Therapeutic Alliance and Common Factors in Treatment

  • Daniella M. Halperin
  • Meara L. Weitzman
  • Michael W. Otto
Chapter
Part of the Series in Anxiety and Related Disorders book series (SARD)

Abstract

Changes in therapy can result from variables unique to a particular treatment package (i.e., specific factors), as a function of variables common to a variety of treatments (i.e., nonspecific/common factors), or a combination of both specific and nonspecific ingredients (Kazdin,1979). Nonspecific (or common) treatment factors include variables that are common across different treatment modalities, which are thought to influence outcomes in therapy but are often not well linked to a mechanism of change. Due to differences in what is posited to be important to the change process by any one treatment theory, specific factors that are deemed crucial for one theoretical approach might be considered a common factor for another approach (Kazdin,1979; Wilkins,1979).

Keywords

Placebo Depression Posit Smit Alprazolam 

References

  1. Arnkoff, D. B., Glass, C. R., & Shapiro, S. J. (2002). Expectations and preferences. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 335–356). New York: Oxford University Press.Google Scholar
  2. Basoglu, M., Lax, T., Kasvikis, Y., & Marks, I. M. (1988). Predictors of improvement in obsessive-compulsive disorder. Journal of Anxiety Disorders, 2(4), 299–317.CrossRefGoogle Scholar
  3. Basoglu, M., Marks, I. M., Kilic, C., Brewin, C. R., & Swinson, R. P. (1994). Alprazolam and exposure for panic disorder with agoraphobia: Attribution of improvement to medication predicts subsequent relapse. British Journal of Psychiatry, 164, 652–659.PubMedCrossRefGoogle Scholar
  4. Biondi, M., & Picardi, A. (2003). Increased probability of remaining in remission from panic disorder with agoraphobia after drug treatment in patients who received concurrent cognitive-behavioural therapy: A follow-up study. Psychotherapy and Psychosomatics, 72(1), 34–42.PubMedCrossRefGoogle Scholar
  5. Bonner, B. L., & Everett, F. L. (1982). Influence of client preparation and therapist prognostic expectations on children’s attitudes and expectations of psychotherapy. Journal of Clinical Child Psychology, 11(3), 202–208.CrossRefGoogle Scholar
  6. Bonner, B. L., & Everett, F. L. (1986). Influence of client preparation and problem severity on attitudes and expectations in child psychotherapy. Professional Psychology: Research and Practice, 17(3), 223–229.CrossRefGoogle Scholar
  7. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.CrossRefGoogle Scholar
  8. Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61(4), 611–619.PubMedCrossRefGoogle Scholar
  9. Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26(1), 25–30.PubMedCrossRefGoogle Scholar
  10. Brewin, C., & Antaki, C. (1982). The role of attributions in psychological treatment. In C. Antaki & C. Brewin (Eds.), Attributions and psychological change: Applications of attributional theories to clinical and educational practice (pp. 23–31). London: Academic Press.Google Scholar
  11. Briere, J. (1988). The long-term clinical correlates of childhood sexual victimization. Annals of the New York Academy of Sciences, 528, 327–334.PubMedCrossRefGoogle Scholar
  12. Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71(5), 843–861.PubMedCrossRefGoogle Scholar
  13. Chambless, D. L., & Gracely, E. J. (1989). Fear of fear and the anxiety disorders. Cognitive Therapy and Research, 13(1), 9–20.CrossRefGoogle Scholar
  14. Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18.PubMedCrossRefGoogle Scholar
  15. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716.PubMedCrossRefGoogle Scholar
  16. Chambless, D. L., Tran, G. Q., & Glass, C. R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11(3), 221–240.PubMedCrossRefGoogle Scholar
  17. Chemtob, C. M., Novaco, R. W., Hamada, R. S., & Gross, D. M. (1997). Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 65(1), 184–189.PubMedCrossRefGoogle Scholar
  18. Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067–1074.PubMedCrossRefGoogle Scholar
  19. Cloitre, M., Stovall-McClough, K. C., Miranda, R., & Chemtob, C. M. (2004). Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 72(3), 411–416.PubMedCrossRefGoogle Scholar
  20. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  21. Cole, P. M., & Putnam, F. W. (1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of Consulting and Clinical Psychology, 60(2), 174–184.PubMedCrossRefGoogle Scholar
  22. Conoley, C. W., Padula, M. A., Payton, D. S., & Daniels, J. A. (1994). Predictors of client implementation of counselor recommendations: Match with problem, difficulty level, and building on client strengths. Journal of Counseling Psychology, 41(1), 3–7.CrossRefGoogle Scholar
  23. Constantino, M. J., Castonguay, L. G., & Schut, A. J. (2002). The working alliance: A flagship for the “scientist–practitioner” model in psychotherapy. In G. S. Tryon (Ed.), Counseling based on process research: Applying what we know (pp. 81–131). Boston, MA: Allyn & Bacon.Google Scholar
  24. Davison, G. C., Tsujimoto, R. N., & Glaros, A. G. (1973). Attribution and the maintenance of behavior change in falling asleep. Journal of Abnormal Psychology, 82(1), 124–133.PubMedCrossRefGoogle Scholar
  25. Day, L., & Reznikoff, M. (1980). Preparation of children and parents for treatment at a children’s psychiatric clinic through videotaped modeling. Journal of Consulting and Clinical Psychology, 48(2), 303–304.PubMedCrossRefGoogle Scholar
  26. Delsignore, A., & Schnyder, U. (2007). Control expectancies as predictors of psychotherapy outcome: A systematic review. British Journal of Clinical Psychology, 46(4), 467–483.PubMedCrossRefGoogle Scholar
  27. Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73–86.PubMedCrossRefGoogle Scholar
  28. Dew, S. E., & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7(1), 21–33.PubMedCrossRefGoogle Scholar
  29. Dozois, D. J. A., & Westra, H. A. (2005). Development of the anxiety change expectancy scale (ACES) and validation in college, community, and clinical samples. Behaviour Research and Therapy, 43(12), 1655–1672.PubMedCrossRefGoogle Scholar
  30. Ehlers, A., Mayou, R. A., & Bryant, B. (1998). Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Journal of Abnormal Psychology, 107(3), 508–519.PubMedCrossRefGoogle Scholar
  31. Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore: Johns Hopkins University Press.Google Scholar
  32. Franklin, M. E., & Foa, E. B. (1998). Cognitive-behavioral treatments for obsessive-compulsive disorder. In P. E. Nathan & J. M. Gorman (Eds.), A guide to treatments that work (pp. 339–357). New York: Oxford University Press.Google Scholar
  33. Freud, S. (1958). On beginning the treatment: Further recommendations on the technique of psychoanalysis. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (pp. 122–144). London: Hogarth Press. (Original work published 1913)Google Scholar
  34. Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.) , Handbook of psychotherapy and behavior change (4th ed., pp. 190–228). Oxford: John Wiley & Sons.Google Scholar
  35. Goossens, M. E. J. B., Vlaeyen, J. W. S., Hidding, A., MKole-Snijders, A. M., & Evers, S. M. A. A. (2005). Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain. Clinical Journal of Pain, 21(1), 18–26.PubMedCrossRefGoogle Scholar
  36. Greenberg, R. P., Constantino, M. J., & Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26(6), 657–678.PubMedCrossRefGoogle Scholar
  37. Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621–632.PubMedCrossRefGoogle Scholar
  38. Hogue, A., Henderson, C. E., Dauber, S., Barajas, P. C., Fried, A., & Liddle, H. A. (2008). Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 76(4), 544–555.PubMedCrossRefGoogle Scholar
  39. Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36(2), 223–233.CrossRefGoogle Scholar
  40. Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139–149.CrossRefGoogle Scholar
  41. Huppert, J. D., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2006). The interaction of motivation and therapist adherence predicts outcome in cognitive behavioral therapy for panic disorder: Preliminary findings. Cognitive and Behavioral Practice, 13(3), 198–204.CrossRefGoogle Scholar
  42. Jeffrey, D. B. (1974). A comparison of the effects of external control and self-control on the modification and maintenance of weight. Journal of Abnormal Psychology, 83(4), 404–410.PubMedCrossRefGoogle Scholar
  43. Kazdin, A. E. (1979). Nonspecific treatment factors in psychology outcome research. Journal of Consulting and Clinical Psychology, 47(5), 846–851.PubMedCrossRefGoogle Scholar
  44. Klein, D. N., Schwartz, J. E., Santiago, N. J., Vivian, D., Vocisano, C., Castonguay, L. G., et al. (2003). Therapeutic alliance in depression treatment: Controlling for prior change and patient characteristics. Journal of Consulting and Clinical Psychology, 71(6), 997–1006.PubMedCrossRefGoogle Scholar
  45. Lazarus, A. A. (2003). Some reactions to Robert Kohlenberg’s article. The Behavior Therapist, 26(7), 380–381.Google Scholar
  46. Linehan, M. M., Cochran, B. N., Mar, C. M., Levensky, E. R., & Comtios, K. A. (2000). Therapeutic burnout among borderline personality disordered clients and their therapists: Development and evaluation of two adaptations of the Maslach Burnout Inventory. Cognitive and Behavioral Practice, 7(3), 329–337.CrossRefGoogle Scholar
  47. Livanou, M., Basoglu, M., Marks, I. M., De Sliva, P., Noshirvani, H., Lovell, K., et al. (2002). Beliefs, sense of control and treatment outcome in post-traumatic stress disorder. Psychological Medicine, 32(1), 157–165.PubMedCrossRefGoogle Scholar
  48. Loeb, K. L., Wilson, G. T., Labouvie, E., Pratt, E. M., Hayaki, J., Walsh, B. T., et al. (2005). Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: A study of process and outcome. Journal of Consulting and Clinical Psychology, 73(6), 1097–1107.PubMedCrossRefGoogle Scholar
  49. Maltby, N., & Tolin, D. F. (2005). A brief motivational intervention for treatment-refusing OCD patients. Cognitive Behaviour Therapy, 34(3), 176–184.PubMedCrossRefGoogle Scholar
  50. Marmar, C. R., Weiss, D. S., & Gaston, L. (1989). Toward the validation of the California therapeutic alliance rating system. Journal of Consulting and Clinical Psychology, 1(1), 46–52.CrossRefGoogle Scholar
  51. Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.PubMedCrossRefGoogle Scholar
  52. Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147–172.CrossRefGoogle Scholar
  53. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change addictive behavior. New York: The Guilford Press.Google Scholar
  54. Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10(2), 155–180.CrossRefGoogle Scholar
  55. Norcross, J. C. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.Google Scholar
  56. Otto, M. W., & Hofmann, S. G. (Eds.). (2009). Avoiding treatment failures in the anxiety disorders. New York: Springer.Google Scholar
  57. Powers, M. B., Smits, J. A. J., Whitley, D., Bystritsky, A., & Telch, M. J. (2008). The effect of attributional processes concerning medication taking on return of fear. Journal of Consulting and Clinical Psychology, 76(3), 478–490.PubMedCrossRefGoogle Scholar
  58. Raue, P. J., Goldfried, M. R., & Barkham, M. (1997). The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 65(4), 582–587.PubMedCrossRefGoogle Scholar
  59. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.PubMedCrossRefGoogle Scholar
  60. Rubak, S., Sandboek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. The British Journal of General Practice, 55, 305–311.PubMedGoogle Scholar
  61. Safran, J. D. (1990). Towards a refinement of cognitive therapy in light of interpersonal theory: I. Theory. Clinical Psychology Review, 10(1), 87–105.CrossRefGoogle Scholar
  62. Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71(3), 452–464.PubMedCrossRefGoogle Scholar
  63. Shuman, A. L., & Shapiro, J. P. (2002). The effects of preparing parents for child psychotherapy on accuracy of expectations and treatment attendance. Community Mental Health Journal, 38(1), 3–16.PubMedCrossRefGoogle Scholar
  64. Slagle, D. M., & Gray, M. J. (2007). The utility of motivational interviewing as an adjunct to exposure therapy in the treatment of anxiety disorders. Professional Psychology: Research and Practice, 38(4), 329–337.CrossRefGoogle Scholar
  65. Smits, J. A. J., Reese, H. E., Powers, M. B., & Otto, M. W. (2009). Combined treatment strategies: Current efficacy and future directions. In M. W. Otto & S. G. Hofmann (Eds.), Avoiding treatment failures in the anxiety disorders (pp. 67–81). New York: Springer.Google Scholar
  66. Snyder, C. R., Ilardi, S., Michael, S. T., & Cheavens, J. (2000). Hope theory: Updating a common process for psychological change. In C. R. Snyder, & R. E. Ingram (Eds.), Handbook of psychological change: Psychotherapy processes and practices for the 21st century (pp. 128–153). New York: Wiley.Google Scholar
  67. Snyder, C. R., Michael, S., & Cheavens, J. (1999). Hope as a psychotherapeutic foundation of common factors, placebos, and expectancies. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 179–200). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  68. Sonne, J., & Janoff, D. (1979). The effect of treatment attributions on the maintenance of weight reduction: A replication and extension. Cognitive Therapy and Research, 3(4), 389–397.CrossRefGoogle Scholar
  69. Spinhoven, P., Giesen-Bloo, J., van Dyck, R., & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 75(1), 104–115.PubMedCrossRefGoogle Scholar
  70. Spitzer, R. L., Williams, J. B., Gibbon, M., & First, M. B. (1990). User’s guide for the structured clinical interview for DSM-III-R – Personality Disorders (SCID-II). Washington, DC: American Psychiatric Association.Google Scholar
  71. Strauss, J. L., Hayes, A. M., Johnson, S. L., Newman, C. F., Brown, G. K., Barber, J. P., et al. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2), 337–345.PubMedCrossRefGoogle Scholar
  72. Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67(6), 894–904.PubMedCrossRefGoogle Scholar
  73. Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620–630.PubMedCrossRefGoogle Scholar
  74. Westra, H. A., & Dozois, D. J. A. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30(4), 481–498.CrossRefGoogle Scholar
  75. Westra, H. A., Dozois, D. J. A., & Marcus, M. (2007). Expectancy, homework compliance, and initial change in cognitive-behavioral therapy for anxiety. Journal of Consulting and Clinical Psychology, 75(3), 363–373.PubMedCrossRefGoogle Scholar
  76. Wilkins, W. (1979). Expectancies in therapy research: Discriminating among heterogeneous nonspecifics. Journal of Consulting and Clinical Psychology, 47(5), 837–845.PubMedCrossRefGoogle Scholar
  77. Wolfe, B. E., & Goldfried, M. R. (1988). Research on psychotherapy integration: Recommendations and conclusions from an NIMH workshop. Journal of Consulting and Clinical Psychology, 56(3), 448–451PubMedCrossRefGoogle Scholar
  78. Woods, C. M., Chambless, D. L., & Steketee, G. (2002). Homework compliance and behavior therapy outcome for panic with agoraphobia and obsessive compulsive disorder. Cognitive Behaviour Therapy, 31(2), 88–95.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Daniella M. Halperin
    • 1
  • Meara L. Weitzman
    • 1
  • Michael W. Otto
    • 1
  1. 1.Department of PsychologyBoston UniversityBostonUSA

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