Psychosocial variables such as attachment style, depression and the working alliance were examined as predictors of treatment outcomes in the context of chronic pain patients receiving physical therapy. Four treatment outcomes were examined: change in pain severity, change in pain interference, patient satisfaction with physical therapy services and patient compliance with treatment recommendations. A model of the interplay between depression and chronic illness presented by Katon (2003) was used as a framework for the current model. Two main hypotheses were suggested. (1) The working alliance is positively related to treatment outcomes. (2) Depression is negatively associated with treatment outcomes. Data were gathered at three outpatient rehabilitation clinics and the physical therapy unit of a multidisciplinary pain clinic in two Midwestern cities. A total of 59 subjects participated and regression analyses found evidence supporting both main hypotheses. The working alliance was found to be positively correlated to the change in pain severity, the change in pain interference, patient satisfaction and patient compliance. Depression was found to be negatively correlated to the change in pain interference, patient satisfaction and patient compliance. Implications for physical therapists working with chronic pain patients include clinical recommendations for developing a good working alliance and screening for depression.

The relationship that develops between a client and therapist is arguably one of the most important factors toward achieving positive outcomes from therapy. Although the therapeutic alliance has been well studied, there is a paucity of research related to the impact of this relationship when the client is an offender, of Aboriginal ancestry, or psychopathic. The present study employed an archival design in which a sample of 427 treated sexual offenders were examined with regard to their experience of therapeutic alliance with their primary therapists. Offenders who were admitted to the Clearwater Sex Offender Program at the Regional Psychiatric Centre Hospital in Saskatoon (RPC Prairies) between 1998 and 2005 completed a measure that rated the strength of their relationship with their primary therapists using the Working Alliance Inventory (WAI) roughly three months after program admission. Approximately 46% of the sample was of Aboriginal ancestry, while the majority of the balance (approximately 52%) was Caucasian. A sub-sample of 111 offenders was also scored on the PCL-R. Analysis of WAI scores among Aboriginal and non-Aboriginal offenders demonstrated a significant difference on the Bond scale of the WAI, suggesting that although the bonds between Aboriginal offenders and their primary therapists were not as strong as they were between non-Aboriginal offenders and therapists, Aboriginal offenders were still able to identify and agree on the goals and the tasks of the treatment (weaker bonds notwithstanding). Aboriginal offenders also spent slightly less time in treatment overall than their non-Aboriginal counterparts. The present research also found that as the scores on the WAI increased, rates of treatment noncompletion decreased, the implications of which would seem to highlight the need to foster and maintain strong therapeutic relationships. In terms of outcome, perhaps unexpectedly, results of the present research found that WAI was not a significant predictor of any recidivism criteria. Aboriginal Ancestry was related to non-sexual violent reconvictions and general reconvictions, but not sexual recidivism. Moreover, offenders who were both Aboriginal and reported low WAI scores were the most likely to recidivate in a non-sexual violent manner and in general, but not sexually. An examination of the relationship of working alliance to psychopathy found that WAI and PCL-R scores were not significantly correlated overall; however, a negative inverse relationship between the Lifestyle and Emotional facets with total WAI score was noted, suggesting that callous-unemotional traits and lifestyle were associated with weaker alliance. Interestingly, these correlations were not evident in the Aboriginal sample suggesting that other factors, aside from levels of psychopathy, were associated with working alliance in this ancestral group. In addition, results of the present analysis revealed WAI and PCL-R together, were better able to predict sexual recidivism for non-Aboriginal offenders than for Aboriginal offenders; however, the WAI and PCL-R jointly predicted nonsexual violent recidivism, but only for non-Aboriginal offenders, and jointly predicted general recidivism for both ancestral groups. Together, the results of this study attempt to further advance our understanding of the therapeutic alliance and its link to treatment outcome, Aboriginal ancestry, and psychopathy.

The research literature has repeatedly emphasized the importance of parent involvement and parent training in the early intervention of young children with autism spectrum disorder (ASD). In fact, parent mediated Early Intensive Behavioral Intervention (EIBI) programs have become a popular method of treatment in recent years. Studies examining these programs have demonstrated that a number of variables may significantly impact the outcomes of EIBI. Moreover, an examination of the psychotherapy literature underscores the importance of a strong parent-therapist alliance as a correlate of positive processes and outcomes in child therapy; while there is very little research examining the working alliance as a factor in parent consultation.The purpose of the present study was to examine the relationship between the working alliance and the consultation process in parent-mediated EIBI for young children with ASD. Forty-four parents of children with an ASD, who were also conducting home-based EIBI programs, completed the Working Alliance Inventory (WAI) (Horvath & Greenberg, 1989) plus other measures that assessed treatment process and outcome. In addition, eight independent consultants completed similar measures to assess perceptions of alliance, process, and outcomes of their consultees.The results showed parent ratings of the working alliance were significantly correlated with parent ratings of treatment acceptability for child treatment as well as for parent consultation. Parent ratings of alliance also correlated significantly with parent ratings of parent progress in consultation and child progress in treatment. Consultant ratings of alliance were significantly correlated with both parent progress and parent improvement in consultation. This suggests that the working alliance may be a contributing factor to the process and outcome of consultation with parents of children with ASD.The results of the present study were compared to the current literature on the therapeutic alliance and relationship factors in consultation. The limitations of the present study and suggestions for future research are also discussed.

No description available.

Supervision of counseling services is a crucial component to professional counselor development (Bernard & Goodyear, 2009). A common and pervasive threat to cross-cultural interpersonal relationships, such as supervision, is the presence of racial microaggressions (Constantine & Sue, 2007). According to Carter (2007) and Helms, Nicholas, and Green (2012), microaggressions are so damaging, that they may even trigger traumatic responses in recipients. The purpose of this study was to examine the relationships among racial microaggressions in supervision, the supervisory working alliance, and traumatic symptomatology in supervisees. This study collected survey data from 86 participants who self-identified as racial, ethnic, or cultural minority group members and who were counselors-in-training, professional counselors, or counselor educators. Data collection included responses to demographic questions, the adapted Experiences of Black Supervisors Scale (EBSS adapted; Barnes, 2011), the Trauma Symptom Check-list 40 (TSC-40; Elliot & Briere, 1992), and the Supervisory Working Alliance Inventory – Trainee Version (SWAI-T; Efstation, Patton, & Kardash, 1990). Bivariate correlations revealed significant relationships among all three of the main variables. The SWAI-T full-scale scores had a moderate negative correlation with the EBSS (adapted) full-scale scores (r = -.637, p < .01) and a moderate negative correlation with the TSC-40 full-scale scores (r = -.372, p < .01). The EBSS (adapted) full-scale scores had a moderate positive correlation with the TSC-40 full-scale scores (r = .513, p < .01). Regression analysis yielded a model whereby 40.6% of the variation in the supervisory alliance can be explained by microaggressions in supervision F (1, 48) = 32.752, p < .01. Hierarchical multiple regression analysis determined that the presence of traumatic experiences does not add to the predictive capacity of the model. The results suggest that the presence of racial microaggressions is an important impediment to the supervisory working alliance. Implications, limitations, and future directions were provided.

This study examined the relationships between attachment style and the levels of self-criticism (comparative and introjective) and forms of dependency (neediness and connectedness) and the working alliance and outcome variables over the course of psychotherapy. Sixty-five adult clients receiving therapy at a mental health clinic completed questionnaires after the first, fifth, and second to last sessions. Strong positive correlations were found between neediness and insecure attachment and negative correlations between neediness and secure attachment. Similar, yet weaker relationships were found between connectedness and attachment. Comparative self-criticism was positively associated with preoccupied and fearful attachment and negatively associated with secure attachment. Similar, yet weaker relationships were found between introjective self-criticism and attachment. Connectedness was associated with a strong working alliance across therapy and comparative self-criticism with a poor working alliance at session five. Although neediness was associated with poor outcome, preoccupied attachment was the best predictor of poor therapeutic outcome. / Counselling Psychology

abstract: This study examined the factor structure of supervisee disclosure in clinical supervision. An original survey measure was created for this study, the Supervisee Disclosure Scale (SDS). Through exploratory factor analysis eight specific content areas of supervisee disclosure were identified. The eight specific content areas of supervisee disclosure include: Perceived Clinical Inadequacy, Transference Issues, Strengths of the Supervisory Relationship, Clinical Successes, Self, Weaknesses of the Supervisory Bond, Dissatisfaction with the Clinical Setting, and Own Clinical Voice. Furthermore, this study examined the potential relationship of clinical experience with the content areas of supervisee disclosure. The results of this study support a relationship between greater clinical experience and disclosure of items related to Self but not with the other content areas. Additionally, the bi-level factor structure of the Working Alliance Inventory/Supervision-Short (WAI-SS) was validated via confirmatory factor analysis. The bi-level factor structure of the WAI-SS identifies a hierarchical structure of general alliance in addition to the specific factors of task, bond, and goal. Lastly, this study preliminarily evaluated the relationship between WAI-SS factors of general alliance, task, bond, and goal and the preliminary specific content areas of supervisee disclosure. The hierarchical factor of general alliance was a statistically significant predictor for all specific content areas of supervisee disclosure. The preliminary findings of this study, highlight the important differences in the relationships among the specific factors of the supervisory working alliance and content areas of supervisee nondisclosure. The factor of task was not significantly correlated with content areas of supervisee disclosure and the factor of goal was only a significant predictor for two content areas of disclosure: Strengths of the Supervisory Relationship and Dissatisfaction with Clinical Setting. The factor of bond was significantly correlated with six content areas of supervisee disclosure and significantly predicted five content areas: Strengths of the Supervisory Relationship, Clinical Successes, Self, Weaknesses of the Supervisory Bond, and Dissatisfaction with the Clinical Setting. This study contributes specificity to the supervision literature on supervisee disclosure and nondisclosure. The results of this study provide a psychometrically sound foundation for future research to identify aspects of the supervisory working alliance that may reduce supervisee nondisclosure. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2018

Doctor of Philosophy / Department of Counseling and Educational Psychology / Stephen L. Benton / This study examined the effects of types of therapist disclosure and their interaction with various combinations of observer, therapist, and client gender-dyads on observer ratings of the working alliance. Participants were 357 undergraduate students (60.2% women) from two Midwestern universities who were randomly assigned to one of 12 conditions. Each condition required students to read one of 12 printed scenarios differentiated by all possible combinations of three types of therapist self-disclosure (similar, dissimilar, no disclosure), two levels of therapist gender, and two levels of client gender. Students rated the scenarios on the perceived working alliance between the therapist and the client, using the 36-item Working Alliance Inventory-Observer (WAI-O). A 2 (student sex) x 2 (therapist sex) x 2 (client sex) x 3 (disclosure type) ANOVA revealed no significant effects on the WAI-O total scale score. In addition, no main effects or interactions were found on WAI-O total scale when male and female student scores were pooled. A 2 x 2 x 2 x 3 MANOVA performed on the WAI-O subscales indicated female observers perceived a stronger client-therapist bond for similar than dissimilar disclosures with male clients. Female observers rated male clients with a stronger bond than female clients, but only in the similar disclosure condition. A main effect was also found for observer sex on the Task and Bond subscales. Although this study did not find gender of the observer, type of therapist disclosure, and the gender of the therapist and their client to influence overall working alliance ratings, results suggest that these factors have an impact on female observer ratings of the bond and task agreement between the therapist and their client. Specifically, two findings emerged: (a) women, not men, observed a stronger bond for male client recipients of similar versus dissimilar disclosure; (b) women, not men observed a stronger bond for male client versus female recipients of a therapist's similar disclosure. Results are discussed in terms of disclosure and gender research.

abstract: While there is an extensive literature on the theoretical and anecdotal basis of humor being a key aspect of psychotherapy, there is relatively little research. In this study, I addressed whether the frequency of therapist humor is related to subsequent therapeutic alliance ratings by the client. I also examined if therapist humor use is related to improvement in client symptomology. I hypothesized that there will be a positive correlation between humor use and the working alliance while there will be a negative correlation between humor use and client symptomology. Video recordings of therapy sessions were coded for humor (defined by laughter present in response to the therapist) or no humor (laughter not present). These ratings were correlated to client perceptions of the working alliance (using the WAI-S) and client symptomology. I found no correlations between humor and changes in working alliance or client symptomology. The results suggest that humor use in counseling does not seem to matter, however possible limitations of the study mitigate such conclusions. / Dissertation/Thesis / Masters Thesis Counseling 2019

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