Teaching on therapeutic alliance

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Charlie
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Joined: Thu Jul 24, 2014 5:40 pm

Teaching on therapeutic alliance

Post by Charlie »

Hi there

Not sure if I'm posting this in the right place, but here goes! I'm a psychotherapy researcher (not clinically trained) and wanted to pick the brains of those of you who are clinically trained/training. Really interested in any kind of clinical training.

We know the alliance is a strong predictor of outcome, but how do we actually teach clinicians to foster a good therapeutic relationship? I'm wondering what teaching/training looks like on the topic of the therapeutic alliance. Have you received formal training on this topic (e.g. theories of the alliance, rupture/repair in the alliance?). I'm really interested in what teaching looks like, how it is assessed etc.

There is so much literature on the importance of the therapeutic alliance, but a lot less on how to manage difficulties in the alliance. I've been reading a lot of work by Safran and Muran, and am especially interested in theories rupture/repair. Chatting with a couple of friends who are on clinical trainings, they were unfamiliar with a lot of the contemporary theories on the topic. This got me wondering what teaching on the topic looks like more widely and I am early stages of applying for a grant to do some work on training on this topic. So really interested to hear anyone's experiences (is there a gap for this sort of training? any good models of alliance training etc). Any thoughts would be much appreciated!
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miriam
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Re: Teaching on therapeutic alliance

Post by miriam »

Sounds interesting. I think the Feedback Informed Treatment model promoted by Scott D Miller might be relevant, as they get clients to rate their perception of whether the therapist has connected with them and is working on the right stuff at the end of each session, and see this as a chance to improve key elements of the alliance that maintain engagement and predicts successful outcomes. His reviews of the outcomes of therapy suggest that alliance is more important than model, adherence, training, or the type of professional people see, and that willingness to really listen to what is needed and what is important (and when you aren't getting it quite right as a therapist) is the best predictor of outcomes - and that often means that self-doubting therapists do a better job than those who are complacently confident they are doing a good job!
Miriam

See my blog at http://clinpsyeye.wordpress.com
Charlie
Posts: 55
Joined: Thu Jul 24, 2014 5:40 pm

Re: Teaching on therapeutic alliance

Post by Charlie »

I hadn't come across this so will look into Scott Miller's work. Sounds very interesting and relevant. Thanks Miriam!
alexh
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Joined: Sun Sep 23, 2012 7:57 pm

Re: Teaching on therapeutic alliance

Post by alexh »

We had some teaching on it during training. Essentially, highlighting the importance, explaining Bordin's concept of it and the moderate link to outcomes/dropout in the context of common factors theory more recently. That same teaching linked to the Barry Duncan and Scott Miller work, particularly the SRS, and Michael Lambert's OQ system.

Have you had a look at Chris Muran, Jeremy Safran and Catherine Eubanks' work on Alliance Focused Training? As far as I know there is not such focused training on DClinpsy or similar trainings about developing the alliance. You have obviously seen their work on ruptures more generally, have you seen their selected articles http://www.safranlab.net/selected-artic ... pters.html

Ardito and Rabellini have a good review of the historical development of the alliance concept. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/ You could see Elvins and Green on the various measures of the alliance.

Brattland has a good recent article (2019) on Miller and Duncan's PCOMS work.

Christoph Fluckiger does lots of research on it including a recent meta-analysis.
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