Showing papers by "Adam O. Horvath published in 2018"
TL;DR: A meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy confirmed the robustness of the positive relation between the alliance and outcome.
Abstract: The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
765 citations
TL;DR: It is argued that a resumption of a conversation about the relationship in the helping context in general, and the alliance in particular, should be resumed and a lack of clarity regarding how several variables within the broader category of therapeutic relationships fit together, overlap, or complement each other is also potentially problematic.
Abstract: Objectives: The aim of this review paper is to summarize the challenges facing research on the alliance now and going forward. The review begins with a brief overview of the development of the concept of the alliance in historical context. Method: A summary of what has been accomplished both within the psychotherapy research community and in other professions is presented. Current challenges facing this line of research are identified, including the existence of a wide range of operational definitions that results in a diffusion of the identity of the alliance concept. It is argued that the current situation generates risks to incremental growth in several lines of research. Conclusions: A case is made that a lack of clarity regarding how several variables within the broader category of therapeutic relationships fit together, overlap, or complement each other is also potentially problematic. Efforts to resolve the lack of a consensual definition are reviewed, and in conclusion, it is argued that a...
83 citations
01 Jan 2018
TL;DR: In this paper, the working relationship between therapist and client can be realized, maintained, and, if necessary, repaired discursively, through the use of conceptual and methodological resources of Conversational Analysis.
Abstract: We show how the working relationship between therapist and client can be realized, maintained, and, if necessary, repaired discursively. Therapists come to each session with intentions rooted in theoretical premises and clinical experiences, but the clinical praxis, the unfolding of therapy itself, involves interactive and sequential responsiveness. Our project involves the use of the conceptual and methodological resources of Conversational Analysis to systematically explicate how different aspects of the relationship between therapist and client and among the clients themselves are managed discursively. As an example of how such approach can serve to better understand the development of the alliance and the achievement of therapeutic change, we provide an analysis of a family therapy consultation by Dr. S. Minuchin and two clients. Methodological and clinical implications of our work are provided.
10 citations