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Using Multivariate Statistics

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 After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures.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.

Although the merits of parents using corporal punishment to discipline children have been argued for decades, a thorough understanding of whether and how corporal punishment affects children has not been reached. Toward this end, the author first presents the results of meta-analyses of the association between parental corporal punishment and 11 child behaviors and experiences. Parental corporal punishment was associated with all child constructs, including higher levels of immediate compliance and aggression and lower levels of moral internalization and mental health. The author then presents a process– context model to explain how parental corporal punishment might cause particular child outcomes and considers alternative explanations. The article concludes by identifying 7 major remaining issues for future

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Corporal punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review.

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

The article traces the development of the concept of the therapeutic working alliance from its psychodynamic origins to current pantheoretical formulations. Research on the alliance is reviewed under four headings: the relation between a positive alliance and success in therapy, the path of the alliance over time, the examination of variables that predispose individuals to develop a strong alliance, and the exploration of the in-therapy factors that influence the development of a positive alliance. Important areas for further research are also noted.

The role of the therapeutic alliance in psychotherapy.

This study examines the relationship between adult attachment style and posttraumatic stress symptomatology in a volunteer sample of adults who reported the experience of childhood abuse Sixty-six individuals completed measures of abuse history, attachment style, and posttraumatic stress symptomatology Results indicated that 76% of participants endorsed one of the three insecure attachment styles (dismissing, fearful, or preoccupied) Analyses of variances revealed that those who displayed fearful and preoccupied attachment styles, which represent a negative view of the self, had the highest mean scores on posttraumatic symptoms Correlational analyses revealed a significant positive relationship between negative view of self and posttraumatic stress symptomatology, but not between negative view of other and posttraumatic stress symptomatology Regression analyses indicated that having a negative view of self was most highly associated with posttraumatic stress symptoms, followed by a history of physical abuse The regression analysis further indicated that negative view of other was unrelated to posttraumatic stress symptoms

Relationship between attachment style and posttraumatic stress symptomatology among adults who report the experience of childhood abuse.

Social Support and the Relationship between Family and Community Violence Exposure and Psychopathology among High Risk Adolescents.

The intergenerational transmission of corporal punishment: a comparison of social learning and temperament models

Social support, attachment, and psychopathology in high risk formerly maltreated adults.

This study examined the mediating role of attachment in the relationship between childhood maltreatment perpetrated by parents and adult symptomatology. Young adults (N = 803), with and without a history of abuse, were recruited from a local university to complete a series of questionnaires inquiring about past maltreatment experiences, adult attachment in current close relationships, and psychological symptomatology. While attachment was found to be a mediator for all three types of abuse when they were looked at individually, a more robust mediated effect was found in the case of psychological abuse. When all three types of parental maltreatment (psychological, physical, and exposure to family violence) were considered simultaneously, attachment mediated the relationship between only psychological abuse and symptomatology. Parallel meditated effects were observed across two measures of symptomatology: trauma-related symptomatology and externalizing and internalizing symptomatology. The results of this study further our understanding of psychological maltreatment and its intra-individual correlates.

Robert T. Muller

Papers

Relationship between attachment style and posttraumatic stress symptomatology among adults who report the experience of childhood abuse.

Social Support and the Relationship between Family and Community Violence Exposure and Psychopathology among High Risk Adolescents.

The intergenerational transmission of corporal punishment: a comparison of social learning and temperament models

Social support, attachment, and psychopathology in high risk formerly maltreated adults.

Attachment as a Mediator between Childhood Maltreatment and Adult Symptomatology