Browsing by Subject "Therapeutic alliance"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    The Impact of the Working Alliance on Vocational Outcomes for People with Severe Mental Illness Enrolled in Employment Programs
    (2007-07) Kukla, Marina Elizabeth; Bond, Gary R., 1944-
    This study was a subset of a large two-year randomized controlled trial of two employment programs providing services to people with severe mental illness (SMI). Because prior research has found that the strength of the relationship, or working alliance, between service providers and people with SMI is related to a variety of beneficial outcomes, the purpose of the current study was to address the working alliance between participants and their vocational workers and its association with employment outcomes, including the total duration of paid employment over two years and mean paid job tenure after two years. Another primary purpose of the current study was to determine whether working alliance differences exist between a team vocational approach (Diversified Placement Approach) and an individual vocational approach (Individual Placement and Support Model). The final aim of the current study was to investigate the psychometric properties of the ad hoc scale utilized to measure the working alliance. Contrary to expectations, no relationship was found between the working alliance and employment outcomes after two years. As expected, it was found that participants in the individual vocational approach (IPS) had higher working alliance scores across the study than participants in the team vocational program (DPA). Finally, the working alliance measure used in this study was found to have promising psychometric properties, including adequate criterion-related validity and test-retest reliability, although the internal consistency was a bit low. The scale items are a loose fit with existing theory, however, necessitating the addition of items and revision of the current scale and underlying theory to enhance its utility in clinical and research settings.
  • Thumbnail Image
    Item
    Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments
    (Wiley, 2018-02) Lysaker, Paul H.; Pattison, Michelle L.; Leonhardt, Bethany L.; Phelps, Scott; Vohs, Jenifer L.; Medicine, School of Medicine
    Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.
  • Thumbnail Image
    Item
    Therapeutic Alliance in Telephone-Administered Cognitive-Behavioral Therapy for Hematopoietic Stem Cell Transplant Survivors
    (American Psychological Association, 2012-10) Applebaum, Allison J.; DuHamel, Katherine N.; Winkel, Gary; Rini, Christine; Greene, Paul B.; Mosher, Catherine E.; Redd, William H.
    Objective: A strong therapeutic alliance has been found to predict psychotherapeutic treatment success across a variety of therapeutic modalities and patient populations. However, only a few studies have examined therapeutic alliance as a predictor of psychotherapy outcome among cancer survivors, and none have examined this relation in telephone-administered cognitive-behavioral therapy (T-CBT). This study evaluated the extent to which therapeutic alliance affected psychotherapy outcomes in survivors of hematopoietic stem cell transplantation (HSCT), a treatment for some cancers. Method: Forty-six patients enrolled in a randomized clinical trial of T-CBT for posttraumatic stress disorder (PTSD) completed a baseline assessment (including self-report measures of PTSD symptoms, depression, and general distress), 10 individual T-CBT sessions, and follow-up assessments at 6, 9, and 12 months post-baseline. Therapeutic alliance was assessed after the 3rd T-CBT session with the Working Alliance Inventory, which yields overall and subscale (task, bond, and goal) scores. Results: Analyses revealed that higher total therapeutic alliance scores prospectively predicted decreased depressive symptomatology; higher task scores predicted decreased overall distress, depressive symptomatology, symptoms of re-experiencing, and avoidance; and higher bond scores predicted decreased depressive symptomatology and symptoms of re-experiencing. Conclusions: These results suggest that assessments of therapeutic alliance should be incorporated into routine clinical care, and therapeutic alliance should be specifically cultivated in interventions to maximize psychotherapeutic benefits involving vulnerable populations such as cancer survivors.