The current study investigated the relationship between clients' object relations functioning and the working alliance. The Social Cognition and Object Relations Scale (SCORS; Westen, 1991), an object relations scoring system for the TAT, was used to assess object relations functioning. Forty-eight therapy clients at a university-based training clinic were administered the TAT, Adult Attachment Scale (AAS), Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1977), and the short form of the Marlowe-Crowne Social Desirability Scale (MCSD; Crowne & Marlowe, 1960). Following the initial assessment of client characteristics shortly after intake, clients and their therapists rated the working alliance 3 sessions later. Results indicated that the SCORS was significantly correlated with client and therapist ratings of the working alliance. The current study also assessed the predictive validity of the SCORS by examining how its various scales are related to aspects of the working alliance and the other measures used in this study. The findings suggest that the relationship between object relations functioning, the working alliance, symptom severity, and attachment disturbance depends on the aspect of object relations that is being assessed.

Both interpersonal dependency and the importance of the therapeutic alliance to successful psychotherapy outcomes have been widely studied. However, these two areas of study rarely have been viewed conjointly despite the reportedly large number of clients with dependency who present for treatment. This study elucidated the relationship between interpersonal dependency and the therapeutic alliance. Additional hypotheses explored client-therapist agreement on alliance strength in relation to client interpersonal dependency. Participants were graduate student therapists (N = 26) and their individual psychotherapy clients (N = 40) in a training clinic at a large, southwestern university. Within their first three sessions of psychotherapy, participating clients told nine Thematic Apperception Test stories and completed structured self-report measures of adult attachment, social desirability, and psychological symptoms. Interpersonal dependency was scored from the TAT stories, using the TAT Oral Dependency (TOD) scoring system developed by Masling, Rabie, and Blondheim (1967) and Huprich (2008). Three sessions following initial data collection, participating clients and their therapists completed structured self-report measures of the therapeutic alliance. Analyses revealed that interpersonal dependency was not significantly associated with client and therapist alliance ratings or the congruence between client and therapist alliance ratings. However, specific scoring categories of the TOD were associated with client alliance scores in opposing directions. In contrast to hypotheses, self-reported attachment-related dependency was significantly related to client alliance ratings and to the congruence between therapist and client alliance ratings. Clients with higher levels of self-reported attachment-related dependency rated the alliance less favorably, in agreement with their therapists, than did clients with lower levels of attachment-related dependency. Additional analyses were unsuccessful in replicating findings from previous research on interpersonal dependency. The clinical and research implications of these findings are discussed.

Bakgrund: Den terapeutiska alliansen är den relation som uppstår mellan den professionella och patienten i behandlingskontexten. Tidigare forskning, som vanligtvis vinklas från den professionellas perspektiv, har visat att en terapeutisk allians gynnar patientens återhämtning och tillfrisknande. Detta är något som både de professionella och patienter anser vara en positiv grund för ett återhämtningsinriktat arbete och därför har vi i denna studie valt att ha vinkeln från ett patientperspektiv. Den form av självskadebeteende som tas upp i denna uppsats är den som inte är av intentionen att ta sitt liv. Vanliga orsaker för självskadebeteende är för att slippa uppleva tomhetskänsla, straffa sig själv eller för att hantera jobbiga känslor. Teorierna som använts vid analysen av den insamlade datan är objektrelationsteorin och anknytningsteorin, då dessa teorier tar upp erfarenheter från tidigare relationer som kan komma att påverka nutida och framtida relationer och kan påverka individernas tillfrisknande. Syfte: Syftet med denna studie är att undersöka betydelsen av den terapeutiska alliansen, vid behandling av självskadebeteende och eventuell bakomliggande problematik hos unga kvinnor mellan 20–29 år. Vi ville ta reda på om patienter med erfarenhet av behandling vid självskadebeteende anser att den terapeutiska alliansen hade en gynnande effekt vid behandlingen. Metod: Denna studie är en kvalitativ studie med semistrukturerade intervjuer både fysiskt och online. Vi valde att intervjua fyra tidigare patienter då vi anser att deras egenlevda erfarenhet och deras infallsvinkel av den terapeutiska alliansen är viktig att både lyfta och synliggöra då deras röst sällan har blivit hörd i tidigare forskning.Resultat: Resultatet i denna studie har visat sig i fyra olika teman. Dessa teman är ”problematik kopplat till självskadebeteende”, ”önskvärda egenskaper hos professionella”, ”icke önskvärda egenskaper hos professionella” och ”hjälpande relationer utanför vården”. Genomgående för alla teman är att den terapeutiska alliansen är en viktig grund för patientens tillfrisknande, och att den professionellas bemötande är av stor vikt vid detta relationsskapande. Detta då grunden för att en behandling ska ha ett positivt utfall då relationen mellan professionell och patient är av betydelse för att patienten ska känna trygghet och förtroende för den professionella. Grunden för en fungerande relation, vilket skapar den terapeutiska alliansen, är att patienten känner en trygghet i att möta den professionella i varje enskilt möte. Konklusion: Det vi kom fram till i denna studie var att den terapeutiska alliansen har en stor betydelse och inverkan för hur patienterna upplever behandling, och därmed hur utfallet av behandlingen blir. Intervjupersonerna föredrog professionella som mötte dem med trygghet, lugn, värme, omsorg och vid behov vågade gå utanför ramarna. Behovet är stort för att möta varje enskild individs individuella behov och den terapeutiska alliansen behövs för att varje patient ska känna sig sedd och hör och bli mött precis där den befinner sig – i varje enskilt möte. Nyckelord: Terapeutisk allians, självskadebeteende, relationer. / Background: The therapeutic alliance is the relationship that arises when the professional and the patient meets during treatment. Previous research, which often is from the professional’s perspective, has shown that the therapeutic alliance promotes a positive outcome for the treatment. This is something that both professionals and patients consider to be a positive basis for the recovery-oriented practice. That is why we have decided to have the patients perspective in this study. The form of self-harm we are writing about in this study is the non-suicidal self-injury. Self-harming is a common thing to do when to avoid experiencing feelings of emptiness, to punish yourself or to deal with tough feelings. The theories that has been used to analyze the collected data is object relation theory and attachment theory. We chose to use these two theories because both of them describe previous relationships that might affect present and future relationships and that might also affect the recovery of every individual. Purpose: The purpose of this study is to explore the importance of therapeutic alliance, when treating young females between 20-29 years with non-suicidal self-injury and other underlying issues. We wanted to find out if the patients with experience of treatment for self-harm considers that the therapeutic alliance had a beneficial effect during treatment. Method: This study is a qualitative study with semi structured interviews, done both in real life and online. We choose to interview four previous patients that have own experience from mental illness and self-harm, that is because we consider their angle of the therapeutic alliance is important to make visible, because their voice rarely has been heard in previous research. Results: The results of this study have been shown in four different themes. These themes are; ”problems related to self-harming”, ”desirable characteristics with professionals”, non-desirable characteristics with professionals” and ”helpful relationships outside of professional care”. The common thing for all of these themes are that the therapeutic alliance is an important basis for the patients recovery, and how the professional chooses to meet and help the patient is of great importance to create a good relationship. A positive outcome for a treatment has its basis in the relationship between the professional and the patient, and the patient needs to trust and feel safe in that relationship. The basis is that the patient feels safe every single time that the patient meets the professional. Conclusion: What we found in this study was that the therapeutic alliance has a big difference and impact when it comes to the patient's experience of the treatment. And that also affects the outcome of the treatment. The people that we interviewed preferred professionals that had characteristics such as being safe, calm, caring and when necessary dared to break some rules. These days the requirement to meet every individuals needs is big and the therapeutic alliance is needed so each patient can feel seen, heard and get the attention it needs - in each individual meeting. Keywords: Therapeutic alliance, self-harm, relations.

The therapeutic relationship has been a cornerstone of the theory and practice of psychotherapy since it first emerged as a healing modality. Research has extensively reported on the therapeutic relationship and its role in the outcomes of psychotherapy. Despite the vast research on the therapeutic relationship, little qualitative exploration has focused on both patient and therapist lived experience. Using a hermeneutic phenomenological qualitative methodology, this study examined the lived experiences of both patients and therapists, within the same therapeutic relationship in a South African context. Three patients and three therapists (i.e. 3 patient-therapist dyads) were interviewed using in-depth semi-structured individual interviews (six interviews in total) to explore their experience of the relationship they developed during therapy, and the meanings that have been made of this. Through thematic analysis, using interpretation to deepen the analysis, several themes and subthemes were identified. Both patients’ and therapists’ lived experiences of the therapeutic relationship in psychodynamic psychotherapy clustered around three major and somewhat similar themes, with various sub-themes. Patients’ lived experiences of the therapeutic relationship centred around the following themes and sub-themes: therapist’s therapeutic approach (holding the patient in mind—knowing them; non-judgmental stance; providing an objective presence— perspective; and a consistent presence), facilitating therapeutic factors (mutuality; and therapist self-disclosure), and process within the relationship (describing the relationship—a lifeline; moment of meeting; change; and the relationship over time). Whilst therapist-participants’ experiences of the therapeutic relationship held somewhat similar themes with subtle differences, namely, patient qualities, facilitating therapeutic factors (holding and containing; theoretical orientation; use of technique; and supportive factors for therapists), and process within the relationship (describing the relationship—intimate yet formal; moment of meeting; change; and the relationship over time). Similarities and differences between patient and therapist experiences are examined that may influence the therapeutic relationship. Conclusions are discussed with a consideration of the limitations of the study as well as implications for future research, practice, and training. / Dissertation (MA)--University of Pretoria, 2019. / Psychology / MA / Unrestricted

The therapeutic alliance is an empirically-supported element of successful psychotherapy. However, the degree to which training programs incorporate alliance-centered components into their curricula and clinical practica remains unclear. The aims of this study were to (a) examine training programs’ awareness of alliance research; (b) determine the extent to which programs incorporate formal, evidence-based alliance training into their pedagogy; (c) determine whether there are differences in evidence-based alliance training practices between programs with different foci/terminal degrees and programs with different training models; and (d) cultivate an understanding of what training programs would consider ideal alliance training practices and the barriers that may interfere with them. Data derived from a quantitative survey of directors (or their designates) of APA-accredited clinical and counseling doctoral programs in the United States and Canada and a follow-up qualitative survey that examined participant reactions to the initial survey results. Generally, respondents indicated that their programs were aware of alliance research trends. However, respondents also largely indicated they do not incorporate systematic, evidence-based alliance training into their programs despite believing that such systematic elements would contribute to ideal alliance training practices. There were no statistically significant differences between graduate program degree type and training model in terms of awareness of alliance research or current alliance training practices. However, differences in views on gold-standard training emerged for training model; practitioner-scholar programs endorsed greater preferences for systematic alliance training relative to clinical scientist and scientist-practitioner programs. Qualitative responses to the findings provide additional context, and implications for training and future research directions are discussed.

No description available.

The therapeutic alliance has consistently been associated with improved client outcomes across numerous psychotherapy outcome studies. Previous systematic reviews have, however, evaluated the univariate association of the alliance with client outcome. The present meta-analytic review examines the association of the alliance with improved client outcomes after accounting for the presence of therapist empathy, client attachment styles, and client expectations. Across 23 independent studies, the alliance, adjusted for the presence of the other variables, remained as the most robust predictor of improved outcomes r = .258 (SE = .01, p < .001), with a 95% confidence interval of r = .18 to r = .33. After accounting for therapeutic alliance, therapist empathy was a small but statistically significant predictor of improved outcomes. These findings provide the first attempt at synthesizing multivariate estimates of the contribution of the alliance with improved outcomes when in the presence of empathy, client attachment style, and client expectations. The findings presented here suggest the superordinate nature of the alliance as a variable that exists on a separate conceptual level from the other variables evaluated.

No description available.

The purpose of this study was to document the process of ASL students (n=12: male=1; female=11) using sandtray therapy as educational psychology assessment and intervention technique, with young people (Grade Nine clients, n=65) in a high-risk, highneed rural school. The aim of the study was to inform knowledge on educational psychology intervention in South Africa given the need for knowledge on relevant psyhological techniques in an ecology of resource constraints, adversity and diversity. The Common Factors Model of therapeutic alliance framed the study by taking cognisance of the therapeutic relationship and therapist skills in the use of sandtray therapy with clients in the given context. A single design case study was used with a phenomenological epistemology. Qualitative data sources included observations (captured in field notes), observations (captured visually and audiovisually), as well as ASL students’ written reflections. Thematic data analysis revealed three main themes: the sandtray process and format used in a rural school; the role of the sandtray in therapeutic alliance; and the enabling and restricting roles of the rural school context during the sandtray therapy. The research findings indicated that by making certain adaptations to the standard sandtray therapy process, it could be implemented successfully as educational psychology assessment and intervention technique with clients in a high risk high need rural school. Steps that could be implemented according to the standard process and format of sandtray therapy included introduction of the sandtray and miniatures, the postcreation phase as well as documenting the completed sandtray. Steps that were adapted for implementation within the rural school context included the setup step, the creation of the sandtray as well as the cleanup of the sandtray. These adaptations were necessary as a result of certain barriers and enablers within the context of the rural school. Barriers included multilingualism, lack of privacy and group format constraints. The sandtray itself, selection of miniatures as well as the collectivist nature of clients’ culture were identified as enablers. This study can therefore inform knowledge on Educational Psychology intervention in South Africa. / Dissertation (MEd)--University of Pretoria, 2017. / Educational Psychology / MEd / Unrestricted

Aim: The purpose of this study is to investigate and describe professional occupational therapists' experiences of what characterizes a good therapeutic relationship between the occupational therapist and the client. Method: The study was designed based on an qualitative approach where data is obtained via semi-structured interviews. The selection was made through strategic selection. Results: The following four main categories emerged: Flexible approach, Client-centered approach, Creating a safe relationship and Confident as an occupational therapist. The category Flexible approach reflects the occupational therapist's ability to adapt to person and situation. The category Client-centered approach means seeing the uniqueness of each client and working based on the client. The category Create a safe relationship reflects various aspects needed to create security in the relationship. The category Confident as an occupational therapist means being confident in the professional role of occupational therapist and also making preparations that provide security for the occupational therapist. Conclusion: These results increase the understanding that there are important aspects that form the basis for a good relationship between occupational therapist and client and how it promotes participation. Additional aspects based on the study are the time perspective required to promote a good relationship, but also the confidens of one's own professional role. The experience of occupational therapists shows that there is an awareness of what constitutes the basis for the good therapeutic relationship and its significance. The study also show that the occupational therapist works actively with the therapeutic relationship in their daily work. The relationship is affected by the occupational therapist's ability to be flexible, confident in himself/herself and his/her own professional role, the ability to work client-centered and the ability to make the client feel safe. Without these aspects, it becomes more difficult to create a good relationship and thus more difficult to promote participation. The relationship requires commitment from the occupational therapist, both to build and maintain it. Further research in the subject could be security in one's own professional role and how it affects the creation of relationships with the client. Other research that may be of value is the time perspective needed to establish a therapeutic relationship in relation to the cost-effectiveness of care