Objective
Patient–oncologist therapeutic alliance is a foundation of quality cancer care, although there is limited research demonstrating its relationship with patient outcomes. We investigated the ...relationship between therapeutic alliance and patient quality of life with a secondary goal of determining whether the association varied by patients' baseline level of psychological distress.
Methods
Cross‐sectional analysis of baseline data from a randomized clinical trial of 672 patients with advanced cancer participating in a primary palliative care intervention trial. Patients completed baseline self‐reported measures of therapeutic alliance (The Human Connection Scale, range: 16–64), overall quality of life (Functional Assessment of Cancer Therapy—Palliative Care, range: 0–184), and psychological distress (Hospital Anxiety and Depression Scale, range: 0–42). First, we determined the relationship between therapeutic alliance and quality of life using multivariable regression adjusting for confounders. We then examined if psychological distress was an effect modifier in this relationship by adding interaction effects of depression and anxiety symptoms on therapeutic alliance into the regression model.
Results
Patients reported high levels of therapeutic alliance (56.4 ± 7.4) and moderate quality of life (130.3 ± 25.5). Stronger therapeutic alliance was associated with better quality of life after adjusting for other confounding factors (β = 3.7, 95% confidence interval = 2.1, 5.3, p < 0.01). The relationship between therapeutic alliance and quality of life was generally consistent regardless of psychological distress.
Conclusions
Collaborative, trusting relationships between patients with advanced cancer and their oncologists are associated with better patient quality of life. Future research should investigate the causal, longitudinal nature of these relationships.
Objective: A meta-analysis revealed a positive correlation between patients' optimistic baseline, or early treatment, outcome expectation (OE) and posttreatment improvement (Constantino, Vîslă, et ...al., 2018. A meta-analysis of the association between patients' early treatment outcome expectation and their posttreatment outcomes. Psychotherapy, 55(4), 473-485.
https://doi.org/10.1037/pst0000169
). However, little is known about mechanisms through which OE operates. Increasingly, several individual studies have pointed to higher therapeutic alliance quality as a promising mediator (candidate mechanism) of the positive OE-improvement link. In this study, we conducted the first meta-analysis of this indirect effect, hypothesizing that alliance would partially mediate the OE-outcome link.
Method: We included published articles involving a clinical sample; therapist-led treatment of at least 3 sessions; pre- or early treatment patient OE measures; during-treatment patient-rated alliance measures; posttreatment outcome measures; and statistical tests of mediation. This meta-analysis included 10 independent samples and over 1,000 patients.
Results: As expected, better alliance quality partially mediated the association between more optimistic OE and improvement; that is, although both were significant, a multivariate analysis revealed that the direct effect was significantly lower than the total effect (standardized difference = −.12, p < .001, 95% CI −.20, −.05). Publication bias was low, as was heterogeneity except for the alliance-outcome path.
Conclusions: Better alliance may be one process that helps transmit the therapeutic influence of early patient OE.
The American Psychological Association task force on empirically supported therapy relationships defined countertransference (CT) management (i.e., awareness of CT) as a “promising” element in ...psychotherapy research. The present study aimed to examine how changes in therapist CT and awareness of CT relate to therapy process and outcome. The data analysis was based on 41 treatments and used the core conflictual relationship theme to measure CT. We found that changes in therapists’ Wishes from the relationship with the patient at the beginning of therapy were related to patients’ working alliance and symptom changes at the end of treatment. Changes in therapist awareness of CT moderated the relationship between therapists’ wishes from the therapy and patients’ symptom changes during therapy. Last, we present a case study and discuss how awareness of CT can help the therapist handle the challenges that arise from it. (PsycInfo Database Record (c) 2024 APA, all rights reserved) (Source: journal abstract)
Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance ...and clinical outcome in the context of teletherapy compared to in-person treatment.
Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome.
Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress.
Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy - in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.
Introduction According to Control-Mastery Theory (CMT)-a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy-patients come to therapy with an unconscious ...plan to disprove their pathogenic beliefs and achieve adaptive goals. One of the primary ways patients work to disconfirm their pathogenic beliefs is by testing them within the therapeutic relationship. Objectives: The present study aimed to replicate and expand the results of previous studies suggesting that therapists' responses that disconfirmed patient's pathogenic beliefs were predictive of patients' within-session progress. Moreover, we wanted to investigate whether these interventions correlated with the therapeutic alliance. Methods: Transcriptions of 81 sessions from five brief psychodynamic psychotherapies were assessed by 11 independent raters. For each case, the patient's plan was formulated and tests identified, the accuracy of the therapist's responses to these tests was rated, and the impact of the therapist's interventions on the patient's subsequent communications and their relationship with the therapeutic alliance was measured. Results: The results supported the central hypothesis of the CMT that when the therapist's interventions passed the patient's tests, the patient showed signs of improvement. Moreover, the ability of the therapist to pass the patient's tests correlated with the therapeutic alliance. Conclusions: The clinical implications and the limitations of these findings are discussed, together with the relevance of a good case formulation for clinicians' optimal responsiveness.
Across psychotherapeutic frameworks, the strength of the therapeutic alliance has been found to correlate with treatment outcomes; however, its role has never been formally assessed in a trial of ...psychedelic-assisted therapy. We aimed to investigate the relationships between therapeutic alliance and rapport, the quality of the acute psychedelic experience and treatment outcomes.
This 2-arm double-blind randomized controlled trial compared escitalopram with psychedelic-assisted therapy for moderate-severe depressive disorder (
= 59). This analysis focused on the psilocybin condition (
= 30), who received two oral doses of 25 mg psilocybin, 3-weeks apart, with psychological preparation, in-session support, and integration therapy. A new psychedelic therapy model, called "Accept-Connect-Embody" (ACE), was developed in this trial. The primary outcome was depression severity 6 weeks post treatment (Quick Inventory of Depressive Symptomatology, QIDS-SR-16). Path analyses tested the hypothesis that therapeutic alliance (Scale To Assess the Therapeutic Relationship Patient Version, STAR-P) would predict depression outcomes via its influence on the acute psychedelic experience, specifically emotional-breakthrough (EBI) and mystical-type experiences (MEQ). The same analysis was performed on the escitalopram arm to test specificity.
The strength of therapeutic alliance predicted pre-session rapport, greater emotional-breakthrough and mystical-type experience (maximum EBI and MEQ scores across the two psilocybin sessions) and final QIDS scores (
= -0.22,
= 0.42 for EBI
;
= -0.19,
= 0.32 for MEQ
). Exploratory path models revealed that final depression outcomes were more strongly affected by emotional breakthrough during the first, and mystical experience during the second session. Emotional breakthrough, but not mystical experience, during the first session had a positive effect on therapeutic alliance ahead of the second session (
= 0.79,
< 0.0001). Therapeutic alliance ahead of the second session had a direct impact on final depression scores, not mediated by the acute experience, with a weaker alliance ahead of the second psilocybin session predicting higher absolute depression scores at endpoint (
= -0.49,
< 0.001)
Future research could consider therapist training and characteristics; specific participant factors, e.g., attachment style or interpersonal trauma, which may underlie the quality of the therapeutic relationship, the psychedelic experience and clinical outcomes; and consider how therapeutic approaches might adapt in cases of weaker therapeutic alliance.
This trial is registered at http://clinicaltrials.gov, identifier (NCT03429075).
Objective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the ...therapeutic alliance.
Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators.
Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction.
Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality.
Digital therapeutic programs are emerging almost daily, offering the potential to reduce healthcare access inequalities by providing more flexible and accessible care options. However, as with ...traditional healthcare, the issue of patient engagement is fundamental, and the latest research have reported that fewer than 30% of users complete these programs in their entirety. Hence, many authors emphasize the importance of studying the role of therapeutic alliances specifically adapted to digital care. The therapeutic alliance encompasses the collaborative aspects of the relationship between the therapist and the patient. In this context there is a need to reconceptualize the alliance within the context of digital healthcare as it can enhance engagement, adherence, and the effectiveness of such treatments. The objective of this qualitative study was to identify the components of the digital therapeutic alliance. A thematic analysis has identified three major themes that appear to constitute the digital therapeutic alliance among 44 users of an online program: trust in the program, perception of interactions, and feeling of consideration. These results prompted a discussion of the challenges of digital healthcare, including the terminology to use. The term “digital therapeutic adherence” is proposed, thereby opening up a field for research and clarification of this important concept distinct from traditional alliance.
Des programmes thérapeutiques numériques voient presque quotidiennement le jour, ce qui pourrait réduire les inégalités d’accès au soin en offrant des prises en charge plus flexibles et plus accessibles. Toutefois, comme avec le soin traditionnel, la question de l’adhésion est fondamentale et les dernières recherches ont rapporté que moins de 30 % des utilisateurs participent aux programmes dans sa totalité. Ainsi, de nombreux auteurs insistent sur l’importance d’étudier le rôle de l’alliance thérapeutique spécifiquement adaptée aux soins numériques. L’alliance décrit les aspects collaboratifs de la relation entre le thérapeute et le patient. Dans ce contexte, il existe un besoin de reconceptualiser l’alliance dans le cadre des prises en charge numériques notamment car cela améliore l’engagement, l’adhésion et l’efficacité de ce type de traitements. L’objectif de cette étude qualitative est d’identifier les composantes de l’alliance thérapeutique numérique. Une analyse thématique a permis d’identifier trois grands thèmes qui semblent constituer l’alliance thérapeutique numérique chez 44 usagers d’un programme en ligne : la confiance dans le programme, la perception des interactions et le sentiment de considération. Ces résultats impliquent une réflexion autour des enjeux des soins numériques et notamment de la terminologie à utiliser. Le terme « adhésion thérapeutique numérique » est proposé ouvrant le champ de recherche et de précision de cet important concept distinct de l’alliance traditionnelle.
Objective: This study investigated therapeutic alliance (TA) trajectories, their demographic and symptomatic predictors, and associations with outcome in psychodynamic child psychotherapy. Method: ...The sample included 89 Turkish children (Mage = 6.87, SD = 2.11, 46% girls) with internalizing (37.11%), externalizing (21.14%), and comorbid (38.20%) problems; 12% of the children were in the nonclinical range. Independent raters coded 328 sessions from different phases of treatment using the Therapy Process Observational Coding System-Alliance Scale. Outcome measures were collected at intake and termination (Children's Behavior Checklist and Teacher Rating Form). Results: Multilevel growth curve modeling indicated that TA showed a quadratic trend (high-low-high) over the course of treatment. The shape-of-change methodology indicated three subgroups following a stable pattern, a slow and an accelerated quadratic TA trajectory. Externalizing problems (teacher report) negatively predicted average TA strength. Boys and children with internalizing problems showed a declining TA trajectory, whereas children with externalizing problems (teacher report) showed an upward TA trajectory. Multivariate multiple regression analyses showed that the average TA (i.e., intercept) and the positive quadratic slope (the high-low-high pattern) positively predicted changes in internalizing and externalizing problems (teacher report). Discussion: This study was the first to show the course of TA development in psychodynamic child psychotherapy, identify a number of child characteristics that facilitate and impede TA. Investigating both the strength and patterns of TA development when examining associations with outcome is important.
What is the public health significance of this article?
This study suggests the aggressive and impulsive behaviors of children with externalizing problems may pose a challenge to relationship strength and that children with internalizing problems may show a decline in interest and willingness to participate in therapy activities, possibly due to avolition associated with underlying depression. Therapists need to compensate for such challenges with increased TA building strategies to keep the relationship strong. Fostering a more rapid positive change and overcoming TA ruptures is critical for symptomatic improvement.
