La toxicomanie a des répercussions importantes tant pour les individus qui en souffrent que pour la société en général (MSSS, 2007). L’efficacité des traitements offerts aux toxicomanes est toutefois affaiblie par la difficulté à maintenir et à engager en traitement cette clientèle (Meier et al., 2006). Dans ce contexte, et puisque la qualité de l’alliance thérapeutique est associée aux résultats et à la persévérance en traitement (Martin et al., 2000; Meier et al., 2005a), l’alliance qui se développe entre le client et le thérapeute en cours de thérapie peut être vue comme une piste de solution prometteuse pour améliorer l’efficacité des traitements de la toxicomanie. La présente étude se propose d’identifier les facteurs associés à l’alliance thérapeutique développée par une clientèle toxicomane en traitement (n = 269). L’étude s’intéresse également à l’influence de doubles problématiques (toxico-justice, toxico-santé mentale) sur les relations existantes entre l’alliance et ces facteurs (effets modérateurs). Les liens entre l’alliance thérapeutique et différentes variables (santé mentale, consommation, satisfaction envers les services, motivation, soutien social, pressions légales) ont été examinés à l’aide d’analyses de régression hiérarchique. Les résultats indiquent que le profil de consommation évalué avant l’entrée en traitement covarie avec l’alliance thérapeutique. Les troubles cognitifs et la satisfaction envers les services sont les deux principales variables évaluées lors de la thérapie de groupe qui sont associées à l’alliance. Des effets modérateurs de la présence de problématiques associées à la toxicomanie (justice, santé mentale) sur la relation entre certaines variables indépendantes et l’alliance ont finalement été observés. / Drug misuse has a major negative impact on individuals and on society as a whole (MSSS, 2007). The efficiency of drug treatments is however weakened by the difficulty retaining and engaging this clientele in treatment (Meier et al., 2006). In this context, and because the quality of the therapeutic alliance is associated with treatment outcome and treatment retention (Martin et al., 2000; Meier et al., 2005a), the alliance which develops between the client and therapist in the course of therapy appeared to be a promising solution to improve the efficiency of the treatments of drug addiction. The present study focus on the factors associated to the therapeutic alliance developed by drug addicts recruited in a drug rehabilitation programme (n = 269). The study is also interested in the influence of problems associated with addiction (justice and mental health) on the existing relations between the alliance and independents variables (moderating effects). The links between the therapeutic alliance and a range of factors (mental health, drug use, satisfaction with services, motivation, social support, legal pressures) are examined. The findings demonstrate that pretreatment drug use covarie with the therapeutic alliance. Cognitive disorders and satisfaction with services are two main variables assess during the group therapy which are associated with the alliance. The moderating effect of problems associated with addiction (justice, mental health) on therapeutic alliance is finally supported.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Cette étude vise à comprendre la place du sentiment d’impuissance de l’intervenant dans l’établissement d’une alliance thérapeutique. La perception des intervenants à l’égard du sentiment d’impuissance et les conséquences possibles qu’ils lui reconnaissent sont analysées. Par les moyens développés par les intervenants pour contrer ce sentiment d’impuissance, des pistes de solutions sont proposées. Par une méthodologie qualitative, vingt-cinq entrevues semi-dirigées ont été réalisées dans le cadre de la recherche «L’identification des interventions qui permettent de bâtir une alliance thérapeutique avec les jeunes contrevenants : un enjeu de première importance» du professeur Louis-Georges Cournoyer de l’École de criminologie de l’Université de Montréal. Elles constituent les données principales de la présente étude. Un groupe de discussion, réalisé en milieu communautaire, a permis de les compléter. Les ruptures d’alliance thérapeutique constituent un contexte favorable au développement du sentiment d’impuissance de l’intervenant, conditionnellement au soutien de l’équipe et à la perception qu’à l’intervenant de son rôle et de son contrôle. Le sentiment d’impuissance peut mener à une remise en question positive. Toutefois, il peut aussi être à l’origine du développement de l’impuissance apprise, qui se traduit par les déficits cognitif, motivationnel et affectif. Parmi les autres conséquences du sentiment d’impuissance, une lutte s’exprime par l’évitement, l’expression de la colère et le contrôle, qui ne sont pas souhaitables en contexte d’intervention. En misant sur le soutien de l’équipe ainsi que sur la perception des intervenants à l’égard de leur rôle et de leur contrôle, il est possible de prévenir et de contrer le sentiment d’impuissance. / This study aims at understanding feelings of powerlessness of the helper and its place in the development of the therapeutic alliance with youths. The workers perceptions about the feeling of powerlessness and the possible consequences it has on their practice are analyzed. A number of solutions are proposed, based on strategies developed by workers. With a qualitative methodology, the twenty-five interviews from the research «Alliance building interventions with youth offenders», conducted by Louis-Georges Cournoyer, professor at the University of Montreal’s School of Criminology, are used. In order to complete this data, a focus group was held with community workers. The therapeutic alliance ruptures, who is mediated by team’s support and worker’s self-perceived role and control, can engender the feeling of powerlesness. This feeling might lead to a positive self-questioning. However, it might also lead to the development of learned helplessness, which manifest itself by cognitive, motivational and affective deficits. Among the other consequences of the feeling of powerlesness, is a struggle that is expressed by withdrawal, anger and control, whom are not suitable in an intervention context. By focusing on the team’s support and on the self-perceived role and control of the worker, it is possible to prevent and counter the feeling of powerlessness.

La littérature scientifique s’intéressant aux adolescents agresseurs sexuels démontre qu’il s’agit d’une population qui apparait souvent résistante au changement (Rich, 2003). Il importe ainsi d’identifier les facteurs qui favorisent ou compromettent le déroulement de l’intervention auprès de cette clientèle. L’alliance thérapeutique et la motivation au changement figurent d’ailleurs parmi ces facteurs ayant démontré leur influence positive. Toutefois, considérant le caractère dynamique de ces dernières, peu d’études ont documenté les particularités de leur développement respectif, spécialement dans un contexte d’autorité tel que celui des adolescents agresseurs sexuels. La présente recherche permet donc de mieux comprendre la contribution de caractéristiques individuelles et environnementales sur le développement de l’alliance thérapeutique et le processus de changement chez cette clientèle juvénile. Basés sur une collecte de données quantitatives auprès de 166 adolescents agresseurs sexuels suivis dans différents centres de traitement spécialisés en délinquance sexuelle au Québec, les résultats obtenus à partir d’analyses corrélationnelles et multivariées illustrent de nombreuses relations significatives entre un ensemble de caractéristiques individuelles et environnementales et le développement de l’alliance thérapeutique et de la motivation au changement. En effet, différents traits de personnalité, les distorsions cognitives, les habiletés sociales, la détresse post-traumatique et les stratégies de coping sont plus ou moins associés à l’établissement d’une relation d’aide et d’une motivation à changer de comportement. De plus, les caractéristiques de l’environnement institutionnel et la perception du soutien social reçu se veulent des facteurs qui influencent généralement de façon positive les variables à l’étude. L’utilisation du Modèle transthéorique du changement permet de nuancer les résultats en ce sens que les facteurs explicatifs de la motivation peuvent différer d’une étape à l’autre dans le cycle du changement. Ainsi, les services offerts aux adolescents ayant commis une agression sexuelle doivent tenir compte du degré de motivation puisque celui-ci semble être associé à des caractéristiques individuelles et environnementales spécifiques. Finalement, il est important de mentionner que les conclusions de cette étude ne permettent pas d’établir des relations causales entre les variables à l’étude. Néanmoins, les résultats indiquent l’importance de porter attention aux facteurs de changement, qui peuvent différer d’une étape à l’autre dans le cycle du changement, et ceux associés au développement de l’alliance thérapeutique. / The scientific literature pertaining to adolescent sexual aggressors indicates that it is a population which often seems to be resistant to change (Rich, 2003). It is important to identify the reasons that promote or compromise the intervention with this clientele. The therapeutic alliance and the motivation to change are among the factors that have demonstrated a positive influence. However, taking into consideration the dynamic nature of the latter, few studies have documented the particularities of their respective development, especially when the adolescent sex offenders are placed in a context of authority. The current study makes it possible to better understand the contribution of individual and environmental traits on the development of a therapeutic alliance and the process of change with this youthful clientele. Based on a quantitative data from 166 adolescent sex offenders tracked in different centers specialized in sexual delinquency in Quebec, the results from correlational and multi-varied analysis show a significant relationship between a set of individuals and environmental characteristics, and the development of the therapeutic alliance and motivation to change. Indeed, different personality traits, cognitive distortions, social skills, post-traumatic stress and coping strategies are more or less linked with the establishment of a helping relationship and motivation to change behaviour. In addition, the characteristics of the institutional environment and the perception of social support received, appear to be factors that generally positively influence the variables under study. The Transtheoretical Model of Change enlightens the results in such a way that the factors explaining the motivation may differ from one step to another in the cycle of change. Thus, the services available to youth who have committed a sexual assault must take into account the degree of motivation, since it seems to be associated with specific individual and environmental characteristics. Finally, it is important to note that the findings of this study do not establish causal relationship between variables in the study. Nonetheless, the results show the importance of awareness of the changing factors, which can differ from one step to the next in the cycle of change and those associated with the development of a therapeutic alliance.

This is a novel attempt to produce a rigorous mathematical model of a complex system. The complex system under study is the relationship between therapists and their clients. The success of psychotherapy depends on the nature of the relationship between a therapist and a client. We use dynamical systems theory to model the dynamics of the emotional interaction between a therapist and client. We determine how the therapeutic endpoint and the dynamics of getting there depend on the parameters of the model. ... We describe the emotional state of both the therapist and client with coupled, first order, nonlinear ordinary differential equations (ODE's). The rate of change of the emotional state of the therapist and client is proportional to their previous state, their uninfluenced state when alone, and an influence function which depends on the state of the other person. We formulated influence functions based on the research literature on psychotherapy and the therapeutic alliance. We then determined the critical points from the intersection of the nullclines and used a numerical ODE solver (Matlab ODE113) to compute the trajectories from different initial conditions. ... The results validate this prototypical approach to psychotherapy ; we have shown that human interaction (in the context of psychotherapy) can be quantified and modeled using differential equations. / by Michael Douglas Norman. / Vita. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.

Made available in DSpace on 2016-03-22T17:26:02Z (GMT). No. of bitstreams: 1 Renata_Muenzer.pdf: 274027 bytes, checksum: 96793540f286000aea6639859fe1c001 (MD5) Previous issue date: 2007-12-18 / Purpose: To verify if therapeutic alliance in the end of the treatment is able to predict the effectiveness of cognitive psychotherapy approach within a six months period after the end of intervention with depressive postpartum mothers. Method: Clinical trial proceeding study with depressive postpartum women. This study included 60 women that were evaluated in the last session with the Beck Depression Inventory (BDI) and the Working Alliance Inventory (WAI). The therapists have also answered to the WAI Inventory. After six months the BDI was re-applied to the clients. Results: The therapeutic alliance when evaluated by the client was not able to predict the treatment effectiveness six months after the therapy (WAI total; p=0,71). On the contrary, when evaluated by the therapist, an elevated alliance was able to predict a worsening on depressive symptoms of the mothers in the period after the treatment (WAI total; p=0,003). Conclusion: The therapist´s perception of an elevated alliance with his client was able to predict a worsening on depressive symptoms of the mothers six months after intervention / Objetivo: Verificar se aliança terapêutica ao final do tratamento é capaz de predizer a efetividade da psicoterapia de fundamentação cognitivista após seis meses do término da intervenção em mulheres deprimidas no pós-parto. Método: Estudo de seguimento de ensaio clínico em mulheres deprimidas no pós-parto. No ensaio foram incluídas 60 mulheres que foram avaliadas na última sessão psicoterápica pelo Beck Depression Inventory (BDI) e Working Alliance Inventory (WAI). Os terapeutas também responderam ao WAI neste momento. Após seis meses o BDI foi re-aplicado às clientes. Resultados: A aliança terapêutica quando avaliada pelo cliente não foi preditora da efetividade do tratamento após seis meses pós-psicoterapia (WAI total; p=0,71). Quando avaliada pelo terapeuta, a aliança alta foi preditora de uma piora dos sintomas depressivos das mães no período pós-tratamento (WAI total; p=0,003). Conclusão: A percepção do terapeuta de uma elevada aliança com seu cliente foi capaz de predizer uma piora da sintomatologia depressiva das mães após seis meses da intervenção

Made available in DSpace on 2016-03-22T17:27:40Z (GMT). No. of bitstreams: 1 D Pedro.pdf: 353549 bytes, checksum: d62e86c5cd24483c00b64813784ea218 (MD5) Previous issue date: 2006-09-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / OBJECTIVE: In this study, we evaluated the impact of defense style on outcome and its relation to the therapeutic alliance. METHOD: Women with postpartum depression were allocated to a brief psychotherapeutic intervention. To evaluate defense style and the alliance, the Defense Style Questionnaire and the Working Alliance Inventory were employed. The main outcome was the final score on the Edinburgh Postnatal Depression Scale (EPDS); anxiety and retention in treatment were also evaluated RESULTS: 59 patients were included; forty-six completed the therapy and 65.4% responded (EPDS<10). Intense use of immature defenses was related to the maintenance of depression and anxiety at endpoint, even when controlled for parity and social class. Results tended to confirm a hierarchy of defense styles. There were no significant correlations with the alliance measures at any sessions. CONCLUSIONS: Intense use of immature defenses was a factor of poor prognosis in psychotherapy, independently of the alliance, which strengthens their status as important variables for treatment selection / Avaliar o impacto dos estilos defensivos no desfecho da psicoterapia breve da depressão pós-parto e a relação dos mesmos com a aliança terapêutica. MÉTODO: Ensaio clínico randomizado, comparando a eficácia de duas intervenções breves para depressão pós-parto. Investigaram-se os mecanismos de defesa e aliança terapêutica mediante o Defense Style Questionnaire e o Working Alliance Inventory. O desfecho principal foi o escore na Edinburgh Postnatal Depression Scale (EPDS) ao final de 7 sessões. Também foram avaliados sintomas ansiosos e permanência em tratamento. RESULTADOS: Foram incluídas 59 pacientes; 46 completaram todas as sessões e 65,4% responderam ao tratamento (EPDS<10). Não houve correlação entre os estilos defensivos e os domínios da aliança em qualquer sessão. O uso intenso de defesas imaturas esteve relacionado à manutenção de sintomas depressivos e ansiosos ao final do tratamento, mesmo quando controlados para paridade e classe social. Os resultados tenderam a confirmar uma hierarquia que vai de um estilo imaturo a um estilo maduro. CONCLUSÕES: Uso intenso de defesas imaturas indicou mau prognóstico em psicoterapia breve, independentemente da aliança terapêutica, reforçando a possibilidade que sejam variáveis importantes para seleção sistemática para tratamento

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

This study investigated temporal patterns of therapeutic alliance development across treatment and their relationship to outcome, and the relationship between client attachment styles and interpersonal problems and alliance strength and patterns across treatment. Sixty-six clients diagnosed with major depression participated in one of two 16-week treatment conditions: Process-experiential therapy and Cognitive-behavioural therapy. Results revealed two alliance “shape” patterns; Stable Linear and Steep Linear-Quadratic, as well as two alliance “shape and level” patterns; High Strength Linear-Quadratic and Low-to-Mid Strength Stable. Results indicated that the two alliance “shape” patterns did not differentially predict treatment outcome. With respect to “shape and level” patterns, results revealed that clients with a High Strength Linear-Quadratic alliance pattern had better treatment outcomes than clients with a Low-to-Mid Strength Stable alliance pattern. In terms of client attachment style, results indicated that clients with a Steep Linear-Quadratic “shape” pattern report more discomfort with closeness at pre-treatment. Further, clients with a High-Strength Linear-Quadratic “shape and level” pattern report more confidence and less need for approval at pre-treatment. With respect to client interpersonal problems, results revealed that clients with a Steep Linear- Quadratic “shape” pattern report being more cold and distant at pre-treatment and clients with a Low-Mid Strength Stable “shape and level” pattern report being more socially inhibited, less assertive, and more overly-accommodating at pre-treatment. Lastly, results revealed that specific client attachment characteristics and interpersonal problems differentially predict total average alliance strength as well as the average strength of the client and therapist bond across treatment.

This study investigated temporal patterns of therapeutic alliance development across treatment and their relationship to outcome, and the relationship between client attachment styles and interpersonal problems and alliance strength and patterns across treatment. Sixty-six clients diagnosed with major depression participated in one of two 16-week treatment conditions: Process-experiential therapy and Cognitive-behavioural therapy. Results revealed two alliance “shape” patterns; Stable Linear and Steep Linear-Quadratic, as well as two alliance “shape and level” patterns; High Strength Linear-Quadratic and Low-to-Mid Strength Stable. Results indicated that the two alliance “shape” patterns did not differentially predict treatment outcome. With respect to “shape and level” patterns, results revealed that clients with a High Strength Linear-Quadratic alliance pattern had better treatment outcomes than clients with a Low-to-Mid Strength Stable alliance pattern. In terms of client attachment style, results indicated that clients with a Steep Linear-Quadratic “shape” pattern report more discomfort with closeness at pre-treatment. Further, clients with a High-Strength Linear-Quadratic “shape and level” pattern report more confidence and less need for approval at pre-treatment. With respect to client interpersonal problems, results revealed that clients with a Steep Linear- Quadratic “shape” pattern report being more cold and distant at pre-treatment and clients with a Low-Mid Strength Stable “shape and level” pattern report being more socially inhibited, less assertive, and more overly-accommodating at pre-treatment. Lastly, results revealed that specific client attachment characteristics and interpersonal problems differentially predict total average alliance strength as well as the average strength of the client and therapist bond across treatment.