Therapeutic Alliance in Treatment Success

Therapeutic Alliance as a Valid Predictor

Researchers have noted an association with therapeutic alliance and treatments on certain disorders more than others, such as PTSD. According to the research conducted by Derubeis, Brotoman, and Gibbons, evidence revealing that contrary to the popular thought, the results of psychotherapy might be significantly more effective than counseling (2005, p. 1). An example of the positive outcome of psychotherapy is the results of the treatments utilized to treat disorders, such as PTSD. Moreover, the use of psychotherapy has demonstrated more visible results than providing patients with counseling services (Derubeis, Brotoman, & Gibbons, 2005, p. 3). Specifically, participants who received “exposure therapy and stress-inoculation training” had better results than those receiving supportive counseling (Derubeis, Brotoman, & Gibbons, 2005, p. 3). Also, the number of symptoms patients with PTSD experienced prior to the experiment was lessened after receiving exposure therapy and stress inoculation training.

Psychotherapy is less likely to yield a positive outcome without the alliance between the therapist and the patient. Psychotherapeutic treatments such as Gestalt therapy are delivered by humans, as opposed to robotic devices. For this reason, personal attributes and personal history are more likely to be interposed with the execution of the therapy. Researchers Baldwin, Wampold, and Imel reference the therapeutic alliance as a stem of the psychodynamic theory while positioning the activity, as the technique and its characterization, as the alliance (2007, p. 842). These results lead to questions, such as the degree of variability therapists have on the outcome of their patients. For the reasons stated above, the study suggests therapists should project certain personal characteristics, such as “flexibility, understanding, supportive, and reflective” (Baldwin, Wampold, & Imel, 2007, p. 841). Portraying the characteristics above is more likely to create a positive and welcoming environment for patients seeking therapy.

Similarly to the study performed by Horvath and Greenberg, in 1994 the recent research gathered by Ardito and Rabellino in 2011 supports the significant association between a positive therapist alliance and a positive patient outcome. Furthermore, results also supported the connection between alliance and outcome in psychotherapy performed on adults and adolescents (Ardito & Rabellino, 2011, p. 270; Horvath & Greenberg, 1994, p. 52). Specifically, the therapeutic outcome was more affected by the quality of the alliance than the selected method of intervention. Such observation was noted in some sessions between the therapist and the adolescent, as opposed to an adult. The research gathered by Ardito and Rabellino reinforces the concept that therapeutic alliance is a constant variable in the results of the therapy, regardless of the type of therapy implemented. The research focused on observing that positive and good quality therapy is more likely to yield positive therapeutic results.

Therapeutic Alliance as an Invalid Predictor

The level of psychiatric problem in each patient is a strong predictor of treatment success in psychotherapy. Researchers Petry and Bickel conducted an elaborative study including 114 participants who engaged in five buprenorphine studies (1999, p. 224). Contrarily to the research stated above, Petry and Bickel’s research indicated that treatment prediction was based on the psychiatric severity and its interaction between therapeutic alliances. Additionally, studies relating to substance abuse patients have demonstrated more positive retention rates in individuals with fewer psychiatric problems (Petry & Brikel, 1999, p. 224). Although this study yields to the idea that therapeutic alliance influences therapeutic results, it does not support it as the only and prominent predictor. The severity and degree of the patient’s psychiatric problem demonstrated a stronger predictor of the therapeutic results.

A study with a larger group of participants focused on treatments for several disorders. An empirical examination performed by Kruprick et al. (1996) utilizing 250 participants indicated the absence of a significant correlation between therapeutic alliance and patient outcome (pp. 532-539). This particular observation was noted in the relationship between “therapeutic alliance and outcome in interpersonal psychotherapy, cognitive behavior therapy, and active and placebo pharmacotherapy with clinical management” (Kruprick et al., 1996, pp. 532-539). Furthermore, the research included in this experimental analysis did not find any significant correlation between alliance compared to cognitive and experiential group therapies for treatments of depression. The duration of the treatments executed in this empirical examination lasted 16 weeks and included 16-20 sessions of 50 minutes in length. This study is a well-designed experiment, as it was constructed by utilizing several treatment levels with a substantial participant sample.

Previous research emphasizing the predictive value of therapeutic alliance and a patient’s outcome in psychotherapy was conducted while focusing on depression treatments. The study completed by Van et al. (2008) presented “object relational functioning for the therapeutic alliance and outcome of short-term psychodynamic supportive psychotherapy in patients with mild to moderately severe depression” (Van et al., 2008, p. 655). Results revealed an association between the object relational functioning and a positive response to treatment, as opposed to a correlation between the treatment and therapist alliance. Furthermore, patients with repeating episodes of depression revealed a lower object relational functioning regardless of the quality and positive therapist approach. Specifically, this study demonstrates an absence of influence in therapeutic alliance and object relational functioning during any of the depression treatments.

References

Ardito, R. B., & Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, And Prospects For Research. Frontiers in Psychology, 2, 270.

Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling The Alliance-outcome Correlation: Exploring The Relative Importance Of Therapist And Patient Variability In The Alliance. Journal of Consulting and Clinical Psychology, 75(6), 842-852.

Derubeis, R. J., Brotman, M. A., & Gibbons, C. J. (2005). A Conceptual and Methodological Analysis of the Nonspecifics Argument. Clinical Psychology: Science and Practice, 12(2), 174-183.

Horvath, A. O., & Greenberg, L. S. (1994). Therapeutic Alliance as Interpersonal Process. The Working Alliance: Theory, research, and practice (p. 52). New York: Wiley.

Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., & al. (1996). The Role Of The Therapeutic Alliance In Psychotherapy And Pharmacotherapy Outcome: Findings In The National Institute Of Mental Health Treatment Of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64(3), 532-539.

Petry, N. M., & Bickel, W. K. (1999). Therapeutic Alliance and Psychiatric Severity as Predictors of Completion of Treatment for Opioid Dependence. Psychiatry Online, 50(2), 219-227.

Van, H. L., Hendriksen, M., Schoevers, R. A., Peen, J., Abraham, R. A., & Dekker, J. (2008). Predictive Value of Object Relations for Therapeutic Alliance and Outcome in Psychotherapy for Depression. The Journal of Nervous and Mental Disease, 196(9), 655-662.