The therapeutic alliance including the therapist's intersubjectivity has proven important in psychotherapy. In dance and movement therapy and couple dancing non-verbal interaction is central, though not high-lighted in verbal psychotherapy. This study explores facilitators of interaction of couple dancing and transfer those to the therapeutic alliance. Interviews with couple dancers were analyzed according to qualitative content analysis and interpreted using attachment and intersubjectivity theory. The results indicate that facilitators of interaction are psychological maturity, intersubjective matching and mindful presence; furthermore, that an agreement is needed but affected by the social context. Implementation of such components in verbal therapy may benefit the therapeutic alliance. It could be done by considering the therapists’ attachment pattern and matching the patient´s one non-verbally. The author concludes that psychological development and intersubjective skills should be considered in psychotherapist training, possibly through practice with tape recording and techniques from the creative and meditative domains.

The therapeutic alliance is a core element of successful treatment in therapy. Recent literature has explored variables that predict the alliance at various time points during therapy, but few studies have explored how the alliance develops over time and the factors that influence its rate of change. The current study addresses these questions by estimating latent growth-curve models to analyze how male and female partners' alliance scores develop over time and how adverse childhood experiences (ACEs) impact the development of the alliance during the first six sessions of therapy. Results from these analyses show that neither men nor women's ACEs had a significant effect on the rate of change in the alliance. A discussion of the attachment implications of these findings, as well as the limitations of this study and potential directions for future research are then presented.

The possibility for a positive treatment result increases when clients decide to stay in their treatment programs. For this to happen the client needs to feel respected and treated with dignity. When the therapist and client are able to build a constructive relationship, a therapeutic alliance will almost certainly follow. This takes work. The purpose of this study was to, thorough the eyes of four therapists, examine to what extent the chosen therapeutic method and/or the personality traits of the therapist creates prerequisites for therapeutic success. Are there shared similarities between different methods of therapy, so called ”Common Factors”, that distinguish themselves as central for creating change?Through qualitative interviews with the therapists working with CBT or Solutionwork and Family systems therapy I found many similarities and some differences. By studying modern research on “Common Factors” and comparing it to the interviews I’ve found several interesting results. Traits like empathy and sensitivity are cornerstones in building the coveted alliance. Change is reached through curiosity, exceptions in behavior and thought but maybe most of all compliments and confirmation. Although it is difficult to define which common factors are of greatest importance this study gives some insight to how therapists with different backgrounds, experience and schooling think about their work and what similarities and differences can be identified in their stories.

Adolescent engagement in home-based treatment is a challenge within the social work field. Studies have suggested that the foundation of clinical practice relies on the clinician's ability to understand the process of engaging adolescents in treatment, which may also include a period of adaptability, relatability, and connectedness within the treatment setting. The purpose of this study is to explore the clinical practice approaches, roles, and experiences utilized in home-based treatment to adolescents residing in a large city in northeastern United States. This study was grounded in the ecological systems theory which provides social workers with an opportunity to assess the relationships between an individuals behaviors and the environment. A qualitative research design was used in this study. Social work clinicians participated in focus groups to address the clinical roles, characteristics, and skills essential for reducing barriers related to adolescent engagement in home-based treatment and explore the clinical practice approaches and knowledge base related to adolescent engagement in home-based treatment, including the areas of competence, respect, empathy, and passion. Data were analyzed using audiotapes of the focus groups, the transcription process, coding, and a reliability check. Findings from this study suggest that effective social work practice techniques depend upon the clinician's ability to engage the adolescent throughout the entire treatment process. The outcomes for this action research study included both challenging and rewarding opportunities for clinicians to increase understanding of characteristics, skills, values, and experiences in providing home-based treatment to adolescents of a large city in the northeastern United States.

Opioid abuse costs affect the majority of the adult population in our society directly or indirectly. The current prevailing medical treatment for opioid addiction is methadone maintenance treatment (MMT). MMT reduces infectious disease spread, illicit drug use, criminal activity, and overdose potential. MMT is only as effective as the length of time a client remains active and compliant with the program. In previous studies, therapeutic alliance (TA) has been shown to positively influence the effectiveness of substance abuse treatment. However, a gap exists in research in regards to the impact of TA on the effectiveness of MMT outcomes. The theoretical framework of this study is based on therapeutic alliance, which guided an examination on whether therapeutic alliance (as measured by the Session Rating Scale) influenced MMT retention and compliance (drug screens and session attendance). Archival data from 264 clients receiving MMT for opioid dependence were reviewed from a nonprofit community-based agency in Arizona. Logistic regression results revealed that TA did not significantly affect retention or compliance. However, issues were noted such as how the SRS was administered, a lack of understanding by clients regarding scoring the SRS, and unique social desirability demands when clients are in MMT. The finding that TA alone did not significantly affect retention and compliance does not decrease the need to find effective means to improve MMT outcomes. Rather, the findings suggest a critical need to identify and utilize measures more appropriate for clients receiving MMT. In doing so, positive social change may be achieved by assisting clinical staff in developing a strong therapeutic alliance with MMT clients as they focus on problem solving as a joint venture when challenges in the recovery process arise.

Indiana University-Purdue University Indianapolis (IUPUI) / This study was a subset of a large two-year randomized controlled trial of two employment programs providing services to people with severe mental illness (SMI). Because prior research has found that the strength of the relationship, or working alliance, between service providers and people with SMI is related to a variety of beneficial outcomes, the purpose of the current study was to address the working alliance between participants and their vocational workers and its association with employment outcomes, including the total duration of paid employment over two years and mean paid job tenure after two years. Another primary purpose of the current study was to determine whether working alliance differences exist between a team vocational approach (Diversified Placement Approach) and an individual vocational approach (Individual Placement and Support Model). The final aim of the current study was to investigate the psychometric properties of the ad hoc scale utilized to measure the working alliance. Contrary to expectations, no relationship was found between the working alliance and employment outcomes after two years. As expected, it was found that participants in the individual vocational approach (IPS) had higher working alliance scores across the study than participants in the team vocational program (DPA). Finally, the working alliance measure used in this study was found to have promising psychometric properties, including adequate criterion-related validity and test-retest reliability, although the internal consistency was a bit low. The scale items are a loose fit with existing theory, however, necessitating the addition of items and revision of the current scale and underlying theory to enhance its utility in clinical and research settings.

Consensual Qualitative Research methodology was used to explore how experienced therapists understood and learned from cases of premature termination. Eleven board certified therapists participated in semi-structured interviews concerning a case of a former client who had left treatment prematurely. They offered their reflections on the client’s presentation, the structure of the treatment, successful aspects of the therapy, problems in the treatment, the process of termination, and the impact on their own professional development. Core ideas were identified in each interview, and were cross-referenced to highlight the most common experiences described by the therapists. Premature terminations resulted from multiple, concurrent problems in the treatment including client un-readiness to change, therapist mistakes, and strains in the therapeutic relationship. Therapists experienced a mixture of emotions following the termination including anger, confusion, sadness, and occasional relief. Although therapists initially described premature termination as the result of client issues and psychopathology, upon reflection they acknowledged their own contributions to the premature termination. In the end, therapists remained uncertain about why their former clients left treatment because they lacked their clients’ perspectives. Recommendations for future research and implications for clinical practice are offered.

There is substantial evidence that the strength of the therapeutic alliance in couples therapy is predictive of successful treatment outcome. However, little research has examined the factors that predict a strong therapeutic alliance in couples therapy. With evidence indicating that attachment styles play an important role in the development of healthy adult relationships, it was hypothesized that the attachment styles of partners in couples therapy would predict the development of a strong therapeutic alliance. Data from 115 heterosexual couples seen at a university-based MFT clinic in the southeastern region of the U.S. were used to test this hypothesis. Using multiple regression, results generally found that attachment styles generally predicted the therapeutic alliance among women, but there was only limited support among men. The results of the study suggest the importance of couples therapists being aware of attachment issues, especially among women, as they relate to the establishment of a strong therapeutic alliance.

The client-therapist relationship has long been recognized as an important element in psychotherapy, and research has demonstrated its robust association with positive outcomes. This study examined the feasibility and preliminary efficacy of training therapists in strategies for improving therapeutic relationships with clients. The strategies were compiled from the empirical literature, drawing on the work of Hilsenroth and Cromer (2007), Castonguay (1996), and Safran and Muran (2000). The study employed a manipulated training design that has the benefit of addressing naturalistic effectiveness questions, while adhering to the rigorous scientific standards of controlled efficacy research (Hayes, 2002). Participants were 57 therapists working at five community mental health clinics who were randomly assigned to the brief alliance training workshop (in which they participated prior to starting treatment with a new client) or to a delayed-training control condition. Outcomes assessed included therapists' self-reported use of alliance strategies in session 1, therapist-rated alliance quality after session 1, and early client engagement. Engagement was operationalized in several ways: number of sessions attended in the first four weeks, planned session frequency (e.g., weekly, monthly), attendance rate (i.e., percent of scheduled sessions attended), and treatment status at the end of four weeks (e.g., therapist and client had next session scheduled, client had terminated unilaterally). Counter to hypotheses, one-way ANOVAs and chi-square analyses revealed no statistically significant differences between the training and the delayed-training conditions on the primary outcomes. However, effect size estimates suggested that clinicians in the training condition reported better alliances with their clients than clinicians who had yet to receive the training (d = 0.40, 95% CI [-0.13, 0.93], small to medium effect). Furthermore, therapists' use of alliance strategies taught in the workshop was significantly correlated with alliance quality. In addition to the preliminary efficacy findings, the study generated important information about the feasibility of conducting psychotherapy research in naturalistic settings, as well as recommendations for future studies. The manipulated training design holds promise for collaborations between researchers and clinicians seeking to bridge science and practice.

The therapeutic alliance, a construct representing agreement and collaboration on therapy goals, therapy tasks, and the emotional bond between client(s) and therapist, is a robust predictor of therapy outcomes in individual, couple, and family therapy. One way to track the therapeutic alliance is through ruptures and repairs. Ruptures are breaks, tensions, or tears in the therapeutic alliance. Ruptures and repairs influence the therapeutic alliance and consequently therapeutic outcomes. Currently, there is a lack of research addressing ruptures and repairs in couple therapy. The first step in researching alliance ruptures is to have a reliable way to assess alliance ruptures. This study will describe the development of the Coding Rupture Indicators in Couples Therapy (CRICT). The CRICT is an observational coding scheme that measures ruptures in couple therapy. The CRICT was developed through collaboration with researchers in marriage and family therapy, creation of items, adaptation of items from established coding schemes from individual therapy, and input and feedback as the CRICT was used and tested by undergraduates in a coding class. This paper will review foundational research of ruptures and repairs as well as the construction and use of the CRICT coding scheme.