The Alliance in Adult Psychotherapy - A Meta-Analytic Synthesis - Fluckiger, C.

The alliance in adult psychotherapy: A meta-analytic synthesis
Fluckiger, c.
Abstract
Alliance continues to be researched and shown to be a variable related to success in
therapy irrespective of theoretical orientation. The study analyzes 295 studies covering
30,000+ patients (between the years 1978 and 2917) for face to face and internet
therapies. The results in both kinds of therapy show robust positive relation between
alliance and outcome.
Definitions and measures

The term alliance refers to the holistic collaborative aspects of therapist-client
relationships. This concept historically dates back to Freud's period as he recognized
the importance of clients' conscious attachment to the therapist. The term therapeutic
alliance can be understood as the client's ability to use the healthy part of her/his ego to
link up with the analyst in therapeutic tasks. There's a distinction between the working
alliance, the client’s ability to align with the tasks of analysis, and the therapeutic
alliance, the capacity of therapist and client to form a personal bond with the therapist.
Another positive influence to the term was made by Rogers with the application of
empirical methods to the investigation of the therapist's facilitative conditions (empathy,
positive regard, genuineness, trustworthiness, etc.).
The “new” alliance focused on conscious aspects of the relationship of collaborative
working together aspects of it. Lubosrky proposed different types of it: Type 1 - clients
belief in the therapist as a source of help provided through a caring relationship and
type 2 - the clients investments and faith in the process as well as commitment (these
are phases).
Bordin proposed a pantheoretical version of this called working alliance based on
Greeson´s ideas. This was based on three components: agreement on therapeutic
goals, consensus on the tasks that make up therapy and a bond.
Definitions: (1) Psychometric definitions (2) Longitudinal unfolding (3) Participants
perspectives (4) Nested data and structure → All detailed in paper
Clinical examples
The alliance is an emergent quality of mutual collaboration which cannot be pinpointed
to one intervention or one aspect such as empathy. This is an unfolding process or
development that can take different forms and may be achieved almost instantly or
nurtured over a long period of time in a responsive relationship Example in text p. 3-4.
Meta analytic review process of selection
Patient contributions
Patient proactivity is desirable and necessary for the process. The evidence indicated that the
therapist makes a large contribution to the alliance but certainly the patient contributed to the
relationship as well: patient trust, processing activities, capacity for attachment and bong, and
social support → These all are extremely relevant fora cooperative and positive alliance.
Clients' problem severity may affect that alliance. Personality disorders tend to pose
challenges and difficulties. However, the evidence here shows that this could be due to
unstable emotional states which impact the perception of the alliance in a single
session.
In regards to substance use disorders and eating disorders the outcomes show slightly
lower alliance outcomes in adult samples but it's also indicated that alliance has other
moderating factors (ethnic minorities in SUD and ED samples.
Alliance in E-Mental Health
It's been hypothesized that alliance is less important in Internet based therapy than in
face to face.
Limitations of research
● No meta-analysis is truly exhaustive
● A significant challenge for research on the alliance lies in the quantification of
potentially different qualities measured
● We need more culturally specific samples in the future and more on electronic
mediated therapies
Diversity considerations
The relationship between a therapist and a client is embedded in cultural norms and
expectations about the psychotherapist/helper role. These minorities are usually
underrepresented in studies and there's a lot of SUD sample dropout, further
decreasing the sample of minorities.
Therapeutic practices
● Build and maintain alliance throughout therapy through a warm emotional bond
or collaborative attachment
● Develop early in treatment agreement on goals and tasks - these reliably predict
therapeutic success
● Respond to clients motivational readiness of change and capabilities during early
sessions
● Create wording or slang with customized quality of inclusiveness and negotiation
● Collaborative words in nonverbal language
● Address ruptures in alliance directly and immediately
● Create individual case formulations by responsiveness to patients individual
needs and preferences
● Alliance may be impacted by different social reference groups that coils result in
divergent alliance ratings, these should be interpreted carefully to not indicate
disagreement since its not negative, but instead may be a marker that a
discussion might prove helpful for the relationship
● Goal and task agreement doesn't mean the therapist automatically accepts
patients goals (or vice versa), a strong alliance is due to negotiation
● Attention should be equally accorded to the alliance in internet mediated therapy

The Alliance in Adult Psychotherapy - A Meta-Analytic Synthesis - Fluckiger, C.

Uploaded by

Copyright:

Available Formats

The Alliance in Adult Psychotherapy - A Meta-Analytic Synthesis - Fluckiger, C.

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Alliance in Adult Psychotherapy - A Meta-Analytic Synthesis - Fluckiger, C.

Uploaded by

Copyright:

Available Formats

The alliance in adult psychotherapy: A meta-analytic synthesis

Definitions and measures

You might also like