Kray,
Todd (1/10) Evaluation of the therapeutic alliance and patient-therapist
emotional exploration in time-limited therapy (Lisa Samstag, Ph.D.; Nicholas
Papouchis, Ph.D.; Howard Mcguire, Ph.D.)
This study investigated the relationship
between the patient-therapist working alliance and depth of in-session
psychological exploration for both patient and therapist in the early phase
(first six sessions) of brief psychotherapy protocols. It examined 29
psychotherapy dyads who completed a 30-session treatment protocol. The strength
of the working alliance was measured by the patient- and therapist-rated
Working Alliance Inventory, Short Form (WAI-S; Tracey & Kokotovic, 1989).
Depth of psychological exploration for patient and therapist was assessed by an
observer-rated measure, The Experiencing Scale (EXP; Gendlin, 1961; Klein,
Coughlin, and Kiesler, 1986). The study's primary objective was to demonstrate
that patients and therapists who endorsed high working alliance scores over the
first three treatment sessions would be rated as having high levels of
psychological exploration in the subsequent three sessions. Additionally, the
study investigated three other hypotheses: (1) patient ratings of the working
alliance would be a better predictor of their own depth of psychological
exploration; (2) discrepancies between patient and therapist ratings of working
alliance would predict a lower level of psychological exploration for both
patient and therapist, and (3) level of patient exploration would be positively
associated with level of therapist exploration. Another objective of the study
was to demonstrate that patients who were rated as having high levels of
psychological exploration would be associated with a reduction in
symptomatology, as assessed by two outcome measures, the Symptom Checklist 90-Revised
(SCL-90 R; Derogatis, 1983), and the Inventory of Interpersonal Problems-32
(IIP-32; Barkham, Hardy, & Startup, 1996). Results demonstrated that: (1)
higher working alliance scores were not associated with greater depth of
psychological exploration for either patients or therapists in the early phase
of treatment, (2) patient working alliance ratings did not better predict
patient level of exploration; (3) patients and therapists did not substantially
differ in their ratings of alliance, and consequently, discrepancy scores did
not predict depth of exploration for either member of the dyad, and (4)
observer ratings of patient and therapist levels of psychological exploration
were strongly associated with each other. Additionally, patients who displayed
high levels of psychological exploration demonstrated a reduction in
symptomatology as measured by the SCL-90, but did not when symptomatology was
assessed using the IIP-64. Implications and recommendations for future research
are discussed.
