G508566734 PGSP s7a Sep 10 03 09 Chaps 4 J Resolution of Altance Ruptures Although therapists of al orientations can create obsaces inthe therapeu relationship algo help improve it. this wasnt the cse, mos treatments would stp beng ben. 5gniiant cecurence of liane problems, And and personal relationship (suchas the one between client and therapist involves some degree of tnd frastation, most paychothery ‘Would end prematurely and without ving fcitated client chang As previously mentioned, esac by Cot-Christoph et al (193) has suggested tha the acacacy ofthe therapist's intervnons may fac nol prablemati re Intionsips. This study, however, hs not provided éesled infomation on bow wis cule take ol sed bythe Barns & Averac! niques to address ns to repair a leader of the cognitive appronc, egative emotion regarding therapy andthe theropantcrelaon- 's negative emotions resulting fom the theca tetve to the clea’ needs, Also ercil to Bums’ contebuton isa technique ca which refers to the therapist’ explicit validation and ex ploration of the client's ercisms and horliy coward the therapist or the therapy. The ‘herspit is encouraged to find some tat in the clients perception ofthe therapist ad apy (even when the client may seem “uveasonsble” and “unfi) and to invite the lent to express feelings of anger, dssppoiniment, or frustration esocated wits hs per ception. According to Bums (1989), the thersps's acknowledgment and inquiry of cl cents negative emotions {o resume engagement in the therapeutic tank prescribed in cog Similar oolso resolve alliance ruptures have been developed by Jeremy Safan and his colleagues (Safran et sl, 1990; Safran & Segal, 199. To facilis the detection of tears in the relationship, they encourage therapist to adopt the trode of “parsipant- ‘obterver" described by Sullivan (1953) Therapists ae alto urged to une empathy in help {ng clients to identity and describe thls experience relted to dficules a the herapevtc relationship. Although Safran and Segal (1980) srqued scan contribute to ance ruptures, chy emphasized tat therapists shoul fist fully explore ther ow contba- tions 10 the relationship problems prior to exploring clients’ cogntve-ntrpesoo paler thst may have elicited unhelpful beheviors from ther 5 len’ submis+ sive behaviors pulling for therapiat’ soil feelings, to identify the failures to be empathic o The Working Alianee 107 Which are primarily technol proses, which ean be thought of as tech ies previously described, the specifi techniques of the el ealto te by Linehan inlode the pis empathic rel ‘experience and ‘respons. Like Bums arningsracegy, th direct validation techaigue is based om he assumption that there are alway ars, even when dome cha 0d dysfunctional behavioes in the re plaszed that such alliance uprces canbe eased by therapist behaviors. Wher case, she angutd thera ir mistakes (8 Well ther 2 Linehan argued that alice problems ae frequent 20d benefit can be achieved by sbilifully repairing relationship problems (including 2g aon of he shill involved in retolving alliance ruptues tothe dfeulties experienced by clint in thei relaionships outside of the therapy session). ‘Thee toategies sed at epasing alnnce tes (e effectiveness of therapy) have begun to receive empirical (Safran et a, 1990: Sean de Moran, 1996; Satan, Maran, & Sams ple, have provided preliminary evidence eepardng the validity ofa four ‘eseibes the chartetrisic processes Cough which ruptures in the cherapeut tae resolved. In Stage 1, the client presents some indeation that there i problem inthe alliance, and the therapist focuses tention onthe hee and now ofthe therapeutic relation ship. a Stage 2th client begin to express concerns about the treatment or therapist a8 fashion. In Stage 3, the the the ellen explore interpersonal fs that block the direct expeesson of widedying concerns. tn Stage 4 the client expresses underying concert, wishes, or nzeds,in 8 dircc, sl fon, Safran and colleagues bave demonstrated both tha the stages of the model occur more frequently in aptre-reslution than in nonesoluion sessions, and thatthe theoretically predicted sequence of model stages is significantly moze likely to take place in ruprure~ ‘eroltion sessions108 Ccapters Foreman and Mermar (1985) found sila therapy by exploring the therapist activities for duce cases from ly poor status and tees cases in wl ‘vt westment. Specifically, they found tha the client the therapist were dealt with more frequent in the improved cas tases Tn an investigation of cognitive therapy Oaston, Marra, and Ri found tat probes ance improved for tose cients whose theca jn an examination of elationthip problems eater than solely focusing on Jem solving. it should also be noted, however, that too much foeus onthe relator found to relate negatively with the alliance (Marmar, Gaston eta, 1989: 19918). Such focus on the therapeutic relationship, however, was taking context of transference intepretatione—which could sugges that probiems in the peuti relationship are caused by clients’ distortions ofthe FReoet from the past, Rather than reflecting & recognition of ance problem, sch interventions may a ies serve to lame cons (e.g. Wi therefore un the ask of resting obstacles inte therapeutic relationship, ‘Taken as whole, these studies suggest that across diferent forms of thersp, the mf alliance ruptures is facilitate by what Binder and Strupp (1997) deseibe as peut metacommunicaion (erm they boron from Donald Kiser, 1996) ot the exploration of paven's und therapt'shere-and-now experience ofthe thespeatc re i. These suategie of metacommunicaion have alzo begun ob tested a8 Pas of ment protocols in clinical als. preliminary investigation conducted at Pen Sate 12 depressed individuals completed an integrative form of cognitive therapy [GeT, Castonguay et el, 2000), As implied by is name, ICT is a rmodifcation of cog therapy (CT) that Lnvolves te integration of prosedures derived from other forms of te. ny for exemple, humanistic, nerpersonl nd psychodynamic. The development of ICT Bae Sased onthe process findings reported in Castonguay et a's (1996) sty, which as Uiseoosed previously, suggested Ut the aztepies used in cognitive therapy to adres the iy be Ineffective but may ship pre tempting to resolve. Spectfclly, when therapists are conducting ICT, they at eogniive the (1979)—except when confronted with signs of treatment rationale or methods in response to such ruptures (8s was hserved in cognitive therapy by Castonguty et a, 1996), therapists are instead insted developed by Burs (1989) and Safan (1993): nquiting about ther 1 with the client's experience seated tthe tures, and recognizing the therapist's contribution to these ruptures. Once the jored and resolved, therapists then resume cognitive thectpy— ‘prior ta the emergence of te ed by Beck et al’ treatment mane. “Although systemic eseessment af the therapeutic process has yet 0 be conducted, servations ofa large numberof therapy sestions (via vdeo) revealed that alice po fens emerged relatively frequently during the application of eogitve techniques an th The Wong ll ly addressed bythe ute of retacommamieation svat th egatd to oucome results, non ofthe 12 indvidaals who completed ICT met 1 eepression atthe end of reatment, The findings also suggested that most ofthe ed at x-month follow wp. The improvement of ii- significantly higher than those who were assigned fo 8 viduals who teceved ICT was Tvatng group. Although is preliminary study did nt involve a direct comparison of ICT the cesuits suggest thatthe graduate students who conducted ICT. ro previouly rained in cogitve therapy) did at least a well i not tater than experienced therapists who were nvelved in previous Wal of cognitive therapy {eg Elkin ee, 1989) ‘The same strategies to repalrallance rupotes are also part of an inegrative went- sent for geetalized anxiety disorder (GAD) that i also being investigated at Peon State versity (Newman, Cesiongusy, & Borkove, 1999), Preliminary e this pew testment may have beneficial pact on GAD cents that hae not fared well hich stands a8 the curent golden standard ‘eaten: for this disorder (Borkovee & Wiseman, 1996). A large-scale ive therapy wih cognitive-behav- ‘when given cognive cause curent linia als involving new ry in aatre, any of thee findings snould be considered teta egies canbe integrated into a waitionsl form of sy show some promise with spet to improving its effectiveness, Interaction Between Alliance and Techuique though iehas been argued tat the therapeutic eationship by itself leads to change (oe 1982), it has long been postulated thatthe therapeutic value ofthe cal agpeets of thetapy, Freud ce a. a prerequisite ave subsequent lechniques take effect. More recently, Bordin (1394) ance not a separate pecequsite, but as a treatment ingredient that clot to genuinely engage in he therapeutic joumey and thos reap its benefits, Ac Condng oBordin, the process allows for advancement inthe technica eaim, and te techie ‘areal can dothe same forthe process. Such tering has heightened Une empirical focus ship and therapetic techniques Sn of psychotherapy researchers t0 a daal lack of consensus ing the alliance is cused (a9131988), for ie ia wwith outcome (eg. DeRubeis & Feley, 1990; Feeley, DeRubeis, & Gelfand, 1999; Ket, Goldied, Hayes, Castonguny, de Goldsamt, 1992; Luborsky, McLellan, Woody, O'Brien, & Auerbach, 1985), otbers have fled and iiprovement (Barber, Cais de Borkver, 1998; DeRubeBDUYDEE 134 PuSP Dua Sep 1u us uy no Cchaper 1989; Henry et a, 1993). The lack of consistant findings taking technique adherence to outcome has pointed tothe need for further exploration ofthe interaction between ths tse of prescribed techniqaes and other therapeutic factors, sach asthe therapetic alliance, hed light on bow alliance and technique in- ough such interaction aed to be provement of allianes, In a recent study of patients wit (1998) found chotherapy, Spe cally mite the effect reported higher boad and greste improvement. As ‘ofthe therapeatic al ect effects on depressed sympioms” (p. 320). between speifc(.. echiques) tueatment factors snd nonspeit ship) fecors, Butler and Sopp (1986) have argued against he for an argument agaist using the term noaspecfc aie Butler and Strupp have argued that sep ‘men represents an inappropriate aud fi estes, According to this argument, payshotherapy techniques separate from thelr ntrpersonalconcexc. According to sible 10 iglate specific, ative weatment ingredients from “nonspecific, Clinical Implications ; The Working Alionce ALL ‘ones, and offorlssimed at doing eo preduce suspect results, regardless of thelr method= ‘und Strpp have adamantly postulate that understand hove ane person (the therapist af ences o fil to influence anoles person (ihe patient within a therapeutie context” (. 37) "These authors noted that his statement underscoces the personal ature of any form of treatment and stets tha it isthe therapist, working within thie interpe the source of therapeutic influence (and wot the therapy jue and Strup (1986) argued that dhe ta ing helping versus hindering tecnica interventions ingroup designs rape sessions need tobe replaced by more context-senstive des ‘employed by Henry etal. (1986), Butler and Stop argue thatthe system study approach seems to repeset the most appropiate and rigorous over concep vers Nndeingtstigues as Bey cecr in a puicular I for a paraigm shit the gre fc fine-grained analyses to improve psychos ‘The argument of Bule and Strupp (1986) highlights the seeming consensus in the it focus on demn: ating thet prychothespy {0 work for particu contexts. 1 ‘A vemendous amount of empirical ereach hasbeen conducted onthe by Oninsky etal (1994), no facet of psychotherapy procest hus ben in recent years athe Aberapeutic an be derived from (1) the link be ntibutions tothe quality of during the course ofBOUBDEU IS PuSP bya Sep 1u us Uy 2 conasterd should make deliberate and systematieeffons io establish and maintain a good therapeatic ree kthough very litle coneens as emerged in psychotherapy esr, ep empirically supported treatments (EST), which typially pu more exp rsretion on tecigues then on the etelishment ofthe therapenti eaters (Cason fay ev ls 1999, Casonguay, Sch, Constantino, & Helps, 1989; Henry, 1998). As vr ioned peviusly, the negative coseguencs of mishandling the thetapeue reli oye rptiation of masualized and EST have been documented in a numberof tu ‘Castonguay etal, 1996; Henry et, 1990; Jones & Pos, 1993) ies leg Client Contribution to the Alliance ‘The empirical iterator is revesling types o froalt to evtablish or maintain a good aliance. Among th poor aiance sre igh level of symptoms, dates ing ego func ce oF defensiveness Lack of emotional ow sel-affiliaton (Le, negative into ‘with interpersonal ‘Poor object relations or negative (hostile) easy eelaionsip with parents Depressogenic cognition, including perfectionism ce and some of these factors, such 9 Jow= nea, sayin prt indies iserepancy between herapitin tern oftheir espective roles in treatment. This suggest in r, qari clients may partcilary benefit from being prepared for what they shoo expe raaetnd to gen fom therapy. As demonstrated by Odinksy etal. (1994), patient ol tobe beneficial for elients, The findings with regard to client a the a), in particular, may well highlight the impor in the eyes ofthe een, When werking wih ents of “inerent generation or religous background, it may be citcal forthe therapist cee ai liens believe ta their perspective on ife wll be understood thei needs Arcsed, ond thee values respected, ‘When wocking wih a indivi the tse preseibed by the thes sychologica i ual who is not nsined to agree withthe rationale and ve peferced erention, however, it may be import r he Working Altance = LAB ‘oftheir approtchs and 10 draw some pre andthe Herpits views If no eommton ground can be found and ifthe client i tctant to ive the benefit ofthe doubt to the Uerpist and engage (at eas temporan) ist may be forced to choose between one of ly been eblaiaed with psychodyn high level of symptoms, resistance, or defensiveness, may before using exploratory methods of intervention unt the ss and problems inimpalument have beea reduced. Related to the ssue of de- 1 helpful fo use seategles developed to facilitate emo- 1978; Greenberg & Paivio, 1997; Greenberg, Rice, & cexpest the el probleme The same suggestion could be made with espect a depestogeni (8. perfec tionism) cognitions, As argued by Rector etal. (1999) och dysfunctional bis may “not ony influence te processing of personally relevant information dicted at seif, but fecve as ablveprint for hw interpersonal interactions are processed and interpreted” (p 320). ch ofthe aforementioned cher Jy be confonted with a umber of si signs ae obvious andceaeyindeatethe deterioration ofthe therapeutic proces, other are {blr Safran and his colleagues (1980) have enumerated mazkers of alliance pire: {Avoidance manewets (ignoring therapi's commento, caecling Selfesteem-eahancng operations (€g. 2el-agarandiing comments) tervenion (efile to us therapeaic intr vention) ‘Ofcourse, such instances of aliane> uptures cas take pl any lien, bu the previously seviewed findings suggest that he, are more probable with certain types of ei- fs than oes. It should als be mentind t ance pres can be expected, on Should not assume that Chey have to be avoided at all cost. As argued by Safran and Segalyep 1U Uy 1Uu:UUua nd chapters fora comesive relational experience. And adres liance problems in way tht ‘Therapist Contribution to the Alliance “Although some client characteristics may predict more freqsent ; hip can be blamed solely on them. As argued ty personal process fnroject This sugpests that therap may have a tendency to teat clients in dhe same mates They may for ‘hontexcessvely when therapy it progresing fas enough. When aac bythe et “hee therapists may azo respond ina complementary hostile fshion rahe han ake noe from the process ‘Such empirical Findings sogsest make al possible effort to maintin what dined, Their engagement in thermp, in oer words, should no onl tion of therapeutic procedures ut also an awareness ofthe proces th en, including their own intemal (feelings and thouphs) at ierprs sto client behav. “hs shown by Henry etal (1990), the disafiiave interaction puters found i sessions of client who failed to respond to therapy do no ovr ata high rte. As the authors cogently argued, even a small amount of negative commu terol impact. Furhermoge, beeaue hos be difi tween them snd the times even for he mos! we Sopervision Gcloding, when posible, 8 toward themselves and, therefore, may be partculcy at risk to display the same cra] and nor- rads toward the people they are trying bel. ty no meaas suggests tha only therapists with ceria personal chs fo adopt a prtcipant-observer ate o to engage in supe apy) After al, no therapist can be consaay sl-acceting 6 et the type of interpersonal behaviors (afiming, understands, baling, teaching) that seem to define good allisnce,Furhermote Heng et (1986) vemonetated thatthe disafliative pattems of interaction that re taking pase in es so cerkhl weatment cam be eoraplementary. This is consent with he assumption, espoed rapists, tht clients lento pol therapist heim i clients ations and atitudes (eg, kostil submission) msy 6 le contral), The main point her it Semonstate ship pat par trigger theroists’ unbelpful behaviors (62h may have a tendency to engege ‘nd should hut be especially attentive tothe enzetment of nonkelpfu interpersonal sof staal a be epay of nonhelpful interpersonal “The empirical Hteratore also suggsite that some téchnical interventions, at Least ‘when applied i specific cortex, may playa sol in oaitaning and potentisly increas ing alisnce ruptures, As described eae, one study in epgaitive therapy suggest terfere withthe process af change if they respond 10 the cl ‘attempting to persuade the Jmniques (Castongusy eal, ‘may not be adequate as tols to aes lines 'o, what should one do when confronted with pr anawers can be provided probuby not resolve the ray preven 2 spit tons or power srugles over he task and gots of therapy. ay be the best second step the focus of (herapy on the fe related (0 the obtervation and eaction withthe cet including, above all, cs seach effors (Casiongoay, 1998; Castonguay a, 2000), rapists contbution (or wat Burs (1989) In fact, it is often followed by16 Chapter the difculy of working with anger (Binder & Strupp, 1997; Bums & Auerbach, 1956, is eraca forthe therapat 0 keep in mind tat he est To remain present and interfere, i subtle or explicit ways, wih the li trent. And although the therapist's fear of clint hostility and anger is perfeclly under Tandab, those who explore such reactions mey well discover ve affect during the course ofa successful metacommenict cn similar to the extinction curve of anxiety. Fit he anger wil ines rough expotute (or sufficient recognition and acceptance), the effect wil gradually de cron. As cogently expressed by Bures and Averbach (1996), if part ofthe client's anger {Epased on the therapist's fasure to be empathic, the thereps's valkaton ofthe insically remove the cause ofthe anger we again observed in out clinical and erpirical work (Castor. puny, 1988; Castongiay et, 2000) isha when therapist hs integrated » partcipant~ metacormmunication skills the therapist wil be ssi fece. From both an interpersonal and technical pe- 1 be expected but seo, toa cetin extent, they shold erpersonal therapists argue tha in err to rmaladapive interpersonal piers, the the fox example, by becoming overontroling with asb- aaesive chen. Uolocking svch pales va he therapist's openness an experience may Tra ie client to exploce cove interpersonal schema (Satan, 1993), Furthermore, the cir vtagagement in metacommucaton with te therapist can provide he client wih « re ce emotionally inedite experience with tegard to aling with Interpersonal fe (Saften, 1993). As sch, the elution of he aljance ruptures can touch many of the principles of change that ext eeross differen Teams of intervention: reinforcement ofthe therapeutic relationship, cquisition af one recive experience and generalization ofthe therapeatic iastonguay, 2000; Goldried, 1980; Goldfiied & Padewer, 198% spective these rupures ae not ot desired. As we mentioned previous ance ruptures should also be expected. The pro: cess of change is frequently dificult; things have to get worse before they get better (Cat astantna, & Newman, 1998), and resistance canbe viewed as an adaptive the course of improvernent (Mahoney, 1991) Clients often have dificult com fronting the fncs and eeting thir viw of set (even when sch view snes). At argued by Strupp (1977) the primary wsk s to nfuence and persuade the cleat og. Although har iid ways of interacting wi they sre known ways tobe and, thecefare, ae cot provoking and can be depressing. The therapist st ean adopt new ways of mut tomate the client tke i 193) metaphor of balance between change (or chil> self and others have brought suf fortabe, Abandoning them is a0 employ the ight ig and met captured by Linehan's Tage) and aseepance. Te terapisi mst be empathic wth he lien fear but ust persuade the ellent thatthe client has ange. interesting ie alsectie of acceptance and change corresponds to Henry e. tion af p20 inerpersonal behavior: ffi the level of balance achieved by Jinprovernent in dialece-behaior therpy for borderline persona an, 1992) ‘Devout itso cloguentlycopres a ercial aspect of thecapeuie change its seo not suprising that the dilete process desribed by Linehan (1993) i consonant with views lof ehangeexqresed by authors from different theoretical bsekgrounds, Working with bor ine personality disorder, tut from a psychodynamic perspective, Alien otal (1996) jaed the impotence of balancing interventions. They waite that expressive and {upporive strategies should not be polarized and pitted against one another.On the con- ty eae and ppriveintvetonsad eDende (260, em: inocgin Time in Therapy ‘esearch clealy indicates thatthe quality of the therapeutic alliance is particularly predic~ tive of outcome when meaeed early in reatreent. Empirical evidence aso shows that ¢ fowallance seoe easly in therapy is astciated with prematore termination (ee Reis & ‘Brown, 1998) The cbvious mplinton i that or ofthe fist eoncems of therapiss should beto provie the conditions fr a bond and oliaborative involvement io develop as posible in therapy "This migh be especi fs spent octral program) that require cl ‘sessment better may be well-advised to inform cl efit uch comprehensive asessmet s W reaetons toward the assessment proces. swith regard othe predictive valli ofthe alianee at mdtueatment to sate tat less client improvement or in- ‘As mentioned previously, tear in the alnce ean pro- and cortesponding ings where a considerable amount of (auch a raining linc associated wi rough a systematle snd comprehensive as sof the ralonale and probable ben- monitor the lias expectations and ‘Bueratons i all vide nique opperturites o explore maladapt behavior ‘Measurement struments to measure the therapeutical ner perspective is that thera pis can and should ue these psychomesically sound measures to monitor the quality of the Uerapewtic relationship during the course of westment. AS ans ought 10 be ‘bound the client feels to the therapist and 3g and able the ce shoul be part I meas depend on the same two major elements Salve involvement) and becsuse al of therm have stong psych‘he ure of psychodynam er studies have found eo celaionship between conducting (Castonguay ot cognitive therapy tay explain why a num alliance and outcome inthis form of weatment. According! CCT (or other nonpsyehodynamic therapies), tat herpist may wer fal measure such asthe WAT. If Gerapst is conducting payehodyrami teats, ices and should bese w decision onthe dimension ofthe er. /TAS could be used i one wanted to pay specific ins such prtcpation or aceptance of r- Sponsblities andthe therapt’s warmth and friendliness, whetea the CALPAS could be ceed if one wanted to target agpects such 88 patient commitment and working copay o¢ therapiet understanding Reseach cleatly indicates the, whee ating source is concemed the ali ‘estan foremost be metsured fom the perspective ofthe cient Ingen ‘Hons of allance measures have, indeed, ben shown to have higher and broude ped validity than observer and there toa by empirical findings but, in fact, makes perfect sense. Because the {ihe one with he problem the one who decides to come back, and Seevlces), the cliont's view about how well the treatment is progressing deserves attention Nevertheless oie versions ean be sed, not ony because they have been found top Jrapeoverent bt also because they provide a diferent lens tough whch o vie the rel hip an, therefore, may eaptze some suble, but untelpful, aspects of the herpetic tionship thatthe lint i not aware of or may not be yet willing to repo "an obvervee measure ofthe aisnee would of eure, be oferous nine practice if one decided to use i inthe sae manner as ina process stay (which involves the el vision of codes). A supervitor watching auio- or videotpes, hoveve feht use obeerver versions of aliance measures. Moreover, without coding seston: wih ct instumaois, such 28 the SASB, supervisors coud systematze thee feedback rocess by taking into account he aspect ofthe therapeu re iments (hostility or withdrawal of th therapist, comps moment p to feus on toward ie therapyiterspis (when the client scores are always higher then those therapist, (2) ta become avae of the he xpestaon or bias aout te thesnpy proces (ee the second reaton described by Hort, 1994, fore discrepancy of eaves betweon client and therapist, p. 69; and (2) (0 become awars of distorted views peur he cient or the teloionship Ln, countertzansference; see the hic reason deseribed This also important “0 consider the findings of Brossard etl (198 rut the therapin' perception ofthe alliance has significant impact on theo perception ofthe alliance, As they cogently argued the The Working Atiaice AID Negtve cousin perepions of te working alae if sce fet the ably ofthe counselor an clint 0 deve alisnce. (203) Some therapists may be emped io disregard the ut sdacdized measure. They may tointepersonel cues, Therapist are also involv erstanding and czing healer. We would venture to guest th ve therapy but I'm not an empathic prs frelyadmiting to aot being open-minded! ower, hat we are sot always em sas rare to mee isto meet a person with our clients, This shouid nd tlvays ava of our lack of empathy. The use of empathy and alliance seales practice and igs and impressions a the end of a (Gee (is perton. It was asf was in my ‘ints shoes!” of “Cash, what a tenible jb I dd! My cent and T were working a cross purposes rt chance to Gece what be oF she should do snd how be or she fel clients, Beoese the research shows that ther typically discrepant, and because the same er ‘en's view bas higher predictive vale, lance measure as pat of third ‘who ae convinced that they know how the client feels about them and the dherspy being conducted ‘Some therapists may also have concems abo ‘time-consuming task on clients (nd themselves) a he end ofa session. Thi fe concern, however, can be circumvented With te use ofa bref version of the WAL, which is composed of only 12 items and i highly comelated with the origin (Tracey & Kokatove, 1965), Such a measue takes no more than a few minutes to domplete. Summary "The concept of the alliance hat along history, Pethaps more then ever before, and arguably peyehodeeary, eg. Celio & sy eta, 1994; Saftan & Muren, 1998, 2000) luewhere (Castongosy, 1997), we know of no psychotherspy book weiten in the past (ecade that hes not refered tothe allance, It is fale to say thet he aliance has reached theSep 1u UU 1UsUse 20 Canter apy. Although temerged as a setnal eontbation rom, ow sands a 4 necetsary condition of change Acros all smponents of the proces statu of lime the psychoanalytic tradition forms of psychotherapy. Not change the aliane has been defined in many ways. Despite the every of se def ‘ions however, the eonsensus inthe fel isha the alliance represents & positive atch, rent between therapist and client, a¢ well as an active and collaborative engagement of these par therapeutic sks designed to help he client. Reflecting he conseptun richnest ofthe arenis have bean ‘chodynamie and human ‘vanstheoretcal view Des Ship each instrument bond and active collabo able to researchers and ‘herapetie reaionship and mocefned-grained analyses of the complex. and sequent ional patters between clint a "As a whole, curent alliance messue, have alo shown more than ade is the level of predictive validity th rmnber of studies. Regardless ofthe 5 or te measuring different dimensions ofthe thrapetic lain. sees the wo agreed-on components ofthe aliance the are current aval- “astument used stessmentpeapecte problems he therapist soneibutesubstanilly othe quality Consistent with efniions of the alliance as a phenomena that is intinsic Saleen et al, 1990), the evidence suggests that cent and therapist relationship Wists fave an impact on the therapeutic relationship, In addition, morrent- fnaon end Renard (1992), fc instance, one particular Ain Amerie cs in thle tendency to have song kinship bonds ands gence fa exemple, if a therapist fled to recognize this aspect ofan indivi ‘erapist may cemein, wedded to an individual therapy approach de positive impact of incorporating family members inthe trestment. And ‘may have wanted the fanly members tobe involve, a fire ‘aot on thls desire may severely damage the allan. Cer rly one of many factors (eg. experianced oppression leading to inherent eds tobe tken into accoun! wea working with Afiean America cles therapists need to be eenitve to perspective divergences and ‘hough thie perspectives I be undestod, thet es respecte. that these individ and prefer structured 5000 pay atetion to thse important sss esearch an ‘by end lg, bat been anchored in cise By investigating the imporance ofthe rationsip, eben jbservsions and theories Pua (en), The ryoterapet proce A Trach honk gp 328-35) New York G far Fess Td Coyne, Ly Can. D.B., Horewit. LO ‘ed Oy Fairey, 8-H, & News, 0.96, sa. kf DB. (1981), Resi Upp. 202-20), New Yor Glo Press. ae A (1991) Compton and elon on ef évtedmenins of the Bp lance ees by Sess et nnn and Clea Peto 6, 65-42, ome a eaten of cozune pendence, Pye ‘et ener SASH) tad Bho cal oly The Working Altance 129 have tested and confimed what hasbeen clear to elniians, Reciprocal, clinicians have and will continve to beret from reseuch knowledge. They, wll further eontzbute toe pirical advances by continually defining new directions of research as wellas by becoming ‘ore involved in therapy studies; see Newman & Castongupy, 1989). As such, the alliance ‘an not only be considered as the vltimat, integrative varaple (Wolfe & Goldied, 1988) bul lo asthe “igure de proue” ot uimite exemplar ofa scentfc-pratitioner approsch tothe advancement of psychoecapy. References Labry L-(1946). The Pen Jura! of Abnoma! Prick i Ls, Geerbeng ZW. {toe Binder, 5. Ld Sup (1997). Ne “A resunenyeeovered and ante teapots prces a uta ica nih prycheapy of ts, Clea! Peyote: Se ince and Practig, & 121-138, Holo, & LC. ny Is con yrans hey fara of Wy Lattay Le CateCenoph P, Tha ‘ai, AOnken by & Galle, 3) Trp uae thay concept fe wectng Iheropy, 15, 282-86, ain ES pele working Herawh aS. ‘exit far gene set code Ta MBDUYDEE 134 PuSP usa Sep 1u us 1U ner 1 aed © Deen a he 299 anal Fee rjcotesny Ree, Sabu, UT cong b na, Me Nea 0 "TPH Novae, The working eho ecmen Pode of the woking alan: Pyebouanlye counseling. Paychorer eave hry fr Spe ron fas faral af Contin one “A (1986). Therap em ctl 6, 47-50 fa agetvectehoiond therapy: Does italy Casogony, L Gx Stas A 2 A ce In PM, Sabor (€8). Pow cen, Ps Boog LB $160) New York [fou took a fea. Ppe eset 3 be fro sing of he Socely fr Pepchotenpy Feveash hen I ‘caongny sy Seay A J Conn, Mo Halper G8. 1999, he rl of ee Fem mani Have By Become sce bt ingredients of haege? ceand Precis 6 9-55 ene. WR, 2 Stop, Ho, (1995) Be 1 ayaie pyc. they. Pecbabeopy, 12 629-638 Bute 5 Fe Srvpp HH (1986). 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The Working Altonce 128 Freud. oroviz alae nym peyebee and Clinical Pasco. ens ks & Marans, ©. ( Paychoterapy alliance LS, Cocebeg Bia), The working ice fp. #5108), New rs Paytoeny $6 S039 oO, Bi ‘cata Pig Caton L & Rng JM. 0992. The iwertary of Therpewie Siegen (TS) ej Pehanerepy Rese seed, Ineretions in ei Reread be rane Betapy. Pcie ty Rec 150-209 foils & Caer 3A, (989) The sling a pyetotiapy: Component cee vecedente, The Conte . 4, Capone of he "Re ite v Fein dust Pryhaogy, 4, 296-306, Coea, © 1 lags, A, (998) The enchsherany Tatonship: Theory retearch and proce. New York We.16 Cendin, £7 (197%, Focusing, New York Everest RS. Qu, My Stapp HM & Hea, London: Harper Ro. nL. Pahoherapy 29,4610 aaa 2 Ducat, A. (980, lee vin inne a yychoberepy Belin for vor Therapy 24 505536. otied, MR, Paiawer, W. 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Sms Moye ‘a Pien, P1956) THe ycbtherey nA. E-Bepin 8, Carel I banda of pehttropy ond beh New Yak Wl ert, octal fluence proces in conte therapy Sponges: Cares C. Them. By Voh Reb. S, Dice E ene, . (952). Thropeui elec of brit he patra: Tage ofa erpea lacs Jur Piyhoteragy: Pracice ond Resvrch, Buen (Es land expres poycotarny i (pp 19-48), Lewin, Begiom: Leven ep (Eis), Poychiherepy proces retcich: Theory aed and phenomenological rescore inebeoviora inorder New Yo rican’ jdgeeats of renal ‘an xeon and eons for in of Se Laboraey, L879. Teal Speci abort L970. TnL. Clever (E4), Sccesslprshotberpy (0p. 99-116, New York Brune). 1930), fap lineas a predict utes Factors exglaing Pe Peeve cat 19. ie working ance TheLd Azeri, A (1985) The rape 1, Cold, M, R (1994) The depen ip in prychdyeamie psehaterepy: The “thane copa thai ie i" are evicene od se meaning for price TBR ‘Theo resorch ond pace p13 beast hang (Se Hover KL (100) Te peta ol chop Explraons ih be THe sin Repo esos Poe (2s) The pyhoiepetic rach handbook Ne Yo ole Pr. a (99), Ieper eens, nce inset tm eg. hogy Reseach 8392-0. Gober (943). Too helping alr me ‘utomes of poche: A Efrine pincotherapy A handboak of reeerh (op. 4.569), New YF ‘Moti C, Maine, Dy Tit Dreiing therapeu oueones New Yor: Base Lavo, Ls MeLellan, AT. Moran, he, Libor Liha. Cai ote by de Feta Hang Mebed Aehieef Geral Peary 3390-2, ray, fara of Canaig and Ci a oye A Sy Meal, M. ‘nl Conucng Peay 40 25% tap 95). Patiern of alliance and ool Clinical Paychology. $5, 379-384. ie Got) Peseta ly cscs pete een Ju ur ond ere ie 73. 11-73 ‘a Semeack (1985, f proces ad ome ins (een inde! pyebote ‘Nevnan, ©. #185). Maina ad ing aut elena. Pr ie liace pe ax ery ‘Tok eocome i unity Bey. Py the poyctaherapeae proces 3. (1996. The olin of hooky. 36-390), New Yar: Guilford Fess. 1 Gata, L- (1989). Toe Shy & Meas, N. ML (1980 Iteration shige HANS " couneing Peteoey 37 I ryholgy, 6, 47-838 am Me, Caiongay Te Qa & “A993. Api. New dmension. cnr: Iepeiona 8 i denprig. Poe press 31 (sett). Peden af xtc of i py nei Pryerewerpy Pr ‘tees of CanerelPyein! 4.pels BDUYDEE 134 PuSP lua Sep 1u us 1U 130 Campers (id), The woring lane: Tony research od pratice(p 225-25) New Yok Wiley J.D. Seta Z V. (1990) interpetenl posers ns ad seh Bais. 30, Sig M.A, Beer, LB, Woed "Te heap bond scale: Payehometie che. merece “Atimant A Joumal of Conslieg 1 Pyceley 1 18-330 pebotberapeati change ona 28 Cine! Pychlosy 6 Shatin EN. 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The mae of ese encoun Duane 323 ots G 8. 2 Kane AS i coin liane, ad pe of hey lena, Paotarapy Revo 5 9, Pring her 35, 206-2 ant 25 aon of pens onmbation wh 2 Fesignvaiened peyenoterapy Pryor man ‘Wie My & oka, (193). A mets aniys of pretoeapy dapat, Pfscional Psscholgy Fevrrch and Proce, 24 190-195. ws BB. (098). Rot ember. anecastry l ef Paha ry 8 Mts Kayley (2000. Rei Uepeion, ured of Conling and Ci ‘oto 68,128