Research demonstrates that rejection sensitivity develops through early, continuing, or acute experiences of rejection from caregivers and significant others. Rejection sensitivity refers to individuals who anxiously or angrily expect, readily perceive, and intensely react to rejection. The question regarding why rejection is feared by rejection sensitive individuals remains unanswered by existing rejection sensitivity literature. Therefore, the current study answers this question using interpretative phenomenological analysis (IPA) to analyse 8 participants' experiences of rejection sensitivity. Four superordinate themes emerged: `experiences of parenting'; `impact of rejection'; `coping with the concept of rejection'; and `identity'. The primary fundamental finding indicates that rejection sensitivity is the same concept as abandonment anxiety. Participants in the current study demonstrate both rejection sensitivity and abandonment anxiety. Furthermore, the origins and characteristics of both concepts are identified as the same. Therefore, these findings indicate that rejection is feared for the same reason that abandonment is feared. In childhood, abandonment is experienced as terrifying and therefore defences are adopted to avoid further abandonment. The concept of `past in present' means that childhood feelings can be timelessly re-experienced in adulthood as actual and unchanged. Therefore, later rejection situations are perceived as abandonment and accordingly alert an individual to impending danger. As a result, rejection is feared because it is perceived as abandonment and as a threat to survival. This finding is fundamental to the fields of rejection sensitivity and abandonment anxiety, in terms of research and therapeutic work with clients. Integrating existing literature provides much greater depth of knowledge and support for these concepts. Recommended therapeutic approaches for abandonment anxiety can also inform interventions for rejection sensitive clients. Findings also suggest that participants experience annihilation anxiety in relation to perceived rejection, which further increases fear. Clinical applications and implications with respect to the findings arc discussed.

Interpretative phenomenological analysis

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.

Results of 24 studies (based on 20 distinct data sets) relating the quality of the working alliance (WA) to therapy outcome were synthesized using meta-analytic procedures. A moderate but reliable association between good WA and positive therapy outcome was found. Overall, the quality of the WA was most predictive of treatment outcomes based on clients' assessments, less so of therapists' assessments, and least predictive of observers' report

Relation between Working Alliance and Outcome in Psychotherapy: A Meta-Analysis.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r .275 (k 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p .0001. The data collected for this meta-analysis were quite variable (heterogeneous). Potential variables such as assessment perspectives (client, therapist, observer), publication source, types of assessment methods and time of assessment were explored.

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Alliance in individual psychotherapy.

Factors that influence client outcome can be divided into four areas: extratherapeutic factors, expectancy effects, specific therapy techniques, and common factors. Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome t

Research summary on the therapeutic relationship and psychotherapy outcome.

The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations.

Aspects of the reliability and criterion-related validity of the patient version of the California Psychotherapy Alliance Scales (CALPAS-P) were examined. The sample consisted of 147 patients consulting in private practice. These patients completed the 24-item CALPAS-P designed to assess 4 alliance dimensions. They also filled out questionnaires on symptomatology (SCL-10), intimacy problems (IIP), social desirability (MC-SDS), and satisfaction (CSQ-8)

Reliability and criterion-related validity of the California psychotherapy alliance scales-patient version

The California Therapeutic Alliance Rating System, was used by judges to rate four therapy sessions for each of 52 subjects treated in brief dynamic psychotherapy for pathological grief

Toward the validation of the California Therapeutic Alliance Rating System.

For older depressed adults treated in behavioral, cognitive, or brief dynamic therapy, we examined alliance-outcome associations over and above initial symptomatology and in-treatment symptomatic c

Alliance Prediction of Outcome Beyond in-Treatment Symptomatic Change as Psychotherapy Processes

Older adults who met criteria for major depressive disorder were randomly assigned to behavioral, cognitive, or brief dynamic therapy. Symptoms were equally reduced across the three treatment conditions. Early in treatment, alliance ratings were obtained from both therapists and patients and were related to outcome. We calculated one therapist alliance composite score and five patient alliance factor scores. In general, no agreement was found between therapists' and patients' judgments of alliance. Levels of alliance were found to be not significantly different across the three treatment conditions. For the sample as a whole, only the patient factor of Patient Commitment was found to be associated with depressive symptoms after treatment, with the strongest findings in the cognitive therapy condition. The Patient Commitment factor uniquely contributed to outcome over and above the contribution of initial symptomatology and symptomatic change at midpoint in therapy. Expected trends of association with outcome were observed for the therapist alliance composite score in brief dynamic therapy and for the patient factor of Patient Working Capacity in both cognitive and brief dynamic therapy. Findings are discussed in terms of their theoretical and clinical implications.

Louise Gaston

Papers

The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations.

Reliability and criterion-related validity of the California psychotherapy alliance scales-patient version

Toward the validation of the California Therapeutic Alliance Rating System.

Alliance Prediction of Outcome Beyond in-Treatment Symptomatic Change as Psychotherapy Processes

Alliance and outcome in late-life depression