The current study investigated the relationship between clients' object relations functioning and the working alliance. The Social Cognition and Object Relations Scale (SCORS; Westen, 1991), an object relations scoring system for the TAT, was used to assess object relations functioning. Forty-eight therapy clients at a university-based training clinic were administered the TAT, Adult Attachment Scale (AAS), Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1977), and the short form of the Marlowe-Crowne Social Desirability Scale (MCSD; Crowne & Marlowe, 1960). Following the initial assessment of client characteristics shortly after intake, clients and their therapists rated the working alliance 3 sessions later. Results indicated that the SCORS was significantly correlated with client and therapist ratings of the working alliance. The current study also assessed the predictive validity of the SCORS by examining how its various scales are related to aspects of the working alliance and the other measures used in this study. The findings suggest that the relationship between object relations functioning, the working alliance, symptom severity, and attachment disturbance depends on the aspect of object relations that is being assessed.

This study explored participants' experiences of being interviewed with the Adult Attachment Interview as a means of supporting counselor self-awareness and fostering effective counselor-client working alliances. A sample of first-year counselor education doctoral students (n = 7) completed an AAI interview and feedback session. Participants completed five reflective journals over three weeks and explored their experiences in individual, semi-structured interviews. Data were analyzed according to interpretative phenomenological analysis protocol. Four superordinate themes emerged from the analysis: (a) reactions to the AAI interview process, (b) process with AAI feedback, (c) AAI and intrapersonal process, and (d) AAI and interpersonal process. Additionally, there were eight subordinate themes: (a) surprised by AAI interview process, (b) interview process sparked reflection, (c) initial reaction to AAI feedback, (d) evolving process of integrating AAI feedback, (e) AAI process increased awareness, (f) increased self-awareness increased self-efficacy, (g) awareness from AAI process prompted relational shifts, (h) impact of AAI on clinical work, (i) importance of relationships, (j) importance of self-awareness, and (k) mutual influence of personal and professional. Findings in this study suggest that the AAI is an effective tool in supporting counselor self-awareness regarding attachment strategies. Additionally, findings suggest multiple personal and professional benefits, such as increased awareness of conflict and stress management strategies. Limitations to the study and further discussion of the results are presented. Implications for clinical practice, counselor education, and future research are also included.

Appalachian clients are often ‘invisible’ within the majority culture and possess characteristics unique to the region that must be considered within the counseling relationship (Tang & Russ, 2007). Individuals in Appalachia have higher incidences of certain mental health disorders and substance use as compared to the national average (Appalachian Regional Commission [ARC], 2008). Although the need for mental health services is evident, limited research exists to inform mental health professionals how to deliver culturally competent interventions to build a working alliance with Appalachian clients. The authors will discuss a framework for mental health professionals to develop a strong working alliance through a review of the cultural distinctions of Appalachian individuals, culturally appropriate counseling interventions, and a case illustration.

No description available.

<div><div><div><p>Objectives: Previous research suggests an association between working alliance, the collaborative and affective bond between patient and therapist, and improved therapeutic treatment outcomes within treatment of severe mental illness (SMI). However, little is known about the mechanisms through which working alliance improves outcomes in this population. Through investigating key elements of recovery within SMI, two possible mediators—patient activation and hope—appear particularly relevant to the relationship between working alliance and improved treatment outcomes. The current study aimed to examine patient activation and hope as potential mediators in the relationship between working alliance and improved depression in individuals with SMI. Additionally, the current study investigated whether or not the patient’s evaluation of which provider is most important to their recovery significantly moderated the relationship between working alliance and patient activation/hope.</p><p>Methods: The current study was a secondary analysis of longitudinal (baseline, 6-month, and 12-month) data comparing two interventions aimed at reducing treatment provider burnout in community mental health settings primarily serving individuals with SMI. Participants (maximum N for analyses = 346) completed measures of working alliance with a linked provider on their treatment team, patient activation, hope, and depression at baseline, 6 months, and 12 months. Using moderated mediation analysis, 6-month patient activation and 6-month hope were examined as mediators in the relationship between baseline working alliance and 12-month improved depression (change score between 12-month and baseline depression). Additionally, whether or not the patient deemed their linked provider as most important to their recovery was tested as a moderator in the relationship between baseline working alliance and 6-month patient activation/hope.</p><p>Results: Overall, the current study’s hypothesized model was not supported. Baseline working alliance did not significantly predict improved depression 12 months later. Further, both patient activation and hope measured at month 6 in the study did not significantly mediate the relationship between working alliance quality at baseline and improved depression at month 12. Additionally, whether or not the patient believed their linked provider was most important to their recovery did not significantly moderate the relationship between baseline working alliance and 6-month patient activation or 6-month hope. However, results indicate that better quality working alliance at baseline did significantly predict higher patient activation at 6 months. Lastly, the current study found a significant positive correlation between importance of provider and baseline working alliance.</p></div></div></div><div><div><div><p>Discussion: Results suggest that improvement in depression may not be a key SMI treatment outcome that relates to working alliance, patient activation, and hope. Further, fostering a positive working alliance (e.g., collaboratively developing goals/tasks in-session) may increase patient’s ability, willingness, and confidence in managing their own mental health care. Additionally, a positive working alliance may also contribute to how important the patient believes the provider is to their recovery. However, those that have seen their provider for longer (e.g., more chronically ill) may be less active in managing their own mental health care. Limitations and possible future directions are discussed.</p></div></div></div>

No description available.

This study aimed to explore supervisee and supervisor experiences of relational depth (RD) within the supervisory relationship and its association with supervisee level of counselor self-efficacy (CSE). Participants in the study were master's level counseling students and their doctoral supervisors in a practicum course. A total of 52 supervisees (aged 22-57; 19.2% male, 80.8% female) and 18 supervisors (aged 25-46; 16.7% male, 83.3% female) participated in the study. Results demonstrated that supervisee perception of the relationship explained approximately 15% of the variance in supervisee CSE. Specifically, supervisee perception of supervisory working alliance (SWA; β = .406, rs2=.997, p = .025) was found to be a significant predictor of CSE while supervisee RD was not a significant unique predictor (β = -.033, rs2=.370, p = .850), with most of the variance explained by RD being shared with SWA. Results also demonstrated that the supervisor perception of the relationship did not significantly explain variance in supervisee CSE. From these results, one may tentatively conclude that the supervisory relationship contributes to CSE, and that RD, as it is currently being measured, may not able to account for variance above or beyond that of the SWA. Extended results are described and summarized using text, tables, and figures. The study has practical and research implications for counselor educators, supervisors, and researchers in the RD field.

Background: Mental health issues and harmful substance use are problems that affect many Canadian youth. Wilderness therapy (WT) is a residential adventure-based therapy modality shown to have some success in treating these issues. Further research is needed regarding the ways that participants change, and if there are certain individuals that benefit more from this treatment than others. Purpose: The purpose of this study is to explore the changes in presenting problems and trait emotional intelligence of participants at one WT organization in Ontario, Canada. The working alliance - shown to have a positive impact on therapeutic treatment - along with sex and age, were examined to determine if these elements moderate outcomes. Methodology: Two separate samples were created from archival data provided by the participating organization. The first sample includes pre and post Youth Outcome Questionnaires (N=30, 14 to 18 year olds). The second sample includes pre and post Trait-Emotional Intelligence Questionnaires (N=68 youth, 16 to 20 year olds). All participants in both groups completed one Working Alliance Inventory post-WT. Descriptive statistics were calculated, paired t-tests were run, and Pearson correlation matrices and visualizations were created. Findings/Conclusions: Findings indicate that older male individuals report greater reductions in presenting problems as a result of their participation in WT. Trait emotional intelligence did not seem to change, and the working alliance did not seem to moderate any of these outcomes. / Graduate

This narrative inquiry study collected stories from parents and teachers to build a deep understanding of the lived experiences of raising or teaching children affected by traumatic grief. Research shows that children who experience adversity or loss as trauma, including childhood traumatic grief, may experience long- term disruptions to executive functions and present learning, behavioural and social challenges within school settings. Current research indicates that the adoption of trauma-informed care practices within schools can successfully support students who have experienced trauma and/or childhood traumatic grief. In particular, the development of strong family-school collaboration, understood recently as a form of working alliance, is key in effectively supporting students experiencing mental health issues, including childhood traumatic grief. Using a narrative inquiry approach, this study shares the stories of three women, a mother, a teacher by profession, and a mother who is a teacher by profession, to develop deep understanding of what is being experienced in supporting children affected by childhood traumatic stress and grief. The findings from this study affirmed the need for increased understanding and awareness of the ways that trauma can impact the education of children affected by trauma. The findings also confirmed that insecure attachments can be mitigated with consistent and attuned care. To do this effectively as educators, there is need for increased resources and supports within the schools. This study confirmed the need for increased collaboration to develop strong relationships between students, parents and teachers. The need for collaboration is essential for the successful support of students struggling with the affects of trauma and these findings affirm current conversations on the importance of trauma-informed approaches, relational schools and working alliances.

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.