Strategic use of observer-perspective questions in couples therapy.

Questions are one of the most frequently used strategies in therapy. There is a body of theoretical work on the kinds of questions that are preferred in specific treatment approaches. However, research on the use of questions in general, how they are formed and what specific therapeutic work they do, is relatively scarce in the literature.

The evolution of patients' concept of the alliance and its relation to outcome: A dynamic latent-class structural equation modeling approach.

The working alliance (WA) has been widely identified as the key concept for psychotherapy and allied health care services. The WA, measured at different phases of diverse kinds of therapies, has been shown to robustly predict posttreatment outcomes. But the way the clients' conceptualization of the alliance evolves overtime, and the relation between this kind of conceptual change and subsequent symptom improvements, has not been investigated.

Examining therapist effects in the alliance-outcome relationship: A multilevel meta-analysis.

Objective: The relationship between the therapeutic alliance and outcome has been supported consistently over time. More recently, studies have examined therapist effects in the alliance-outcome relationship and came up with somewhat mixed findings. The purpose of this study was to replicate and extend previous meta-analytic work using a much larger data set, permitting not only the verification of the overall impact of the therapists' contribution but, at the same time, controlling for several potential covariates effecting this relationship.

Getting to "Yes": Overcoming Client Reluctance to Engage in Chair Work.

Goals: Securing clients' active and enthusiastic collaboration to participate in activities therapists would like to implement in therapy (e.g., free association, exposure, or the engagement in chair work) is a core mission in therapy.

The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis.

Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7.

Method: We applied a 2-stage individual participant data meta-analytic approach.

Assessing the alliance-outcome association adjusted for patient characteristics and treatment processes: A meta-analytic summary of direct comparisons.

The alliance is widely recognized as a robust predictor of posttreatment outcomes. However, there is a debate regarding whether the alliance is an epiphenomenon of intake characteristics and/or treatment processes occurring over the course of treatment. This meta-analysis aimed to synthesize the evidence on this issue.

Responding to self-criticism in psychotherapy.

Objective: We explored the interactive process in which therapists respond to client self-critical positions.

Methods: Drawing from the resources of conversation analysis (CA), we examined a corpus of in-session self-critical sequences of talk occurring in different kinds of treatments: Client Centered Therapy, (CCT), Emotion Focused Therapy (EFT), Psychoanalytic Psychotherapy (PP) and in different cultural contexts.

Results: It was found that client self-critical talk performed various functions pertaining to diminished control, accountability (e.

Jeremy Safran: a hero's journey.

In this essay I explore Jeremy Safran's intellectual career as a or monomyth within the specific context of psychotherapy research. I argue that he fits such model in the sense that his work - though deeply informed by theories - was singularly focused and driven by his own sense of his role and mission within the profession. Rather than attempting to review in detail the entire scope or specific parts of his research contributions, I look at his scholarship as a kind of quest, a pursuit that was trans-theoretical but unified by foundational questions about the unique nature of the relationship between therapist and patient.

The alliance in adult psychotherapy: A meta-analytic synthesis.

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators.

Research on the alliance: Knowledge in search of a theory.

Objectives: The aim of this review paper is to summarize the challenges facing research on the alliance now and going forward. The review begins with a brief overview of the development of the concept of the alliance in historical context.

Method: A summary of what has been accomplished both within the psychotherapy research community and in other professions is presented.

The therapeutic relationship in action: how therapists and clients co-manage relational disaffiliation.

Over the past three decades a great deal of energy has been invested in examining the consequences of relational stresses and their repair. Less work has been done to examine how therapists and clients actually achieve re-affiliation through verbal and non-verbal resources, how such affiliation becomes vulnerable and at risk, and how therapists attempt to re-establish affiliative ties with the client-or fail to do so. We utilize the method of Conversation Analysis (CA) to examine clinical cases that involve extended episodes of disaffiliation.

Therapeutic collaboration and resistance: describing the nature and quality of the therapeutic relationship within ambivalence events using the Therapeutic Collaboration Coding System.

Objectives: We understand ambivalence as a cyclical movement between two opposing parts of the self. The emergence of a novel part produces an innovative moment, challenging the current maladaptive self-narrative. However, the novel part is subsequently attenuated by a return to the maladaptive self-narrative.

How collaboration in therapy becomes therapeutic: the therapeutic collaboration coding system.

Background: The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy.

Aim: We propose a conceptual account of how collaboration in therapy becomes therapeutic.

Substance use disorders and racial/ethnic minorities matter: a meta-analytic examination of the relation between alliance and outcome.

The purpose of this meta analysis was to examine the moderating impact of substance use disorder as inclusion/exclusion criterion as well as the percentage of racial/ethnic minorities on the strength of the alliance-outcome relationship in psychotherapy. It was hypothesized that the presence of a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I substance use disorder as a criterion and the presence of racial/ethnic minorities as a sociocultural indicator are moderately correlated client factors reducing the relationship between alliance and outcome. A random effects restricted maximum-likelihood estimator was used for omnibus and moderator models (k = 94).

You can't step into the same river twice, but you can stub your toes on the same rock: psychotherapy outcome from a 50-year perspective.

H.H. Strupp's 1963 article, The Outcome Problem in Psychotherapy Revisited, and the exchange between Eysenck and Strupp that followed the article were reexamined to answer the question: What, if anything, has changed in the world of psychotherapy research over half a century since the article was originally published? Many of the issues that provided the impetus for the article and the focal point of the passionate debate between Strupp and Eysenck have been long put to rest.

Therapist effects in the therapeutic alliance-outcome relationship: a restricted-maximum likelihood meta-analysis.

Objective: Although the relationship between the therapeutic alliance and outcome has been supported consistently across several studies and meta-analyses, there is less known about how the patient and therapist contribute to this relationship. The purpose of this present meta-analysis was to (1) test for therapist effects in the alliance-outcome correlation and (2) extend the findings of previous research by examining several potential confounds/covariates of this relationship.

Method: A random effects analysis examined several moderators of the alliance-outcome correlation.

How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis.

Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome.

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as "alliance," "therapeutic alliance," "helping alliance," or "working alliance" were the inclusion criteria.

The alliance in context: Accomplishments, challenges, and future directions.

Research on the alliance is reviewed in a historic context. Different conceptualizations of the nature and role of the alliance are examined within the framework of theories about the role and function of the relationship in treatment. The evolution of these concepts is cast in the broader context of the current debate concerning an appropriate conceptual framework for empirically supported therapy.

Optimizing the alliance in couple therapy.

The complexity of the relation between alliance and outcome in couple therapy was investigated in a study of 47 couples in brief therapy. Self-rated alliance was measured after the first and third sessions using the couple version of the Working Alliance Inventory. The results indicated that the correlation between alliance and outcome was significantly stronger when the partners agreed about the strength of the alliance, when the male partner's alliance was stronger than the female's, and when the strength of both partners' alliance increased as therapy progressed.