales, Counselor Rating Form, Penn Alliance Scales, Therapeutic Bond Scale, Working Alliance Inventory, Vanderbilt Therapeutic Alliance Scale) in various formats and rater versions, resulting in a total of 15 alliance measure variants were included in this analysis. This second study was different from previous alliance-outcome meta-analyses as I only included studies that (a) could be identified as providing psychotherapy, as opposed to other mental health services, (b) assessed the alliance from individual adult psychotherapy, (c) were identified as using the most commonly used alliance measures, and (d) measured the alliance at the midpoint of treatment, or earlier. This second study also differed from previous meta-analyses as I conducted separate analyses for correlational data and partial correlational data. The reliability generalization study found that majority of the alliance measures were good choices for assessing the alliance based on their mean reliability coefficients. The validity generalization study found relatively no difference in the early alliance’s ability to predict treatment outcomes in individual adult psychotherapy between full correlation data (r = .24) and partial correlation data (r = .23). There was also no difference found among the different alliance measures, or their variants, in their ability to predict treatment outcomes, suggesting that no one alliance measure is statistically better at predicting outcomes. The results from both studies suggest that, based on their overall level of reliability as well as their ability to predict treatment outcomes, both researcher and clinicians should consider these measures, with few exceptions, as comparably good choices for assessing the alliance in adult individual psychotherapy.

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, apesar do grau de comprometimento do seu funcionamento psíquico. / Backgroud: The establishment of a therapeutic alliance of good quality in analytic psychotherapy is crucial for the process an results. This study evaluated the relashionship between level of defense mechanisms and the quality of the therapeutic alliance established during the psychotherapy. Methods: Patients in psychotherapy and their respective therapists answered the Helping Alliance Questionnaire (HAq II – patient version and HAQ II therapist version respectively). The symptoms were accessed by means of SCL-90, and the level of defenses through the Defensive Style Questionnaire of DSM-IV-TR. Results: There were no association between the quality of the therapeutic alliance and the patient level of defense mechanisms in this sample. On the other hand, it was found a significant difference when the HAqII answered by patients and therapist versions were compared: patients established a stronger therapeutic alliance in relation to their therapists. Discussion: The independence of levels of defense mechanisms used by the patients in relation to the quality of the established therapeutic alliance leads to the idea that training and personal characteristics of the therapists may lead to the development of an ability to connect well with patients in spite of their psychic functioning.

abstract: This study examined the relationship of client pretreatment interpersonal problems (measured by the Inventory of Interpersonal Problems) to the therapeutic alliance (as measured early in treatment by a self report version of the Working Alliance Inventory‐ Short) using multilevel modeling to account for client and counselor variables. Specifically, the correlations of dominance, hostility and cold/distance interpersonal problems with the initial working alliance were investigated. Participants consisted of 144 clients and 44 graduate student counselors at the Counselor Training Center at Arizona State University. The intraclass value of .23 indicated there is a sizable effect, with counselor differences accounting for 23% of the variance in client alliance ratings, supporting the use of multilevel modeling. There was a dominance counselor gender interaction with working alliance scores. Clients who had problems with dominance reported higher working alliance scores with male counselors while clients who had problems with submissiveness reported higher working alliance scores with female counselors. Hostile dominance interpersonal problems were associated with lower initial working alliance scores regardless of counselor gender. Implications for clinical practice are discussed. / Dissertation/Thesis / M.C. Counseling Psychology 2012

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, apesar do grau de comprometimento do seu funcionamento psíquico. / Backgroud: The establishment of a therapeutic alliance of good quality in analytic psychotherapy is crucial for the process an results. This study evaluated the relashionship between level of defense mechanisms and the quality of the therapeutic alliance established during the psychotherapy. Methods: Patients in psychotherapy and their respective therapists answered the Helping Alliance Questionnaire (HAq II – patient version and HAQ II therapist version respectively). The symptoms were accessed by means of SCL-90, and the level of defenses through the Defensive Style Questionnaire of DSM-IV-TR. Results: There were no association between the quality of the therapeutic alliance and the patient level of defense mechanisms in this sample. On the other hand, it was found a significant difference when the HAqII answered by patients and therapist versions were compared: patients established a stronger therapeutic alliance in relation to their therapists. Discussion: The independence of levels of defense mechanisms used by the patients in relation to the quality of the established therapeutic alliance leads to the idea that training and personal characteristics of the therapists may lead to the development of an ability to connect well with patients in spite of their psychic functioning.

There has been relatively little robust research investigating the experience of family therapy from a client’s perspective. Much of the literature fails to make clear their methods for analysing the data, and takes an ‘either or’ approach to family and individual perspectives. Thus, either whole family perspectives, or the perspectives of a particular group are sought, making it difficult to understand the impact of the family context on individual perspectives or vice versa. The present research seeks to understand the family therapy experiences of individuals within their familial context. Two families of three were interviewed using a semi-structured interview guide and interviews were analysed using Interpretative Phenomenological Analysis. Results are presented as two family case studies. One over-arching theme of ‘the safety of the therapeutic relationship’ emerged from the accounts of both families. The therapeutic relationship provided the safety to talk and explore problems and relationships. This was described as cathartic and helped family members to see themselves and each other differently. Varying degrees of exploration of individuals was associated with differing levels of engagement with therapy. Being able to explore relationships for both families allowed them to develop new understandings of each other. Gender also emerged as an important theme and this is discussed in relation to issues of power and gender. Some key methodological limitations of the research including the small number of participants and the impact of an overly detailed interview schedule on the data are discussed. As this study involves two case studies of three family members each, it is not easily transferable, but points to some key themes and processes which have implications for practice and future research.