Psychology

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Subject: search.filters.subject.Working Alliance

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    Cultural Humility and Outcome Rating Scale: Multilevel Mediation Effects of Dyadic Working Alliance
    (2023) Dixon, Katherine Morales; Kivlighan Jr., Dennis M.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Abstract Current psychotherapy research on cultural humility (CH) indicates that CH is positively associated with client treatment outcomes and that working alliance may mediate the relationship between CH and treatment outcome. However, these studies have used cross-sectional data and have largely ignored the nested nature of therapist-client data sets. To address this gap in the literature, the current study applied a two-level, time-lagged, Multilevel Structural Equation Model (MSEM) to a longitudinal data set and examined whether working alliance mediates the relationship between client-perceived CH of the therapist and client-perceived symptom improvement (Outcome Rating Scale; ORS). The working alliance was conceptualized and operationalized as a dyadic construct (Cl-WA, Th-WA). Results were mixed; contrary to predictions, sessions in which clients perceived the therapist as higher in CH compared to average sessions were associated with poorer ORS scores. This relationship between cultural humility and client perceived improvement was not significant at the between-client level. The mediation hypothesis was supported at the within-client level but not at the between-client level. Implications for practice and research are discussed.
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    Psychotherapy Process and Relationship in the Context of a Brief, Attachment-Based, Mother-Infant Intervention
    (American Psychological Association, 2015) Woodhouse, Susan S.; Lauer, Maria; Beeney, Julie R. S.; Cassidy, Jude
    The present study investigated links between the observer-rated process of psychotherapy and 2 key psychotherapy relationship constructs (i.e., working alliance and attachment to the therapist) in the context of a brief, attachment-based, home-visiting, mother–infant intervention that aimed to promote later secure infant attachment. Additionally, links between observer ratings of intervener and mother contributions to process were examined. Participants included 85 economically stressed mothers of first-born, 5.5-month-old, temperamentally irritable infants. Therapists included 2 doctoral-level and 4 master’s-level home visitors. Observer-rated therapist psychotherapy process variables (i.e., warmth, exploration, and negative attitude) were not linked to maternal ratings of working alliance. Therapist warmth, however, was positively associated with maternal ratings of security of attachment to the therapist, and therapist negative attitude was positively related to maternal ratings of preoccupied-merger attachment to the therapist. As expected, both therapist warmth and exploration were positively associated with both maternal participation and exploration. Therapist negative attitude was inversely related to maternal exploration, but not to maternal participation. Results support the idea that attention to the psychotherapy process and relationship may be important in the context of a brief home-visiting parenting intervention with a nonclinical sample. (APA PsycInfo Database Record (c) 2016 APA, all rights reserved)
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    CLIENT ATTACHMENT AS A PREDICTOR OF THERAPIST INTERVENTIONS, THE WORKING ALLIANCE, AND THE REAL RELATIONSHIP IN THE INITIAL, MIDDLE, AND FINAL PHASES OF PSYCHOTHERAPY
    (2013) Jackson, John Lawrence; Hill, Clara E; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This study investigated client attachment style as a predictor of (a) therapist interventions in an early, middle, and late session of psychotherapy; (b) client and therapist post-session ratings of the working alliance over the course of therapy; and (c) client and therapist post-session ratings of the real relationship over the course of therapy. A total of 41 clients and 14 therapists completed measures prior to and throughout open-term courses of psychotherapy ranging from 8 to 106 sessions. Client attachment style was measured using the anxiety and avoidance subscale scores from the Experiences in Close Relationships scale (ECR; Brennan, Clark, & Shaver, 1998). Therapist interventions were coded by trained observers using the Psychotherapy Q-Set (PQS; Jones, 2000). A factor analysis of therapist interventions revealed four factors: Therapist Facilitative Approach (TFA), Therapist Psychodynamic versus Behavioral Interventions (TPB), Therapist Supportive Approach (TSA), and Therapist Process Comments (TPC). Client attachment avoidance was positively associated with Therapist Supportive Approach (TSA), such that therapists were more likely to use directly supportive interventions with clients who endorsed higher levels of attachment avoidance at the outset of therapy. Otherwise, client attachment ratings were not significantly associated to overall levels of therapist interventions or change in therapist interventions over the course of therapy. Neither client attachment anxiety nor avoidance significantly predicted initial levels, mean levels, or patterns of change in client or therapist ratings of the working alliance or the real relationship over the course of psychotherapy. The findings are discussed in the context of findings and methodological differences from other investigations of client attachment, therapist interventions, and client and therapist ratings of the working alliance and the real relationship. Implications for future research and clinical practice are also discussed.