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Working Alliance &
Common Factors in Therapy:
Old and New Challenges.
AIMS for this presentation:
- Review stages of client readiness for change.
- Examine client and therapist characteristics that facilitate positive outcomes.
- Explore common curative factors responsible for quality outcomes in therapy.
- Provide an overview of the working alliance as a powerful dynamic construct.
Motivational Readiness
& Stages of Change:
Pre-contemplation (no intentions)
Contemplation (considering)
Preparation (some commitment)
Action (new behaviours)
Maintenance (working consistently over time)
Termination (self-efficacy, 100% confidence)
(Prochaska, DiClementi, Norcross, 1992 )
Readiness &
Stage of Change: “CUSTOMER”
GREEN LIGHT
- Able to identify goal (agree)
- Views self as part of solution (explore)
- Willing to take steps (encourage)
- A “doer”
Homework : Assign doing tasks.
(BTC, 1993; deShazer; Prochaska & DiClemente)
Client Characteristics related to
Positive Outcomes: (Weiner, 1998)
- Client motivated , and hopes to change, and expects that intervention will help accomplish the change.
- Client is a likable person with good capacity for expressing and reflecting on their experiences.
- Reasonably intact personality.
Therapist Characteristics &
Bond development: (Pope, 1998)
10 most significant attributes
Empathy, Acceptance,
Genuineness, Sensitivity,
Flexibility, Open-mindedness,
Emotional Stability, Confidence,
Interest in people, Fairness.
What Theory Works Best?
Outcome Research: Efficacy!
- Comprehensively proven that therapeutic interventions do have a positive impact
- 25-50 years of research: Failure to establish any one school/theory/model is superior to any other (Smith, Glass, & Miller, 1980)
- “Everyone has won and all must have prizes!”
- Shared core/common features that are curative
- Not IF it works or WHAT works, but HOW it works…
(Lambert, 1992)
Four Common Curative Factors:
- Client Factors (remission, inner strengths, goal directedness, motivation, personal agency, fortuitous events, social support, faith) 40%
- Expectancy/Placebo/Hope (credibility) 15%
- Techniques/Models (questions, feedback, reframing, interpretation, modelling, info) 15%
- Therapeutic Relationship Factors (empathy, warmth, respect, genuineness, acceptance, encouragement of risk-taking) 30%
Common Characteristics of
“Proven” Therapies (O'Donohue et al, 2000)
APA "empirically valid" therapies:
- Involved skill building rather than insight or catharsis;
- Had a specific focus rather than a general one;
- Included regular , ongoing assessment of progress ;
- Relatively brief in duration (20 visits or less).
Understanding the
Working Alliance: (Bordin, 1980)
- Integrates both the relational and technical aspects of therapy
- Strongly associated with outcome across all forms of treatment and intervention
Characteristics:
- Strength of alliance is predictive
- Strength of alliance fluctuates throughout relationship (ruptures and repairs)
- Early Vs. late scores as a marker of success
- Strength of early alliance allows strains and ruptures to be addressed
Phases:
- Phase one occurs in the initial session/s (Bond phase)
- Phase two begins as therapist starts addressing client issues (Work phase)
- Phase two is characterized by one or more strains and ruptures
- Direct therapist focus on ruptures can repair the alliance
Client Behaviours
that Strain the Alliance:
- Overt and indirect expression of negative feelings toward the therapist or the process
- Disagreement about the goals or tasks
- Over-compliance or avoidance manoeuvres
- ‘Self’-enhancing communication that is based in power conflicts (e.g., boasting)
- Non-responsiveness or continued Docsity.com
Clients’ perceptions of
non-alliance minded Therapists :
- critical, hostile
- non-attentive
- non-empathic
- forgetful, suspicious
- belief that the therapist is not clear about their expectations and goals