To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.

Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review.

Recent theoretical discussions of optimism as an inherent aspect of human nature converge with empirical investigations of optimism as an individual difference to show that optimism can be a highly beneficial psychological characteristic linked to good mood, perseverance, achievement, and physical health. Questions remain about optimism as a research topic and more generally as a societal value. Is the meaning of optimism richer than its current conceptualization in cognitive terms? Are optimism and pessimism mutually exclusive? What is the relationship between optimism and reality, and what are the costs of optimistic beliefs that prove to be wrong? How can optimism be cultivated? How does optimism play itself out across different cultures? Optimism promises to be one of the important topics of interest to positive social science, as long as it is approached in an even-handed way.

The future of optimism.

BACKGROUND: Postal and electronic questionnaires are widely used for data collection in epidemiological studies but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of health research. OBJECTIVES: To identify effective strategies to increase response to postal and electronic questionnaires. SEARCH STRATEGY: We searched 14 electronic databases to February 2008 and manually searched the reference lists of relevant trials and reviews, and all issues of two journals. We contacted the authors of all trials or reviews to ask about unpublished trials. Where necessary, we also contacted authors to confirm methods of allocation used and to clarify results presented. We assessed the eligibility of each trial using pre-defined criteria. SELECTION CRITERIA: Randomised controlled trials of methods to increase response to postal or electronic questionnaires. DATA COLLECTION AND ANALYSIS: We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity among trial odds ratios using a Chi(2) test and the degree of inconsistency between trial results was quantified using the I(2) statistic. MAIN RESULTS: PostalWe found 481 eligible trials. The trials evaluated 110 different ways of increasing response to postal questionnaires. We found substantial heterogeneity among trial results in half of the strategies. The odds of response were at least doubled using monetary incentives (odds ratio 1.87; 95% CI 1.73 to 2.04; heterogeneity P < 0.00001, I(2) = 84%), recorded delivery (1.76; 95% CI 1.43 to 2.18; P = 0.0001, I(2) = 71%), a teaser on the envelope - e.g. a comment suggesting to participants that they may benefit if they open it (3.08; 95% CI 1.27 to 7.44) and a more interesting questionnaire topic (2.00; 95% CI 1.32 to 3.04; P = 0.06, I(2) = 80%). The odds of response were substantially higher with pre-notification (1.45; 95% CI 1.29 to 1.63; P < 0.00001, I(2) = 89%), follow-up contact (1.35; 95% CI 1.18 to 1.55; P < 0.00001, I(2) = 76%), unconditional incentives (1.61; 1.36 to 1.89; P < 0.00001, I(2) = 88%), shorter questionnaires (1.64; 95% CI 1.43 to 1.87; P < 0.00001, I(2) = 91%), providing a second copy of the questionnaire at follow up (1.46; 95% CI 1.13 to 1.90; P < 0.00001, I(2) = 82%), mentioning an obligation to respond (1.61; 95% CI 1.16 to 2.22; P = 0.98, I(2) = 0%) and university sponsorship (1.32; 95% CI 1.13 to 1.54; P < 0.00001, I(2) = 83%). The odds of response were also increased with non-monetary incentives (1.15; 95% CI 1.08 to 1.22; P < 0.00001, I(2) = 79%), personalised questionnaires (1.14; 95% CI 1.07 to 1.22; P < 0.00001, I(2) = 63%), use of hand-written addresses (1.25; 95% CI 1.08 to 1.45; P = 0.32, I(2) = 14%), use of stamped return envelopes as opposed to franked return envelopes (1.24; 95% CI 1.14 to 1.35; P < 0.00001, I(2) = 69%), an assurance of confidentiality (1.33; 95% CI 1.24 to 1.42) and first class outward mailing (1.11; 95% CI 1.02 to 1.21; P = 0.78, I(2) = 0%). The odds of response were reduced when the questionnaire included questions of a sensitive nature (0.94; 95% CI 0.88 to 1.00; P = 0.51, I(2) = 0%).ElectronicWe found 32 eligible trials. The trials evaluated 27 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity among trial results in half of the strategies. The odds of response were increased by more than a half using non-monetary incentives (1.72; 95% CI 1.09 to 2.72; heterogeneity P < 0.00001, I(2) = 95%), shorter e-questionnaires (1.73; 1.40 to 2.13; P = 0.08, I(2) = 68%), including a statement that others had responded (1.52; 95% CI 1.36 to 1.70), and a more interesting topic (1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third using a lottery with immediate notification of results (1.37; 95% CI 1.13 to 1.65), an offer of survey results (1.36; 95% CI 1.15 to 1.61), and using a white background (1.31; 95% CI 1.10 to 1.56). The odds of response were also increased with personalised e-questionnaires (1.24; 95% CI 1.17 to 1.32; P = 0.07, I(2) = 41%), using a simple header (1.23; 95% CI 1.03 to 1.48), using textual representation of response categories (1.19; 95% CI 1.05 to 1.36), and giving a deadline (1.18; 95% CI 1.03 to 1.34). The odds of response tripled when a picture was included in an e-mail (3.05; 95% CI 1.84 to 5.06; P = 0.27, I(2) = 19%). The odds of response were reduced when "Survey" was mentioned in the e-mail subject line (0.81; 95% CI 0.67 to 0.97; P = 0.33, I(2) = 0%), and when the e-mail included a male signature (0.55; 95% CI 0.38 to 0.80; P = 0.96, I(2) = 0%). AUTHORS' CONCLUSIONS: Health researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this systematic review.

/pdf/methods-to-increase-response-to-postal-and-electronic-4sjz3r84m4.pdf

Methods to increase response to postal and electronic questionnaires

In this article, we review the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture-repair episodes and treatment outcome (r = .24, z = 3.06, 95% CI [.09, .39], p = .002, k = 3, N = 148). The second meta-analysis reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles (prepost r = .65, z = 5.56, 95% CI [.46, .78], p < .001, k = 8, N = 376). Both meta-analyses provided promising evidence regarding the relevance of alliance rupture-repair processes to therapeutic outcome. The limitations of the research reviewed are discussed as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy.

Repairing alliance ruptures.

Exciting advances have been made in the study of psychological and subjective well-being. However, this literature has, curiously, had minimal impact on clinical/counseling practice or applied psychology, including counseling psychology-a subfield historically devoted to the concept of hygiology and the promotion of optimal human functioning. This article provides an overview and critique of various approaches to defining, conceptualizing, and studying well-being, including its correlates and presumed causes. Practical implications of the literature are considered. Provisional, integrative models of normative and restorative well-being are offered as vehicles for bridging the gap between basic research and practice. Suggestions are also offered for practice-friendly inquiry on well-being and for incorporating well-being as one ingredient of a multifaceted conception of mental health and positive adaptation.

http://psycnet.apa.org/journals/cou/51/4/482.pdf

Toward a Unifying Theoretical and Practical Perspective on Well-Being and Psychosocial Adjustment.

Using 53 studies, comprising 52 separate data sets, published in refereed journals from 1985 through 2006, the authors conducted meta-analyses of the correlation and mean difference between client–therapist alliance ratings. Client and therapist alliance ratings were moderately correlated ( =.36, SD=.00); clients’ ratings were higher than ratings by their therapists ( =.63, SD=.42). Client disturbance was a significant moderator of client–therapist alliance rating discrepancies; clients with milder disturbances or with substance abuse problems tended to have larger rating discrepancies with their therapists than clients with more severe disturbances or moderate disturbance without substance abuse.

https://www.gc.cuny.edu/CUNY_GC/media/CUNY-Graduate-Center/PDF/Programs/Ed%20Psych/tryon,-blackwell,---Hammel.pdf

A meta-analytic examination of client-therapist perspectives of the working alliance.

Relationship of Working Alliance to Mutual and Unilateral Termination.

Foreword - Georgiana Shick Tryon. 1. Engagement in Counseling - Georgiana Shick Tryon (City University of New York Graduate School and University Center). 2. Client Expectations about Counseling - Ann Westcot Barisch (Lewis University). 3. Client Resistance - James R. Mahalick (Boston College). 4. The Working Alliance: A Flagship for the "Scientist-Practitioner" Model in Psychotherapy - Michael J. Constantino, Louis Georges Castonguay & Alexander J. Schut (Pennsylvania State University). 5. The Learning Alliance of Supervision: Research to Practice - Elizabeth Holloway & Pilar Gonzales- Doupe (University of Wisconsin- Madison). 6. Transference, Interpretation, and Insight: A Research-Practice Model - Dennis M. Kivlighan, Jr. (University of Missouri- Columbia). 7. Empathy - Changming Duan, Teresa B. Rose & Rebecca A. Kraatz (University of Missouri- Kansas City). 8. Therapist Techniques - Elizabeth Nutt Williams. 9. Stages of Counseling and Therapy: An Examination of Complimentarity and the Working Alliance - Terence J.G. Tracey (Arizona State University). 10. Social Influence in Counseling: Application of the Elaboration Likelihood Model to Counseling - Martin Heesacker & Marnie G. Shanbhag (University of Florida). 11. Session Evaluation and the Session Evaluation Questionnaire - William B. Stiles, Lisa E. Gordon & James A. Lani (Miami University). 12. The Termination of Psychotherapy: What Research Tells Us About the Process of Ending Treatment - Charles J. Gelso & Susan S. Woodhouse (University of Maryland).

Counseling Based On Process Research: Applying What We Know

Investigated the relation of client-counselor evaluation of initial interview to client return for another session. At the end of the initial session, 5 professionals, 5 practicum trainees, and their 290 college-student clients completed the depth and smoothness indexes of the Session Evaluation Questionnaire (Stiles, 1980). Clients also completed the Client Satisfaction Questionnaire (Larsen, Attkisson, Hargreaves, & Nguyen, 1979), and counselors completed items from the Pre-Counseling Assessment Blank (Gelso & Johnson, 1983). The duration of the intake interview was recorded. Client return was positively related to: longer interviews; deeper interviews, as rated by both client and counselor; and greater client satisfaction, disturbance, and motivation. The results are discussed in relation to the concept that the initial session represents an engagement session when clients return for more sessions. During the summer of 1984, while evaluating the experience of practicum trainees during the previous academic year, I formulated a concept that was later termed engagement. Examining numbers of clients and sessions for each practicum student, I discovered that practicum students with more positive supervisory evaluations saw their clients for more sessions than did trainees with less positive evaluations. After further numerical calculation, I found that these trainees could be differentiated by the percentage of clients returning to counseling for a second session. At the center where these calculations were made, there is no screening procedure for clients, who are assigned to counselors (both professionals and trainees) on the basis of mutual free time. The counselor who conducts the initial interview handles all subsequent counseling for the client. Sometimes the center's professionals have clients referred specifically to them. These clients are not included when the center staff examines the percentages of clients who return for a second interview. Professionals generally have a higher client-return rate than do trainees.

Session Depth and Smoothness in Relation to the Concept of Engagement in Counseling

The study investigated the relationship of therapist-rated client and therapist involvement and client relatedness in the first session to strength of working alliance, measured after the third session, and type of client termination. Ten therapists and their 109 college student clients participated. How well the client related at intake was positively associated with client and therapist alliance scores. Client intake involvement was positively associated with client alliance assessment. Unilateral client terminations were related to weaker client and therapist working alliance evaluations. Results indicate the importance of building a strong alliance in the early phases of counseling.

Georgiana Shick Tryon

Papers

A meta-analytic examination of client-therapist perspectives of the working alliance.

Relationship of Working Alliance to Mutual and Unilateral Termination.

Counseling Based On Process Research: Applying What We Know

Session Depth and Smoothness in Relation to the Concept of Engagement in Counseling

Client Involvement, Working Alliance, and Type of Therapy Termination