Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review.
01 Jun 2000-Journal of Consulting and Clinical Psychology (American Psychological Association)-Vol. 68, Iss: 3, pp 438-450
TL;DR: 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.
Abstract: 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 After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures.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.
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TL;DR: Almost all interracial encounters are prone to microaggressions; this article uses the White counselor--client of color counseling dyad to illustrate how they impair the development of a therapeutic alliance.
Abstract: Racial microaggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. Perpetrators of microaggressions are often unaware that they engage in such communications when they interact with racial/ethnic minorities. A taxonomy of racial microaggressions in everyday life was created through a review of the social psychological literature on aversive racism, from formulations regarding the manifestation and impact of everyday racism, and from reading numerous personal narratives of counselors (both White and those of color) on their racial/cultural awakening. Microaggressions seem to appear in three forms: microassault, microinsult, and microinvalidation. Almost all interracial encounters are prone to microaggressions; this article uses the White counselor--client of color counseling dyad to illustrate how they impair the development of a therapeutic alliance. Suggestions regarding education and training and research in the helping professions are discussed.
3,916 citations
15 Sep 2016
TL;DR: An overview of the current evidence of major depressive disorder, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment, is provided.
Abstract: Major depressive disorder (MDD) is a debilitating disease that is characterized by depressed mood, diminished interests, impaired cognitive function and vegetative symptoms, such as disturbed sleep or appetite. MDD occurs about twice as often in women than it does in men and affects one in six adults in their lifetime. The aetiology of MDD is multifactorial and its heritability is estimated to be approximately 35%. In addition, environmental factors, such as sexual, physical or emotional abuse during childhood, are strongly associated with the risk of developing MDD. No established mechanism can explain all aspects of the disease. However, MDD is associated with alterations in regional brain volumes, particularly the hippocampus, and with functional changes in brain circuits, such as the cognitive control network and the affective-salience network. Furthermore, disturbances in the main neurobiological stress-responsive systems, including the hypothalamic-pituitary-adrenal axis and the immune system, occur in MDD. Management primarily comprises psychotherapy and pharmacological treatment. For treatment-resistant patients who have not responded to several augmentation or combination treatment attempts, electroconvulsive therapy is the treatment with the best empirical evidence. In this Primer, we provide an overview of the current evidence of MDD, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment.
1,728 citations
TL;DR: A research synthesis of the relation between alliance and the outcomes of individual psychotherapy covered over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments.
Abstract: 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.
1,717 citations
Cites background or methods or result from "Relation of the therapeutic allianc..."
...For identifying studies published between 1973 and 2000, we relied on data from previous analyses (Horvath & Symonds, 1991; Martin et al., 2000; Horvath & Bedi, 2002) but the effect sizes (ES) where recalculated (using more up-to-date methods) for all but 10 of the oldest unpublished studies which were no longer available....
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...Each of these four instruments has been in use for over 20 years and has demonstrated an acceptable level of internal consistency (Martin et al., 2000)....
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...The magnitude of the relationship we found in the current meta-analysis is a little larger but similar to the values reported in previous research (Horvath & Symonds, 1991 r .26, k 26; Martin et al., 2000, r .22, k 79; Horvath & Bedi, 2002, r .21, k 100)....
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...For identifying studies published between 1973 and 2000, we relied on data from previous analyses (Horvath & Symonds, 1991; Martin et al., 2000; Horvath & Bedi, 2002) but the effect sizes (ES) where recalculated (using more up-to-date methods) for all but 10 of the oldest unpublished studies which…...
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TL;DR: The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005.
Abstract: The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005.
1,716 citations
TL;DR: The authors found that common factors such as empathy, warmth, and the therapeutic relationship correlate more highly with client outcome than extratherapeutic factors, expectancy effects, specific therapy techniques, and common factors.
Abstract: 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
1,541 citations
References
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01 Jan 1953
TL;DR: The Complete Psychological Works of Sigmund Freud in English as mentioned in this paper is the first full paperback publication of the standard edition of the complete psychological works in English, containing twenty-four volumes.
Abstract: Indexes and Bibliographies. This collection of twenty-four volumes is the first full paperback publication of the standard edition of The Complete Psychological Works of Sigmund Freud in English
11,462 citations
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01 Jan 1985
TL;DR: In this article, the authors present a model for estimating the effect size from a series of experiments using a fixed effect model and a general linear model, and combine these two models to estimate the effect magnitude.
Abstract: Preface. Introduction. Data Sets. Tests of Statistical Significance of Combined Results. Vote-Counting Methods. Estimation of a Single Effect Size: Parametric and Nonparametric Methods. Parametric Estimation of Effect Size from a Series of Experiments. Fitting Parametric Fixed Effect Models to Effect Sizes: Categorical Methods. Fitting Parametric Fixed Effect Models to Effect Sizes: General Linear Models. Random Effects Models for Effect Sizes. Multivariate Models for Effect Sizes. Combining Estimates of Correlation Coefficients. Diagnostic Procedures for Research Synthesis Models. Clustering Estimates of Effect Magnitude. Estimation of Effect Size When Not All Study Outcomes Are Observed. Meta-Analysis in the Physical and Biological Sciences. Appendix. References. Index.
9,769 citations
"Relation of the therapeutic allianc..." refers methods in this paper
...Because analyses in this area of research are usually reported as correlations between alliance and outcome, we used a variation of the product–moment correlation as the effect size estimate (Hedges & Olkin, 1985; Hunter & Schmidt, 1990; Rosenthal, 1991)....
[...]
TL;DR: In this paper, the authors present a model for estimating the effect size from a series of experiments using a fixed effect model and a general linear model, and combine these two models to estimate the effect magnitude.
Abstract: Preface. Introduction. Data Sets. Tests of Statistical Significance of Combined Results. Vote-Counting Methods. Estimation of a Single Effect Size: Parametric and Nonparametric Methods. Parametric Estimation of Effect Size from a Series of Experiments. Fitting Parametric Fixed Effect Models to Effect Sizes: Categorical Methods. Fitting Parametric Fixed Effect Models to Effect Sizes: General Linear Models. Random Effects Models for Effect Sizes. Multivariate Models for Effect Sizes. Combining Estimates of Correlation Coefficients. Diagnostic Procedures for Research Synthesis Models. Clustering Estimates of Effect Magnitude. Estimation of Effect Size When Not All Study Outcomes Are Observed. Meta-Analysis in the Physical and Biological Sciences. Appendix. References. Index.
7,063 citations
Book•
01 Jan 1984TL;DR: In this paper, the authors define research results, retrieve and assess research results and compare and combine research results to combine probabilities, and evaluate meta-analytic procedures and meta-Analytic results.
Abstract: Introduction Defining Research Results Retrieving and Assessing Research Results Comparing and Combining Research Results Combining Probabilities Illustrations of Meta-Analytic Procedures The Evaluation of Meta-Analytic Procedures and Meta-Analytic Results
5,181 citations
"Relation of the therapeutic allianc..." refers methods in this paper
...Because analyses in this area of research are usually reported as correlations between alliance and outcome, we used a variation of the product–moment correlation as the effect size estimate (Hedges & Olkin, 1985; Hunter & Schmidt, 1990; Rosenthal, 1991)....
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Book•
01 Jan 1990TL;DR: In this article, the authors present a meta-analysis of Artifact Distributions and their impact on study outcomes. But they focus mainly on the second-order sampling error and related issues.
Abstract: PART ONE: INTRODUCTION TO META-ANALYSIS Integrating Research Findings Across Studies Study Artifacts and Their Impact on Study Outcomes PART TWO: META-ANALYSIS OF CORRELATIONS Meta-Analysis of Correlations Corrected Individually for Artifacts Meta-Analysis of Correlations Using Artifact Distributions Technical Questions in Meta-Analysis of Correlations PART THREE: META-ANALYSIS OF EXPERIMENTAL EFFECTS AND OTHER DICHOTOMOUS COMPARISONS Treatment Effects Experimental Artifacts and Their Impact Meta-Analysis Methods for d Values Technical Questions in Meta-Analysis of d Values PART FOUR: GENERAL ISSUES IN META-ANALYSIS Second Order Sampling Error and Related Issues Cumulation of Findings within Studies Methods of Integrating Findings Across Studies Locating, Selecting, and Evaluating Studies General Criticisms of Meta-Analysis Summary of Psychometric Meta-Analysis
4,673 citations