Thesis (Psy. D.)--Wheaton College, 2005. / Abstract. Includes bibliographical references (leaves 66-70).

Thesis (Ph. D. in Psychology)--Vanderbilt University, Aug. 2006. / Title from title screen. Includes bibliographical references.

Thesis (Ph.D.)--Ohio University, August, 2009. / Title from PDF t.p. Includes bibliographical references.

Thesis (M.S.)--University of Massachusetts Amherst, 2008. / Includes bibliographical references (p. 36-40).

Background. Recent research into attachment theory has suggested it provides a useful framework for understanding the psychological therapeutic process. Clinical application of attachment theory has been a recent development in adult mental health research. Previous studies have focused on patient attachment styles and a systematic review of the literature highlights the limited research that explores both patient and clinician attachment patterns. The reported study aims to explore both patient and therapist attachment and the dyadic interaction on the therapeutic process, and, in particular, how attachment influences the early engagement and development of the therapeutic alliance. Methods. Patient participants and clinician participants completed a self-report measure of attachment prior to commencing a psychological intervention. Early engagement was measured through appointment attendance and independent therapeutic alliance ratings from patients and clinicians were completed after the third appointment. Correlations and regression analysis explored the extent to which patient and clinician attachment predicts early engagement and the therapeutic alliance. Results. Fifty-five patients and 38 clinician’s self-report attachment styles indicate greater security amongst clinicians. Patients presenting to mental health services reported higher levels of anxious and avoidant attachment patterns, which were predictive of greater psychological distress. Patient avoidant attachment was associated with poor engagement and both patient anxiety and avoidance attachment were predictive of therapeutic alliance. No relationship was found between therapist attachment and early engagement or therapeutic alliance, and there were no significant interactions between patient and therapist attachments patterns. Conclusions. Findings from the current study suggest that patient attachment style is predictive of reported psychological distress, early engagement and therapeutic alliance. Applying the principles of attachment theory to clinical practice could therefore provide greater insight into the interpersonal dynamics between patient and therapist and help inform services as to how to improve engagement and alliance with insecure patients. The strengths and weaknesses of the study are discussed, which highlights the need for further research with larger samples to build on the current limited findings.

The underlying assumptions of Western counselling and psychotherapy are based on Western European values such as individualism and autonomy. How applicable then are the goals and practices of Western counselling and psychotherapy when applied to non-Western cultures? This research study interviews eight Western-trained Chinese counsellors/psychotherapists who have experience with counselling both Western European clients and Chinese clients. It was found that the establishment of rapport using traditional Western counselling theories has varying amounts of success depending on (a.) the familiarity of the client to Western values, (b.) the familiarity of the counsellor/psychotherapist with Chinese values, (c.) the awareness to not apply knowledge of a client's culture in a stereotypical way, and (d.) the willingness of the counsellor/psychotherapist to be open, flexible, and patient in negotiating a process that fits comfortably with BOTH the particular counsellor/psychotherapist's cultural bias and the particular client's cultural bias. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

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The therapeutic alliance is largely recognized as an important component of the therapeutic process. For clients of all ages, the therapeutic alliance has been associated with positive outcomes and increased engagement in therapy (Bachelor, 2013; Bhola, & Kapur, 2013; Liber et al., 2010). However, very few studies have explored the complex process of fostering the therapeutic alliance with adolescent clients, while also maintaining a positive therapeutic relationship with the adolescent’s caregivers. The present study attempted to fill the gap in the literature through qualitatively exploring therapists’ perspectives of the therapeutic alliance with adolescents and their caregivers. In order to discover the essence of therapists’ experiences of the therapeutic alliance with adolescents and their caregivers, a phenomenological research design was employed. Nine therapists were interviewed about their experiences of the therapeutic alliance with adolescents and their caregivers. The interviews were transcribed and analyzed, and various themes and subthemes were revealed. The themes were divided into three sections: (1) conceptualizing the therapeutic alliance, (2) therapeutic alliance with adolescents, and (3) therapeutic alliance with caregivers. Two themes emerged within the ‘conceptualizing the therapeutic alliance’ section: (1) trust, and (2) foundation of therapy. Two themes and various subthemes emerged within the ‘therapeutic alliance with adolescents’ section. The first theme describes the obstacles that therapists face when attempting to build the alliance with adolescent clients, and contained three subthemes: (1) viewed as an authority figure, (2) resistance to therapy, and (3) differences in SES. The second theme describes the strategies that therapists use to develop the therapeutic alliance and contains three subthemes: (1) discuss interests, (2) honor their voice, and (3) describe limits of confidentiality. Two themes were unveiled within the ‘therapeutic alliance with caregivers’ section: (1) obstacles, and (2) strategies. The ‘obstacles’ theme describes barriers that therapists face when constructing the alliance with caregivers of adolescent clients, and contains two subthemes: (1) fear of triangulation, and (2) caregivers’ expectations. The ‘strategies’ theme contains four subthemes: (1) empathy, (2) give caregivers an active role, (3) collaborative approach, and (4) establish clear boundaries. Clinical implications, recommendations for future research, and limitations of the study are discussed.

This qualitative study aimed to identify how personnel working in a residential home in Sweden work withCognitive Behavioral Therapy (CBT) orientation within the organization. Semi-structured interviews were conducted with five personnel. The research questions were; How do the personnel describe the CBT orientation? How do the personnel describe the CBT tools and methods? How do the personnel describe and measure the implementation of CBT? The results were analyzed an Interpretive Phenomenological Analysis (IPA) tool in order to gain a greater understanding of the data. The theories used to analyze the results were the learning theory, attachment theory and New Public Management (NPM). The results of this study indicate that CBT was incorporated in the daily lives of the residents throughout the course of the day and the personnel described common methods such as Aggression Replacement Therapy (ART), Dialectal Behavioral Therapy (DBT), and Motivational Interviewing (MI).