The generalizability of the psychoanalytic concept of the working alliance.
01 Jan 1979-Psychotherapy (Division of Psychotherapy (29), American Psychological Association)-Vol. 16, Iss: 3, pp 252-260
TL;DR: Bordin this article reviewed and elaborated the psychoanalytic concept of the working alliance and argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances embedded in them, and that the strength, rather than the kind of working alliance, will prove to be the major factor in change achieved through psychotherapy.
Abstract: The psychoanalytic concept of the working alliance is reviewed and elaborated. It is argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances embedded in them. Moreover, the strength, rather than the kind of working alliance, will prove to be the major factor in change achieved through psychotherapy. Strength of alliance will be a function of the goodness of fit of the respective personalities of patient and therapist to the demands of the working alliance. Past research bearing on these propositions and indicated future research are discussed. Extensions to changes sought in teaching and other group processes are briefly touched. Proliferation of psychotherapies has dominated the sixties and seventies. Thirty-six psychotherapies (Harper, 1959) had to be supplemented by an additional compilation (Harper, 1975). Unchecked, this trend would come perilously close to the solipsism, a psychotherapeutic method for each psychotherapist. Not unexpectedly, research in psychotherapy has suffered from an analogous lack of convergence, and with it a disappointing impotence about providing empirical tests of competing claims. As Donald Campbell (1976) suggests, given the wide prevalence of the need for psychotherapy, and the continuing ability of individuals or society to pay for it, the winnowing of this harvest of methods must come from research. Campbell (1976) speaks to the practitioner, exhorting him or her to engage in systematic follow-up. This essay addresses those prac1 An earlier version of this paper was given at the annual meeting of the Society for Psychotherapy, June, 1975. * Requests for reprints should be sent to Edward S. Bordin, Ph.D., University of Michigan Counseling Center, 1007 East Huron Street, Ann Arbor, Michigan 48109. titioners who are also research workers, to call attention to a point of view that can encompass most, if not all, approaches to psychotherapy and can lead toward the needed convergence in research. There has been a promising rate of growth of research and research workers, with encouraging trends toward a coming together on basic issues: I aim to contribute to that movement. Moreover, because of the generalizability of my ideas to all change situations, I hope to stimulate research applications to teaching and to community change processes. 1 propose that the working alliance between the person who seeks change and the one who offers to be a change agent is one of the keys, if not the key, to the change process. The working alliance can be defined and elaborated in terms which make it universally applicable, and can be shown to be valuable for integrating knowledge—particularly for pointing to new research directions. As my initial statement suggests, a working alliance between a person seeking change and a change agent can occur in many places besides the locale of psychotherapy. The concept of the working alliance would seem to be applicable in the relation between student and teacher, between community action group and leader, and, with only slight extension, between child and parent. While I believe such extensions to be fruitful, they are beyond the scope of this paper. I shall confine myself to the therapeutic working alliance, making only brief inferences to extensions to other change enterprises.2 2 One might extend the idea of working alliances to nonchange situations. Although prisons, under reform ideology, have been set up as change situations, most observation suggests that staff and inmates typically arrive at a mutually agreed-upon alliance to get through their relationship with as little upset as possible.
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01 Jan 2014
TL;DR: In this article, the authors used interpretative phenomenological analysis (IPA) to analyse 8 participants' experiences of rejection sensitivity and found that rejection sensitivity is the same concept as abandonment anxiety.
Abstract: 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.
3,365 citations
3,168 citations
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.
3,127 citations
TL;DR: This paper reviews the conceptual and empirical literature in order to develop a model of the various aspects of the doctor-patient relationship encompassed by the concept of 'patient-centredness' and to assess the advantages and disadvantages of alternative methods of measurement.
2,609 citations
Cites background from "The generalizability of the psychoa..."
...More recent developments (Roth & Fonagy, 1996) emphasise the importance of aspects of the professional±patient relationship, including (a) the patient's perception of the relevance and potency of interventions oered, (b) agreement over the goals of treatment, and (c) cognitive and aective components, such as the personal bond between doctor and patient and perception of the doctor as caring, sensitive and sympathetic (Bordin, 1979; Squier, 1990)....
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...(1996) and Mead and Bower (2000) the exchange of psychosocial information (by either party) is treated as patient-centred whereas biomedical information-exchange is not....
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...…perception of the relevance and potency of interventions o ered, (b) agreement over the goals of treatment, and (c) cognitive and a ective components, such as the personal bond between doctor and patient and perception of the doctor as caring, sensitive and sympathetic (Bordin, 1979; Squier, 1990)....
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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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Book•
01 Feb 1961TL;DR: This popular study of "psychological healing"treats topics ranging from religious revivalism and magical healing to contemporary psychotherapies, from the role of the shaman in nonindustrialized societies to the traditional mental hospital.
Abstract: This popular study of "psychological healing"treats topics ranging from religious revivalism and magical healing to contemporary psychotherapies, from the role of the shaman in nonindustrialized societies to the traditional mental hospital. Jerome and Julia Frank (who are father and daughter) contend that these therapies share common elements that improve the "morale"of sufferers. And in combating the "demoralizing meaning"that people attach to their experiences, the authors argue, many therapies are surprisingly similar to rhetoric (the art of persuasion) and to hermeneutics (the study of meanings). Highly acclaimed in previous editions, Persuasion and Healing has been completely revised and expanded. In addition to a broadened exploration of the role of demoralization in illness, this latest edition offers updated information on topics including self-help, family therapy, psychopharmacology, psychotherapy for the mentally ill, and techniques such as primal therapy and bioenergetics. As they explore the power of "healing rhetoric"in these activities, the authors strengthen the ties among the various healing profession.
1,492 citations
Book•
01 Jun 1967
TL;DR: In this article, a systematic and comprehensive volume devoted essentially to the fundamentals of psychoanalytic technique: transference and resistance, is devoted to the patient's real relationship to the analyst, the working alliance, and the transference relationship.
Abstract: This systematic and comprehensive volume, written in a lively and clear style, is devoted essentially to the fundamentals of psychoanalytic technique: transference and resistance. The author approaches psychoanalytic technique from a classical theoretical framework, but he frequently gives an entirely fresh view of traditionally accepted procedures. His most important new contribution consists in the clear distinction between the patient's 'real relationship' to the analyst, the 'working alliance', and the transference relationship. His discussion of the contradictory and often conflicting demands which each of these elements makes on the technical skills of the analyst is particularly illuminating. In many fascinating case illustrations, he shows how the analyst carries out therapeutic psychoanalysis while respecting the diversity of psychic constellations in different patients and at different points in their analyses. This book can be recommended - without qualification - to the beginning student because of the thorough clarification and documentation of the basic principles of psychoanalytic technique.
1,166 citations
"The generalizability of the psychoa..." refers background in this paper
...The second draws, among others, on Zetzel (1956) and especially on Greenson (1967) for the significance of the real relationship in psychoanalytic work....
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Book•
01 Apr 1970TL;DR: Research in psychotherapy as mentioned in this paper is a comprehensive synthesis and assessment of the psychotherapeutic research literature for the use of both researchers and those in clinical practice, which is designed as a general reference work, an instruction guide, and a source of information about specific aspects and problems of research.
Abstract: Research in Psychotherapy is a comprehensive synthesis and assessment of the psychotherapeutic research literature for the use of both researchers and those in clinical practice. It is designed as a general reference work, an instruction guide, and a source of information about specific aspects and problems of research.The book consists of three parts. Part 1 discusses principles and methods of research as they are applied to psychotherapy. It provides general background material and principles to help non-researchers appreciate some of the important problems that are encountered. In Part 2, existing research on the effects of psychotherapy and the determinants and correlates of outcome are clustered and reviewed. Chapters 4 to 7 are concerned strictly with a review and appraisal of controlled studies that were designed to evaluate the effects of psychotherapy. Chapters 8 to 13 deal with a large body of research on various factors associated with therapeutic outcome--method, style, and technique variables; patient, therapist, and time variables. Part 3 is concerned with research on aspects of the therapeutic process and on the effect of many of these same variables on the therapeutic interchange as distinct from the outcome of therapy. Also discussed is research on various therapeutic phenomena and conditions about which so much has been written and so little really known.Research in Psychotherapy was written in the conviction that clinical practice should be influenced by research and that rigorous research that meets acceptable experimental standards can be done on the field of psychotherapy.
700 citations
582 citations
"The generalizability of the psychoa..." refers background in this paper
...One line of evidence comes from the work on the influence of expectations on therapeutic outcome by such investigators as Frank (1961, 1964), Goldstein (1962), Orne (1968), and Strong (1968)....
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...The conceptual framework of the working alliance, in emphasizing the need for consensus, directs attention to the process of reaching agreement, and gives less attention to the manipulation of expectations (Goldstein, 1962; Strong, 1968)....
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535 citations
"The generalizability of the psychoa..." refers background in this paper
...The second draws, among others, on Zetzel (1956) and especially on Greenson (1967) for the significance of the real relationship in psychoanalytic work....
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