Teacher-student relationships can influence the academic, social, and behavioral adjustment of children and youth. Students with emotional/behavioral disorders (EBD) experience poor quality relationships with teachers. The current study explores the importance of working alliance (i.e., agreement on tasks and goals, bond) among teachers and their students. Seventy-six teacher-student dyads completed measures of classroom working alliance, perceptions of the student-teacher relationship, student engagement, and student behavior (i.e., externalizing and internalizing behavior). Findings indicated that (a) students and teachers have weak agreement about the quality of their alliance, (b) working alliance was associated with student engagement, and (c) students’ externalizing symptomology predicted teacher ratings of alliance. Interpretation of these findings, study limitations, and suggestions for future research and practice are discussed.

Key Aim: The purpose of this study was to examine complex concerns and challenges encountered by counselling and psychotherapy trainers, and support them to deliver a consistent, relationship-centred learning approach within Higher Education (HE). Background: Counselling and psychotherapy training is central to regulating practice, however, studies conceptualising trainers’ concerns and challenges in the United Kingdom (UK) are sparse. Literature generally evaluates trainer challenges from a professional competence and/or gatekeeping perspective. Little evidence exists identifying problems connected with ‘professionalisation’. Aims and Objectives: The aim was to evaluate trainers’ multidimensional unease that can hinder working relationships. The intention was to: explore difficult patterns of behaviour and group dynamics in the ‘training alliance’; explore trainers’ perceptions and experiences when confronted with gatekeeping issues; collaboratively develop strategies to enhance trainers’ learning experience; examine the processes needed to sustain these strategies; and identify the lessons learnt to inform practice, education, and research. Approach and Methods: A qualitative, co-operative inquiry approach enabled trainers to question their situated and propositional knowledge, reconcile professional challenges, allay concerns about individual fitness to practice, and provide alternative responses to students, peers, and managerial hierarchies in HE and professional bodies. This approach has a political and social element, according with personal desire to make change. Thematic analysis uncovered new insights, expanded or modified principles and re-examine accepted interpretations during 8 inquiry sessions with 5 experienced trainers, and 3 associated workshops. A primarily iterative and inductive process of immersion, involved reflexive engagement, and sharing of data with trainer/practitioners. Findings: 6 overarching themes were identified: Trying to Make Sense of Significant Events; Negotiating Conflict and Incongruity in Training Groups; Navigating Inherent Challenges within Counsellor Training Teams; Teaching as a Never-Ending Challenge; Organisational Constraints and Challenges; and Contemplating Individual Connection in a Collaborative Context. Discussion and Conclusion: Findings supported previous research suggesting trainers require training, and that trainers’ concerns and challenges are interlinked; beginning with interpersonal challenges that subsequently impact on trainers’ professional and intra-personal sense of identity. Co-operative inquiry can benefit programme teams in terms of the co-construction of trainers’ realities and dynamic negotiation of meaning. Co-researchers’ knowledge and confidence in responding to potential conflict in training was enhanced. To achieve the best outcome, this knowledge needs implementing in practice; programme team involvement is a prerequisite, and support is required by professional bodies and HE to ensure ethical training practice in the face of student disgruntlement, management demands in HE and from professional accrediting bodies.

Two groups of therapist characteristics were explored as predictors of working alliance (WA) with African American women substance abusers (n = 102). This study tested the hypotheses that Population Sensitive Therapist Characteristics (PSTCs; i.e. multicultural competence [MC], egalitarianism [EG], and empowerment [EM]) would explain an additional and significant amount of the variance in WA beyond that explained by general therapist characteristics (GTCs; i.e. empathy, regard, and genuineness); and that GTCs partially mediate the effect of each individual PSTC on WA. Hierarchical multiple regression revealed that PSTCs explained an additional 12% of the variance in WA, after controlling for GTCs. Bootstrapping analyses demonstrated that GTCs fully mediated the effect of MC and EM on WA, and partially mediated the effect of EG on WA. Together, these findings suggest therapists can facilitate a stronger WA with the target population through demonstration of PSTCs and that these characteristics are facilitative in whole or in part, because they increase the likelihood the therapist is perceived as demonstrating GTCs (i.e. empathy, regard, and genuineness).

Social anxiety disorder (SAD) is the 3rd most common psychiatric diagnosis, and is associated with significant social, occupational, health, and educational impairment. Fortunately, both pharmacological and psychological treatments can reduce symptoms. Cognitive behavioral therapy is considered the gold standard treatment for SAD, and a robust literature supports its effectiveness. In contrast, process related factors, including the role of the working alliance, have received less attention in treatment of SAD. The current study examined development of the working alliance for a SAD sample. The working alliance is characterized as the collaborative relationship between a client and therapist, and includes shared goals, strategies, and an attachment bond. Within the context of SAD, the working alliance is particularly interesting, as the alliance itself is a social relationship that may elicit anxiety, which, in turn, may impact development of the alliance. The present study also investigated whether treatment type, that is, exposure group therapy (EGT) versus virtual reality exposure (VRE) therapy, or pre-treatment symptom severity influenced the working alliance trajectory. Data were provided by an adult sample presenting with a primary diagnosis of SAD. Participants were randomly assigned to one of two treatment conditions, both involved use of a manualized CBT treatment approach. Standardized measures of social anxiety were administered pre-treatment whereas working alliance ratings were obtained after each session. Results indicated high levels of working alliance and significant change in ratings over time. Treatment condition did not contribute to significant differences in the working alliance trajectory. Regarding the impact of SAD symptoms, initially high ratings of fear was associated with progressively increasing rates of growth in the working alliance whereas high initial ratings of avoidance signified steeper increase in the working alliance earlier in treatment followed by a declining rate of change over time. The current study contributes to the limited literature regarding the working alliance trajectory for clients with SAD, and is the first to consider the impact of VRE treatment on this trajectory. Findings also provide preliminary evidence for the differential impact of initial fear and avoidance as well as a potential curvature for the working alliance trajectory when using CBT.

The interest of mindfulness has grown steadily during the last two decades. Mindfulness presence in the area of social work is mostly as an intervention offered to clients. However, the purpose of this study is to examine what implications the social worker’s mindfulness may have for the relationship with the clients. There is a lack of scientific studies focusing on mindfulness and the relationship between the client and the social worker. To fill this void we turned to psychology and psychotherapy research. The method used was a narrative review. The results were analyzed using a theoretical framework consisting of a theory viewing social work as reflexive-therapeutic and theories about the working alliance. The research about mindfulness effects on the relationships is still very new and contains a wide variety of definitions, operationalizations and study designs. The results show that mindfulness may enhance the social worker’s ability to create and establish a strong and constructive relationship with the clients. For example it seems like mindfulness cultivates the social worker’s ability to be less judging as well as more accepting, present, attentive and empathetic.

Thesis (M.A.)--Miami University, Dept. of Psychology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 42-51).

Abstract Extensive research has been conducted out on the construct of therapeutic alliance. With the growing emphasis on evidence-based practice in psychology it is vital that measures used in both clinical and research settings are empirically well-suited for the population under investigation. However, many measurement issues related to the reliability and validity of the alliance construct remain unaddressed or unresolved. Two studies were designed to add to the scientific evidence on the therapeutic alliance by establishing empirical evidence of the psychometric properties of this construct’s most commonly used measures, with the intention of identifying the most psychometrically sound alliance measures. This was first done by systematically reviewing the literature to identify studies that used the most commonly used alliance measures. Next, key psychometric properties of each measure (internal reliability and predictive validity) were reviewed to determine if the alliance was assessed in the context of individual adult psychotherapy. In the first study, I conducted a reliability generalization analysis to (a) estimate the average reliability coefficient of each alliance measure identified in the systematic review and (b) examine the potential influence that study characteristics may have had on the reliability estimates. Six different alliance measures were included (Agnew Relationship Measure, California Psychotherapy Alliance Scales, Counselor Rating Form, Penn Alliance Scales, Therapeutic Bond Scale, Working Alliance Inventory), in various formats and rater versions, resulting in a total of 17 alliance measure variants for this first analysis. In the second study, I conducted a validity generalization analysis using only those studies from the first study that were identified as containing outcome data. The purpose of this study was to synthesize the alliance-outcome effect sizes that have been reported for the most commonly used therapeutic alliance measures and to assess the potential impact study characteristics may have on those effect sizes. Five different alliance measures (California Psychotherapy Alliance Scales, Counselor Rating Form, Penn Alliance Scales, Therapeutic Bond Scale, Working Alliance Inventory, Vanderbilt Therapeutic Alliance Scale) in various formats and rater versions, resulting in a total of 15 alliance measure variants were included in this analysis. This second study was different from previous alliance-outcome meta-analyses as I only included studies that (a) could be identified as providing psychotherapy, as opposed to other mental health services, (b) assessed the alliance from individual adult psychotherapy, (c) were identified as using the most commonly used alliance measures, and (d) measured the alliance at the midpoint of treatment, or earlier. This second study also differed from previous meta-analyses as I conducted separate analyses for correlational data and partial correlational data. The reliability generalization study found that majority of the alliance measures were good choices for assessing the alliance based on their mean reliability coefficients. The validity generalization study found relatively no difference in the early alliance’s ability to predict treatment outcomes in individual adult psychotherapy between full correlation data (r = .24) and partial correlation data (r = .23). There was also no difference found among the different alliance measures, or their variants, in their ability to predict treatment outcomes, suggesting that no one alliance measure is statistically better at predicting outcomes. The results from both studies suggest that, based on their overall level of reliability as well as their ability to predict treatment outcomes, both researcher and clinicians should consider these measures, with few exceptions, as comparably good choices for assessing the alliance in adult individual psychotherapy.

Kronisk smärta utgör ett folkhälsoproblem, där psykologiska faktorer är betydelsefulla. Psykologiska behandlingar har god effekt, och det finns ett växande intresse för den terapeutiska alliansen i smärtbehandling. Syftet med denna studie var att undersöka relationen mellan patientkaraktäristiska, allians och utfall, i två behandlingar för smärta; KBT och exponering. Ljudinspelningar av behandlingssessioner har skattats avseende allians med instrumentet Working Alliance Inventory. Ångest före behandling hade ett positivt samband med alliansen i båda behandlingarna. Det fanns inga statistiskt signifikanta samband mellan allians och utfall. Regressionsanalyser visade att ångest, behandlingens trovärdighet, depression och katatstroftankar predicerade utfall. Detta visar att specifika patientkaraktäristika har särskild betydelse för behandlingsutfall och att alliansen är mindre betydelsefull, möjligen på grund av att alla observerade allianser var "good enough".

Despite evidence supporting a robust relation between common factors- aspects of the therapeutic setting that are common across all types of treatment- and treatment response, little is known about the mechanisms by which these common factors effect change. Two of the most well-researched common factors include the client’s expectations about the effectiveness of treatment (termed outcome expectancy), and the quality of the therapeutic relationship (termed working alliance). Using archival data, the present study tests the hypothesis that the relation between outcome expectancy and symptom reduction is mediated by the alliance following treatment for social anxiety disorder. Data were collected in a sample of 65 individuals who received cognitive behavioral therapy for social phobia with public speaking fears. Mediation analyses were conducted using Andrew Hayes’ Process Macro (Hayes, 2013). None of the mediation analyses were significant. These findings suggest that the mechanisms of common factor variables may vary by disorder.

There has been relatively little robust research investigating the experience of family therapy from a client’s perspective. Much of the literature fails to make clear their methods for analysing the data, and takes an ‘either or’ approach to family and individual perspectives. Thus, either whole family perspectives, or the perspectives of a particular group are sought, making it difficult to understand the impact of the family context on individual perspectives or vice versa. The present research seeks to understand the family therapy experiences of individuals within their familial context. Two families of three were interviewed using a semi-structured interview guide and interviews were analysed using Interpretative Phenomenological Analysis. Results are presented as two family case studies. One over-arching theme of ‘the safety of the therapeutic relationship’ emerged from the accounts of both families. The therapeutic relationship provided the safety to talk and explore problems and relationships. This was described as cathartic and helped family members to see themselves and each other differently. Varying degrees of exploration of individuals was associated with differing levels of engagement with therapy. Being able to explore relationships for both families allowed them to develop new understandings of each other. Gender also emerged as an important theme and this is discussed in relation to issues of power and gender. Some key methodological limitations of the research including the small number of participants and the impact of an overly detailed interview schedule on the data are discussed. As this study involves two case studies of three family members each, it is not easily transferable, but points to some key themes and processes which have implications for practice and future research.