Order and Pattern Formation in Psychotherapy

Frontiers in psychology, 2015

There is broad consensus that the therapeutic alliance constitutes a core common factor for all modalities of psychotherapy. Meta-analyses corroborated that alliance, as it emerges from therapeutic process, is a significant predictor of therapy outcome. Psychotherapy process is traditionally described and explored using two categorically different approaches, the experiential (first-person) perspective and the behavioral (third-person) perspective. We propose to add to this duality a third, structural approach. Dynamical systems theory and synergetics on the one hand and enactivist theory on the other together can provide this structural approach, which contributes in specific ways to a clarification of the alliance factor. Systems theory offers concepts and tools for the modeling of the individual self and, building on this, of alliance processes. In the enactive perspective, the self is conceived as a socially enacted autonomous system that strives to maintain identity by observin...

Psychotherapy Research, 2009

The relevance of the shape of alliance processes over the course of psychotherapy has already been highlighted in several process-outcome studies on very brief psychotherapy. The present study applies the shape-of-change methodology to short-term dynamic psychotherapies (STDP) and complements this method with hierarchical linear modeling (HLM). A total of 50 psychotherapies of up to 40 sessions were included. The shape-ofchange methodology yields three main patterns: stable, linear and quadratic growth. In particular, the linear growth pattern, along with the slope parameter, is related to treatment outcome. This study sheds additional light on alliance process research, underlines the importance of alliance shape for outcome and also helps to understand its limitations better.

Observations from therapeutic practice and a series of empirical findings, for example, those on discontinuous change in psychotherapeutic processes, suggest modelling the therapeutic process as a self-organizing system with stable and critical instable phases and abrupt transitions. Here, a concept of psychotherapeutic change is presented that applies self-organization theory to psychodynamic principles. The authors explain the observa- tions and considerations that form the basis of the concept and present some connections with existing find- ings and concepts. On the basis of this model, they generated two hypotheses regarding the co-occurrence of instability and discontinuous change and the degree of synchrony between the therapist and patient. A study design to test these hypotheses was developed and applied to a single case (psychodynamic therapy). After each session, patient and therapist rated their interaction. A measure of instability was calculated across the resulting time series. Sequences of destabilization were observed. On the basis of points of extreme instability, the pro- cess was divided into phases. Local instability maxima were accompanied by significant discontinuous change. Destabilization was highly synchronous in therapist and patient ratings. The authors discussed the concept and the methodological procedure. The approach enables the operationalization of crises and to empirically assess the significance of critical phases and developments within the therapeutic relationship.

Counselling and Psychotherapy Research, 2011

Alliance evolutions, i.e., ruptures and resolutions over the course of psychotherapy, have shown to be an important descriptive feature in different forms of psychotherapy, and in particular in psychodynamic psychotherapy. This case study of a client presenting elements of adjustment disorder undergoing short-term dynamic psychotherapy is drawn from a systematic naturalistic study and aims at illustrating, on a session-by-session-level, the processes of alliance ruptures and resolutions, by comparing both the client's and the therapist's perspectives. Two episodes of alliance evolution are more fully studied, in relation to the evolution of transference, as well as the client's defensive functioning and core conflictual theme. These concepts are measured by means of valid, reliable observer-rater methods, based on session transcripts: Defense Mechanisms Rating Scales (DMRS; Perry, 1990) for defensive functioning and Core Conflictual Relationship Theme (CCRT; Luborsky, & Crits-Christoph, 1990) for the conflicts. Alliance is measured after each session using the Helping Alliance questionnaire (HAq-II). Results indicate that these episodes of alliance ruptures and resolutions may be understood as key moments of the whole therapeutic process reflecting the client's main relationship stakes. Illustrations are provided based on the client's in-session processes and related to the alliance development over the course of the entire therapy.

Anales de Psicologia, 2014

Título: El desarrollo de la alianza terapéutica y la aparición de rupturas en la Alianza. Resumen: Objetivos: Este estudio evaluó el desarrollo de la alianza terapéutica y la aparición de rupturas de alianzas, en una muestra de pacientes con diferentes diagnósticos y resultados terapéuticos. Diseño: Se analizaron los datos longitudinales de 38 díadas terapéuticas que recibieran terapia cognitivo-conductual. La muestra incluyó a casos de abandonos, así como casos exitosos y no exitosos. La muestra incluyó a casos con trastornos del Eje I y Eje II. Método: Al final de cada sesión, los pacientes evaluaron la alianza mediante el Inventario de Alianza de Terapéutica (WAI). Seis jueces entrenados en la observación de los marcadores de ruptura de alianza con un sistema de observación de rupturas, codificaran 201 sesiones terapéuticas grabadas en vídeo. Se aplicaran modelos estadísticos longitudinales a los datos. Resultados: Se encontró que el patrón de desarrollo de la alianza de los casos de éxito era diferente de la de los casos sin éxito y abandonos. En media, los pacientes con trastornos de la personalidad iniciaran la terapia con una menor puntuación en el WAI que disminuyó con el tiempo, mientras que los pacientes con trastornos del Eje I iniciaran la terapia con una mayor puntuación en el WAI que aumentó con el tiempo. Palabras clave: dDesarrollo de la alianza terapéutica; rupturas en la alianza, trastornos del Eje I; trastornos del Eje II.

Psychotherapy: Theory, Research, Practice, Training, 1995

Pattern of change in the therapeutic alliance across time-limited, 20-session individual psychotherapy was investigated with the procedure of hierarchical linear modeling (HIM) in two samples of 32 psychiatric outpatients, those with low and those with high quality of object relations (QOR). Significant (p < .05) variation in the pattern of change in the therapeutic alliance was found within each sample.

2013

Despite the long tradition in psychotherapy research literature concerning the role of therapeutic alliance (TA), both in terms of process and outcome in clinical intervention, little is known about its specific characteristics in short term dynamic psychotherapy (STDP). Accordingly, the main aim of the present work is to focus on the formal features of TA in a good outcome STDP. We applied the Collaborative Interaction Scale ) to verbatim transcripts in order to track macro and micro evolution of TA while considering the interplay of both therapist and patient contributions. Data were analyzed in terms of TA general trend, TA climate onset and high impact session TA characteristics. Results sustain the STDP theory of technique ) concerning the general process, the onset features and patient therapist interplay from a TA perspective.

Psychotherapy research : journal of the Society for Psychotherapy Research, 2016

The therapeutic alliance is considered the most robust process variable associated with positive therapeutic outcome in a variety of psychotherapeutic models [Alexander, L. B., & Luborsky, L. (1986). The Penn Helping Alliance Scales. In L. S. Greenberg & W. M. Pinsoff (Eds.), The psychotherapeutic process: A research handbook (pp. 325-356). New York: Guilford Press; Horvath, A. O., Gaston, L., & Luborsky, L. (1993). The alliance as predictor of benefits of counseling and therapy. In N. Miller, L. Luborsky, J. Barber, & J. P. Docherty (Eds.), Psychodynamic treatment research: A handbook for clinical practice (pp. 247-274). New York, NY: Basic Books; Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9-16; Orlinky, D., Grawe, K., & Parks, B. (1994). Process and outcome in psychotherapy: Noch einmal. In A. Bergin & J. S. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 270-378). New Y...

Psychotherapy, 1990

The alliance represents a promising construct for understanding change process in therapy. While theoretically sound and clinically useful, empirical evidence supports its predictive validity of psychotherapy outcome. The diverse theoretical perspectives on the alliance are reviewed and contrasted. Empirical results on the dimensionality of the various alliance measures are presented. Methodological recommendations are proposed. The predictive validity of the alliance is examined, as are the various hypothesized functions played by the alliance. Possible research strategies are suggested. As the field of psychotherapy research moves toward focusing on the simultaneous examination of both process and outcome of treatment, the overarching aim has become the understanding of the mechanisms of change. The ultimate goal is to develop more effective methods of treatment (VandenBos, 1986). In this perspective, the importance of theoretically relevant and clinically useful concepts has been stressed in the search for the effective ingredients of psychotherapy (Kiesler, 1985). A key concept of the psycho-The author wishes to thank Dr. Charles R. Marmar, M.D., and Dr. Stephane Sabourin, Ph.D., for their precious comments on a previous draft of the manuscript.