THERAPEUTIC ALLIANCE

Community Mental Health Professionals' Schemas: Implication for Quality of Therapeutic Alliance

Table of Contents

Introduction3

The therapeutic alliance3

Strengths and shortcomings of the alliance concept5

Conceptualization of alliance6

Genealogy6

Measurement of the therapeutic alliance9

Working Alliance Inventory (WAI)9

Schema Questionnaire - Short form (SQ-SF)10

Procedure11

Power Calculation /Expected Number Of Participants11

Statistical Analysis11

Descriptive Statistics12

Frequency Table12

Cross Tabulation16

Pearson's Chi-square16

Linear Regression22

Correlation Coefficient R23

Multiple Regressions27

Correlation29

ANOVA30

Discussion34

Future developments in the analysis of alliance in treatment37

Conclusion41

References44

Community Mental Health Professionals' Schemas: Implication for Quality of Therapeutic Alliance

Introduction

The therapeutic alliance refers to the interpersonal processes that occur in the relationship between a therapist and client. The importance of understanding the therapeutic alliance is illustrated through research that has found that a good quality alliance is related to a better therapeutic outcome (Horvath & Symonds, 1991). It has been suggested that attachment theory can provide a framework within which to explore the therapeutic alliance (Bowlby, 1988a). Although there has been considerable research on the relationship between client attachment patterns and the therapeutic alliance, at present there is a lack of synthesis of findings in this area. This paper therefore systematically reviews the empirical studies that have examined the relationship between clients' self reported attachment patterns and the therapeutic alliance. The intention is to evaluate whether assessing clients' attachment patterns would be beneficial to therapists and service providers. The concepts of therapeutic alliance and attachment will be discussed separately before exploring how they may fit together.

The therapeutic alliance

The concept of the therapeutic alliance was originally developed within the psychodynamic tradition (for a detailed description of its origins see Horvath & Luborsky, 1993). However, over time research has consistently indicated that the strength of the therapist-client relationship is an important variable in determining therapeutic success, independently of the type of therapy delivered (Martin, Garske, & Davis, 2000). Thus the concept has been adopted across therapeutic orientations and has emerged as an important common factor in the efficacy of the adult psychotherapeutic process (Norcross, 2002).

Differences in the way that researchers conceptualise and term the therapeutic alliance (e.g. working or helping alliance, therapeutic relationship) have led to the call for a clarification of the concepts underlying alliance in order to provide a cohesive definition (Elvins & Green, 2008). Bordin (1979) was the first to present a generic synthesis of alliance constructs and conceptualised it as a purposeful collaborative relationship which involves a blend of three features. These features are; (a) an agreement between the therapist and client on the goals of therapy, (b) an agreement of a task/s that can be done to achieve these goals, and (c) the development of bonds, that is the development of enough trust, respect, confidence and personal attachment between the therapist and the client to achieve the goals and take part in the tasks.

This conceptualisation was consistent with the idea that the alliance is a common factor across therapeutic orientations and modalities. As a result, Bordin's conceptualisation began to dominate the literature and validated measurement scales were developed based on this theory. Two examples are the Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) and the ...