DRAFT: This module has unpublished changes.

 

Name: Darius  Muniz

Literature Review Summary Table (Revision)

 

Reference (APA Style)

 

Juni, S. & Stack, J.E. (2005). Ego function as a correlate of addiction. American Journal on Addictions,

 

             14, 83-93.

 

Research Question(s)

 

Is there a direct relationship between drug addiction and ego functioning through coping strategies that affect domains of the addiction severity index? Is there a relationship between education and adaptive ego functioning? What adaptive ego functioning do IV users utilize as opposed to non IV users? 4. Is adaptive ego functioning determined by the users’ primary or secondary drug of choice?

Hypotheses

 

Addiction severity and increased use of dangerous drugs, particularly in high-risk modes, will correlate with poor ego functioning and less adaptive functioning.

Participants

 

Respondents included 36 men and 53 women (N=89) in an urban substance abuse treatment facility. These respondents ranged in age from 19 to 45 with a mean age of 32 in which all had been diagnosed as drug dependent according to criteria from Axis II of the DSM-IV.

Procedures/Measures

 

Measures:  1. Self Report EFA (Ego Function Assessment)-  twelve scales of functioning are indexed by this measure, which consists of ten Likert items with higher scores indicative of more adaptive ego functioning.  2. ASI (Addiction Severity Index)- This measure is an index of addiction mal-adaptation focusing primarily on specific repercussions of addiction in the medical, employment, alcohol, drug, legal, family, and psychiatric domains. 3. Constrictive factor- representative of less adaptive ego functioning. 4. Incorporative factor- representative of higher adaptive ego functioning. Procedures: Negotiations with an urban treatment center allowed the researchers to assemble research data with treatment protocols in clients’ records. This enabled the researchers to correlate EFA results from a previous scale standardization project with ASI and demographic data from patient charts.

Main Findings

 

1. The incorporative factor (less adaptive ego functioning) was correlated with decreased problems in the medical and alcohol domains of the Addiction Severity Index. 2. Correlations between EFA factors and education was positively correlated with the constrictive factor (less adaptive ego functioning), and showed no correlation with the incorporative factor (higher adaptive ego functioning). 3. IV abusers showed higher levels of the incorporative factor (higher adaptive ego functioning) and Non IV users showed higher levels of the constrictive factor (lower adaptive ego functioning). 4. The incorporative factor was related to secondary drug choice and primary drug choice showed a trend towards correlating with both the incorporative and constrictive EFA factors.

One Question I Have Is….

 

Due to the small sample size the analyses that were performed in this study were limited. If the sample size were generously larger would the analysis of that study generate similar or dramatically different results from the present study?

 

 

Name: Darius  Muniz

                                                                      Literature Review Summary Table (Revision)

 

Reference (APA Style)

 

Katz, B., Juni, S., & Matz, P. (2003). The values of psychoanalytic psychotherapists, 1979 vs. 1993: A

      cross-over comparative study. Current Psychology, 21, 339-361

Research Question(s)

 

Do psychotherapist values change as societal values change over time? Is a shared Psychotherapist professional identity manifested through their specific theoretical orientation? Does a group sharing a specific theoretical orientation also share similar values? Is there a difference in values between male and female psychoanalysts?

Hypotheses

 

Changes in society during the two study periods will reflect changes in the psychotherapists’ values. Consistencies in psychotherapist values, between the time periods of the two studies, might be attributed to shared professional identity and socialization.

Participants

 

For the first study there were 27 male and 28 female post doctoral trainees (N=59) with a psychoanalytic orientation. For the second study there were 66 male and 113 female post doctoral trainees (N=179) also with a psychoanalytic orientation.

Procedures/Measures

 

Procedure:  In 1978 and 1992, during well-known training programs in psychoanalysis and psychotherapy, data collection was facilitated within these programs. In 1978 research packets were made available to the participants and were collected via a drop-off box for the completed forms. In 1992, individual packets were mailed to all members of the same training program and enclosed was a demographic questionnaire, the RVS, and a pre-paid return envelope. Through the Rokeach value survey, the values of the group of 1979 psychoanalytic trainees were examined and compared to the group of practicing psychoanalysts in 1993. Measures: The Rokeach Value Survey (RVS) consists of two lists of values: 18 Terminal values, which are idealized end-states of existence, and 18 Instrumental values, which are desirable codes of behavior.

Main Findings

 

For instrumental values (desirable codes of behavior) between the two time periods, 15 of the 18 mean pairs did not differ significantly suggesting that the values of desirable codes of behavior for psychoanalysts remained unchanged over time. Terminal values (idealized end states of existence) have become more important for psychoanalysts in 1993 than they were in 1978. Psychoanalysts were found to embrace a value system that emphasizes personal goals over social goals which was in line with the orientation of psychoanalysis and its functions through theory and practice of focusing on the individual and their very personal struggles. For terminal values of male and female psychoanalysts in 1979, there were no significant differences suggesting an internal consistency between the two genders. For instrumental values in 1979, there were no significant differences between the genders which demonstrated that in 1979, there were no distinguishable differences in the values of male and female psychoanalysts for that time period. The results of this study point towards a psychoanalytic values system. The terminal values ranked highest correlated with peoples’ relationship to themselves and to others and the terminal values ranked lowest was not related to the individual life experience consistent with a psychoanalytic perspective. These results indicate a consistency in the values of psychoanalysts over the course of a 14-year span which suggests that professional participation in this field reveals a shared value system.

One Question I Have Is….

 

Did the limited number of respondents for the 1979 data set dramatically affect the outcome of the comparisons under investigation? Also since the majority of the participants were white, did this factor perhaps bias the results of this study? Would this study produce similar or different results if the theoretical orientation of the respondents were different?                                                                                                                  

DRAFT: This module has unpublished changes.

Darius Muniz

Professor Katsiafica

Fieldwork I

February 13th, 2011

 

                                                    Counseling Psychology Topic

            My topic related to counseling psychology is the overall effectiveness of counseling therapies when dealing with either voluntary clients or clients that are mandated to counseling because of some mandatory requirement. The effectiveness of counseling is greatly dependent on a client-therapist relationship that is built around rapport, client openness, and mutual trust. This relationship is one of the key factors in predicting positive therapeutic outcomes for clients seeking to identify and overcome problems effecting their functioning in their everyday lives. Once a client is comfortable with their therapist, common setbacks to productive therapy like projection of past relationships or viewing their therapist in an authoritative light, can dramatically affect and impede the advancement made towards therapeutic progress.

            Clients that come to counseling voluntarily are usually impacted by some negative functioning in their lives that intrudes on their feelings of satisfaction and personal accomplishment. They realize this impairment and have made the personal choice to seek out a counseling professional in helping them to identify and overcome whatever impairment is causing these feelings and hence the negative outcomes in their lives. A client that is voluntary has already made the conscience and deliberate decision to allow this counseling practitioner to become an intimate ally in helping to work through any difficulties and in so doing, is more open and willing to create a positive client-therapist relationship in accomplishing positive goals.

            In contrast, when a client is mandated to counseling let’s say through the courts due to a criminal case (i.e. domestic violence, drugs, assault, etc…) this client is more guarded and non responsive to counseling therapies. The necessary and crucial aspect of a strong client-therapist relationship is initially strained and more than likely doomed for failure due to the circumstances that the client has come to therapy. The client will view their therapist as an authoritative figure in which the courts have positioned in a place to extract damaging information to the detriment of the clients well being or some other misguided and paranoid view that comes with being forced into an action. Though the counselors intentions are ones of helping and the achievement of positive outcomes and goals, the relationship and hence positive treatment outcomes are more than likely doomed to be unproductive for both parties involved.

            Research on the effects of different techniques that will aid in relieving the tensions, strains, and negative views on the part of mandated clients need to be explored. Also, the differences between voluntary and mandated clients on the therapeutic relationship in respect to productive counseling need to be evaluated in determining if counseling is appropriate and warranted. The client is the main component within the counseling framework and without their full and voluntary cooperation no treatment can be successful.

DRAFT: This module has unpublished changes.

Darius Muniz

Professor Katsiafica

Fieldwork I

February 16th, 2011

 

                                                         Research Question

Is the therapeutic alliance between client and counselor an accurate predictor of positive treatment outcomes?

                                                                 Article 1

Kramer , U., de Roten , Y., Beretta , V., Michel , L ., & Despland , J. N., (2008). Patient’s and       

     therapist’s views of early alliance building in dynamic psychotherapy: Patterns and relation to

     outcome. Journal of counseling psychology, 55 (1), 89-95. doi: 10.1037/0022-0167.55.1.89

 

                                                                Summary

This study aimed to test the hypothesis that traditionally only utilizes the client’s views on the therapeutic alliance in predicting treatment outcome, by also utilizing the therapist’s views on alliance. Two research questions were intended to be answered 1. Do the patient’s and therapist’s alliance patterns differ? 2. does the patient’s or the therapist’s, or both, alliance patterns predict outcome? The clients (N = 50) were self-referred university students at a European university consultation center. Participants’ mean age was 24 years (SD - 4.3; range - 18–39), and (70%) were women. The therapists (N = 13) were experienced psychiatrists and psychotherapists, and all had over 10 years of clinical experience in the field of psychotherapy.

The measures utilized were the helping alliance questionnaire (HAq–I) which was a self-report 11-item questionnaire rated by means of a 6-point-Likert scale and the Symptom Checklist–90 (SCL–90) which includes 90 items addressing various somatic and psychological signs of distress. intraclass correlation coefficients, ICC’s, yielded coefficients ranging from .05 to .10, all non-significant for patients and coefficients ranging from .08 to .22 which were also all non-significant for therapists. It was found that patients’ and therapists’ shape-of-change parameters correlated significantly in 19% of the cases, between three out of four corresponding parameters and a marginal link between clusters has been found by chi-square statistics.

For alliance–outcome link, addressed by the second research question, no link was found of the patient’s patterns but a strong effect of the therapist’s patterns was found. The therapist’s pattern described as stable is the most predictive of positive outcome. They were able to reproduce the absence of link in the patient’s patterns and that would suggest that the therapist’s patterns of alliance construction best predicted outcome.

 

                                                             Abstract

Patients and therapists have somewhat divergent perspectives of alliance. Usually in psychotherapy research, the focus is on the patient’s view of alliance, predicting parts of outcome. This study questions this hypothesis by applying the shape-of-change procedure to patient’s and therapist’s view of alliance building processes in dynamic psychotherapy. The results of this naturalistic study indicate that none of the 3 patient patterns is related to outcome at the end of psychotherapy, but a specific therapist’s pattern— out of 2—is linked to positive symptom change. These results are discussed in the context of present research on therapeutic alliance, especially in terms of level and process, its measurement, and potential in predicting outcome in dynamic psychotherapy.

 

                                                            Article 2

Tryon , G. S., Blackwell , S. C., & Hammel , E. F., (2007). A meta-analytic examination of

     client-therapist perspectives of the working alliance. Psychotherapy research, 17(6), 629- 

     642. doi: 10.1080/10503300701320611

 

                                                            Summary

This study utilized meta-analyses to investigate the relationship between client and therapist alliance ratings by assessing 1. the correlation between client and therapist ratings of the alliance and 2. the mean differences in client-therapist alliance ratings along with their possible moderating factors. Two meta-analyses were conducted, one to obtain the correlation between client-therapist alliance ratings and the second to obtain the mean of the alliance measures used.  Thirty-two data sets were utilized presenting correlational data for Client-therapist alliance ratings and the total sample size for the meta-analyses for the data was 2,331 Client-therapist dyads.

The results indicate that client and therapist working alliance ratings illustrate both convergence and divergence. The correlational meta-analysis indicates that client and therapist alliance ratings are moderately positively related. The result suggests that, when the internal consistency of alliance measures is controlled for, clients’ and therapists’ alliance ratings covary in a moderately consistent, positive way regardless of client disturbance, therapist experience, therapy length, alliance measure, or type of treatment. The meta-analysis for Client-therapist differences in alliance ratings indicated an overall medium to large effect for the difference between clients’ and therapists’ alliance ratings, with clients rating the alliance more favorably than their therapists.

This meta-analyses shows that the clients’ view of the alliance will vary with but also be more positive than their therapists and if a client has a lower alliance rating than their therapist, this is unusual and may be an indicator that therapy is not progressing well. Client-therapist rating discrepancies were not the same for all clients. Clients with substance abuse problems and those with mild disturbances tended to have larger client-therapist rating discrepancies than did clients with moderate disturbances without substance abuse concerns and more severely disturbed clients. Ratings using clients with substance abuse and mildly disturbed clients accounted for most of the residual variance in meta-analyses based on client disturbance, therapist experience, length of treatment, alliance measures, and treatment types.

 

                                                                Abstract

Using 53 studies, comprising 52 separate data sets, published in refereed journals from 1985 through 2006, the authors conducted meta-analyses of the correlation and mean difference between client therapist alliance ratings. Client and therapist alliance ratings were moderately correlated (/r_.36, SD_.00); clients’ ratings were higher than ratings by their therapists (/d_.63, SD_.42). Client disturbance was a significant moderator of client therapist alliance rating

discrepancies; clients with milder disturbances or with substance abuse problems tended to have larger rating discrepancies with their therapists than clients with more severe disturbances or moderate disturbance without substance abuse.

                                                              Article 3

Hersoug , A. G., Hoglend , P., Monsen , J. T., & Havik , O. E., (2001). Quality of working

     alliance in psychotherapy: Therapist variables and patient-therapist similarity as

     Predictors. The journal of psychotherapy practice and research, 10, 205-216.

 

                                                               Summary

This study tested several hypotheses which included 1.the therapists’ self-evaluation of progress and skill is related to working alliance: better self-evaluation should be related to higher quality of alliance. 2. A warm interpersonal style in the therapists is related to better quality of working alliance. 3. Therapists’ pattern coefficients of self-attack and self-control are related to less favorable working alliance. 4. Therapists’ memories of warm parental bonding are related to better quality of working alliance and 5. Patient/therapist value similarity may be related to

working alliance.

A sample of outpatients (N=270) from 15 outpatient psychiatric clinics within the Norwegian Public Health system were utilized along with 39 clinical psychologists, 13 psychiatrists, 4 social workers, and 3 nurses. Working alliance was assessed by utilizing the Working Alliance Inventory (WAI). The correlations between patient-rated and therapist rated alliance were low to moderate. The result was in line with previous research, and it confirms that patients and therapists have different evaluations of the working alliance. Patients’ rating of the alliance were on the average higher than therapists’ and none of the therapists’ pre-treatment characteristics were strongly related to the quality of working alliance, either as rated by the patient or the therapist, early or later in therapy.

                                                                Abstract

Therapist characteristics were explored as possible predictors of working alliance, rated early and later in therapy both by therapists (n_59) and patients (n_270) in an ongoing multisite project on process and outcome of psychotherapy. Patients and therapists had divergent perspectives on the working alliance. Therapists’ experience, training, skill, and progress as

therapists did not have any significant impact on alliance as rated by patients. Training and skill were positively related to alliance as rated by therapists. Interpersonal relationships on the cold–warm dimension had a moderate impact for both patients’ and therapists’ alliance ratings. Some implications for therapist training are discussed.

DRAFT: This module has unpublished changes.

Darius Muniz

Professor Katsiafica

Fieldwork I

February 21st, 2011

                                                              Assignment 5

                                                            

                                                                References

Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques

     positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1), 1-33.

Ackerman and Hilsenroth (2003) examine therapists’ personal attributes and techniques utilized during counseling sessions that have a positive influence on the therapeutic alliance. This article highlights that therapist attributes such as being honest, respectful, and trustworthy as well as techniques such as exploration and reflection have been found to positively impact the therapeutic alliance. This article is relevant because it details the qualities of a therapist that provide a strong foundation for establishing a strong working alliance between counselor and client.

Barber, J. P., Stratt, R., Halperin, G., & Connolly, M. B. (2001). Supportive techniques: Are they found in different therapies? The Journal of Psychotherapy Practice and Research, 10(3), 165-172.

Barber, Stratt, Halperin, and Connolly (2001) examine the use of universal supportive techniques across different fields of psychotherapy. The authors establish the link between supportive techniques utilized by therapists in relation to the therapeutic alliance. This article is relevant because it demonstrates that a therapists’ technique along with a strong working alliance are crucial for achieving positive treatment outcomes.

Dew, S. E., & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7(1), 21-35. doi: 10.1007/s11020-005-1963-5

Dew and Bickman (2005) examine the expectancies literature for both adult and child studies that emphasizes the relationship between client expectancies and the therapeutic alliance. Client expectancies and factors such as client improvement have been shown to be related to the therapeutic alliance. This article is relevant because it establishes the relationship between client expectations and a strong therapeutic alliance.

Duff, C. T., & Bedi, R. P. (2010). Counselor behaviors that predict therapeutic alliance: From the client's perspective. Counseling Psychology Quarterly, 23(1), 91-110 doi:10.1080/09515071003688165

Duff and Bedi (2010) tried to identify specific counselor behaviors through the conceptualization of clients that were related to promoting a strong therapeutic alliance. Several of these key counselor behaviors (i.e. making encouraging remarks or greeting the client with a smile) were shown to be related to a strong therapeutic alliance. This article is relevant because it empirically demonstrates the importance of counselor behaviors in developing a strong working alliance.

 

Elvins, R., & Green, J. (2008). The conceptualization and measurement of therapeutic alliance: An empirical review. Clinical Psychology Review, 28(7), 1167-1187. doi:10.1016/j.cpr.2008.04.002

Elvins and Green (2008) in this study state that it is well known that the therapeutic alliance is a major variable in predicting positive treatment outcomes. They examine both current measures and specific conceptualizations of the therapeutic alliance and suggest further steps for future research. This article is relevant because it identifies the concepts and measures that are currently used to research the impact of the therapeutic alliance on positive treatment outcomes.

Handwerk, M. L., et al… (2008). The role of therapeutic alliance in therapy outcomes for youth in residential care. Residential Treatment for Children Youth, 25(2), 145-167. doi:10.1080/08865710802310152

Handwerk et al… (2008) examine the impact of the therapeutic alliance on therapy outcomes for youth with behavioral and emotional problems residing in residential care. Study participants were youths in a residential treatment facility who were referred to an onsite psychotherapy clinic. This article is relevant because it directly tests the relationship between therapeutic alliance and treatment outcomes and also identifies a possible target group for our research question.

Ilgen, M. A., Mckellar, J., Moos, R., & Finney, J. W. (2006). Therapeutic alliance and the relationship between motivation and treatment outcomes in patients with alcohol use disorder. Journal of Substance Abuse Treatment, 31(2), 157-162.

Ilgen, Mckellar, Moos and Finney (2006) examine whether a positive therapeutic alliance is particularly beneficial for patients entering AUD (alcohol use disorder) treatment with low motivation. They tested the influence of motivation, therapeutic alliance, and their interaction on 6-month and 1-year alcohol use. This article is relevant because it tests if a strong therapeutic alliance is beneficial for patients with low motivation and also is a possible target group for our research question.

Joyce, A. S., Piper, W. E. (1998). Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236-248.

Joyce and Piper (1998) examined patient and therapist expectancies during short term psychotherapy. Relationships between expectancy ratings and measures of the therapeutic alliance and treatment outcome were examined. This article is relevant because it explores the link between the therapeutic alliance, client expectations, and positive treatment outcomes.

 

Keijsers, G. P. J., Schaap, C.P.D.R., & Hoogduin, C. A. L. (2000). The impact of      interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy. Behavior Modification, 24(2), 264- 297. DOI: 10.1177/0145445500242006

 

Keijsers, Schaap, and Hoogduin (2000) examine characteristics of the therapeutic relationship in cognitive-behavior therapy (CBT) and to identify therapist or patient interpersonal behavior that affects treatment outcome. Two clusters of interpersonal behavior have been identified that are clearly associated with CBT outcome: the Rogerian therapist variables; empathy, non-possessive warmth, positive regard, genuineness; and the therapeutic alliance. This article is relevant because it researches the effectiveness of the therapeutic alliance on CBT outcomes and also identifies a possible treatment focus, CBT, for our research question.

Lunnen, K. M., & Ogles, B. M. (1998). A multiperspective, multivariable evaluation of reliable change. Journal of Consulting and Clinical Psychology, 66(2), 400-410.

Lunnen, & Ogles (1998) examine the perceived level of change (as subjectively reported from 3 distinct perspectives) across outcome groupings based on Jacobson and Truax's reliable change index (RCI) and also subjective reports of therapeutic alliance and satisfaction across outcome groupings. This article is relevant because it directly researches the relationship between the therapeutic alliance and client satisfaction in relation to treatment outcomes.

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. doi: IO.I037//0022-006X.68.3.438

Martin, Garske, and Davis (2000) conducted this meta-analysis to identify the underlying patterns in the alliance literature and conducted an empirical review of the many existing studies that relate alliance to outcome. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been observed to influence this relationship. This article is relevant because it analyzes research literature that directly correlates the therapeutic alliance with positive treatment outcomes which answers my current research question.

McLeod, B. D., & Weisz, J. R. (2005). The therapy process observational coding system-alliance scale: Measure characteristics and prediction of outcome in usual clinical practice. Journal of Consulting and Clinical Psychology, 73(2), 323-333. DOI: 10.1037/0022-006X.73.2.323

McLeod and Weisz (2005) describe psychometric characteristics of the new Therapy Process Observational Coding System—Alliance scale (TPOCS–A; B. D. McLeod, 2001) and illustrates its use in the study of treatment internalized disorders. The (TPOCS–A) uses session observation to assess child–therapist and parent–therapist alliance. This article is relevant because it identifies a current measure of the therapeutic alliance and may identify a possible focus group for our research question.

Shirk, S. R., Gudmundsen, G., Kaplinski, H. C., & McMakin, D. L. (2008). Alliance and outcome in cognitive-behavioral therapy for adolescent depression. Journal of Clinical Child and Adolescent Psychology, 37(3), 631-639. doi: 10.1080/15374410802148061

Shirk, Gudmundsen, Kaplinski, and McMakin (2008) examined predictive relations between therapeutic alliance and treatment. Alliance was measured after the third session from both therapist and adolescent perspectives, and change in depressive symptoms was assessed by structured interview and self-report. This article is relevant because it examines the relationship between the therapeutic alliance through CBT and treatment outcomes and also identifies  a possible treatment focus (CBT) and target group (adolescents) for our research question.

Tryon, G. S., Blackwell, S. C., & Hammell, E. F. (2007). A meta-analytic examination of client-therapist perspectives of the working alliance. Psychotherapy Research, 17(6), 629-642.   doi: 10.1080/10503300701320611

Tryon, Blackwell, and Hammell (2007) examined 53 studies; utilizing 52 separate data sets published in journals from 1985 through 2006, conducted a meta-analysis of the correlation and mean difference between client and therapist alliance ratings. Client and therapist alliance ratings were moderately correlated and clients’ ratings were higher than ratings by their therapists. This article is relevant because it directly correlates through Meta analysis the relationship between the therapeutic alliance and the differences between client and therapists ratings of its importance.

Weerasekera, P., Linder, B., Greenberg, L., & Watson, J. (2001). The working alliance in client-centered and process-experiential therapy of depression. Psychotherapy Research, 11(2), 221-233.

Weerasekera, Linder, Greenberg, and Watson (2001) examined the development of the working alliance in process experiential (PE) and client centered therapy of depression. Results revealed the size of the alliance outcome relation to be dependent on alliance dimension (i.e. goal, task, or bond), outcome measure (symptom improvement vs self esteem, relational problems) and time in treatment alliance. This article is relevant because it directly examines the relationship of the therapeutic alliance with outcomes in PE and client centered therapy in patients with depression and also outlines possible treatments and disorders to focus on in our research question.

 

 

DRAFT: This module has unpublished changes.

Darius Muniz

Professor Katsiafica

Fieldwork I

March 1st, 2011

                                                            Assignment 6 (Outline)

I. Introduction-

 Our introduction and literature review will cover a) The therapeutic alliance, b) Substance abuse treatment, c) Implications and studies on therapeutic alliance in substance abuse therapy.

A) We will begin by discussing four aspects of the therapeutic alliance that are instrumental in assessing its effectiveness in psychotherapy. Counselor traits and techniques are personal qualities of the therapist that promotes strong ties between counselor and client and the techniques employed by the counselor as ways of bringing this working alliance to a point of complete trust and mutual teamwork towards positive treatment outcomes for the client. Client expectancies are expectations by the client that will determine if there will be a strong working alliance between themselves and their counselor. These expectancies can either strengthen the working alliance (if the expectations are met by the counselor) or weaken and prevent a strong working alliance (if expectations are not met creating a level of distrust and resentment). Measurement of therapeutic alliance will cover the current measures and inventories that assess the different aspects and specific components that make up a strong therapeutic alliance. These measures range the gambit from counselor/client perceptions, therapist qualities, client expectations, and goal setting to name a few. Finally we will discuss the relationship between the therapeutic alliance and treatment outcome for clients in psychotherapy.

1. Counselor traits and techniques-

Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques

     positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1), 1-33.

Duff, C. T., & Bedi, R. P. (2010). Counselor behaviors that predict therapeutic alliance: From the client's perspective. Counseling Psychology Quarterly, 23(1), 91-110 doi:10.1080/09515071003688165

2. Client Expectancies-

Dew, S. E., & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7(1), 21-35. doi: 10.1007/s11020-005-1963-5

Joyce, A. S., Piper, W. E. (1998). Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236-248.

3. Measurement of therapeutic alliance-

Elvins, R., & Green, J. (2008). The conceptualization and measurement of therapeutic alliance: An empirical review. Clinical Psychology Review, 28(7), 1167-1187. doi:10.1016/j.cpr.2008.04.002

Lunnen, K. M., & Ogles, B. M. (1998). A multiperspective, multivariable evaluation of reliable change. Journal of Consulting and Clinical Psychology, 66(2), 400-410.

McLeod, B. D., & Weisz, J. R. (2005). The therapy process observational coding system-alliance scale: Measure characteristics and prediction of outcome in usual clinical practice. Journal of Consulting and Clinical Psychology, 73(2), 323-333. DOI: 10.1037/0022-006X.73.2.323

4. Therapeutic Alliance and Treatment Outcome-

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. doi: IO.I037//0022-006X.68.3.438

Shirk, S. R., Gudmundsen, G., Kaplinski, H. C., & McMakin, D. L. (2008). Alliance and outcome in cognitive-behavioral therapy for adolescent depression. Journal of Clinical Child and Adolescent Psychology, 37(3), 631-639. doi: 10.1080/15374410802148061

B) For the literature on substance abuse we will be discussing three aspects that holistically encompass the experience of substance abuse from counselor to client. Treatments for substance abuse will cover the techniques and different preventive treatments utilized in therapy for substance abusers. History of physical or mental abuse will attempt to link a prevalence of past physical or mental abuse and trauma with developing drug seeking behaviors or becoming a drug attic. Treatment of substance abusers and outcome will review if the different treatments administered to substance abusers have had a positive or negative effect on positive treatment outcomes.

 

 

1. Treatments for substance abuse-

Anglin, M.D., Conner, B.T., Annon, J.J., & Longshore, D. (2009). Longitudinal effects of

     LAAM and methadone maintenance on heroin addict behavior. The Journal of

     Behavioral Health Services & Research, 36(2), 267-282.

 

Borg, L., Broe, D.M., Ho, A., & Kreek, M.J. (1999). Cocaine abuse sharply reduced in an

     effective methadone maintenance program. Journal of Addictive Diseases, 18(4),

     63-75.

Kreek, M.J., Borg, L., Ducat, E., & Ray, B. (2010). Pharmacotherapy in the treatment of

     addiction: Methadone. Journal of Addictive Diseases, 29(2), 200-216.

 

Veilleux, J.C., Colvin, P.J., Anderson, J., York, C. & Heinz, A.J. (2010). A review of the

     opioid dependence treatment: Pharmacological and psychosocial interventions to

     treat opioid addiction. Clinical Psychology Review, 30(2), 155- 166.

 

2. History of physical or mental abuse in relation to substance abuse-

Bartholomew, N.G., Courtney, K., Rowan- Szal, G.A., & Simpson, D.W. (2005). Sexual

     abuse history and treatment outcomes among women undergoing methadone

     treatment. Journal of Substance Abuse Treatment, 29(3), 231-235.

 

Branstetter, S.A., Bower, E.H., Kamien, J., & Amass, L. (2008). A history of sexual,

     emotional, or physical abuse predicts adjustment of opioid maintenance treatment, 

     34(20), 208- 214.

 

 

3. Treatment of substance abusers and Outcome-

Novick, D.M., Richman, B.L., Friedman, J.M., & Friedman, J.E. (1993). The medical

     status of methadone maintenance patients in treatment for 11-18 years. Drug and

     Alcohol Dependence, 33(3), 235- 245.

 

Senbanjo, R., Wolff, K., Marshall, E.J., & Strang, J. (2009). Persistence of heroin use

     despite methadone treatment: Poor coping self- efficacy predicts continued heroin

     use. Drug and Alcohol Review, 28(6), 608- 615.

 

Strain, E.C., Sitzer, M.L., Liebson, I.A., & Bigelow, G.E. (1993). Methadone dose and

     treatment outcome. Drug and Alcohol Dependence, 33(2), 105- 117.

 

C) For the discussion on implications and studies on therapeutic alliance in substance abuse therapy we will cover a) therapeutic alliance and substance abuse, b) therapeutic alliance and drug treatment completion.

 

 

A) Therapeutic alliance and substance abuse-

Meier, P.S., Barrowclough, C. and Donmall, M.C. (2005) The role of the therapeutic alliance in      the treatment of substance misuse: a critical review of the literature. Addiction, 100 (3). pp. 304-316.  doi.org/10.1111/j.1360-0443.2004.00935.x

 

DiClemente, C. C. (1999). Motivation for change: Implications for substance abuse treatment.

     Psychological Science, 10(3). 209-213.

 

B) Therapeutic alliance and drug treatment completion-

Cournoyer, L.-G., Brochu, S., Landry, M. and Bergeron, J. (2007), Therapeutic alliance, patient behavior and dropout in a drug rehabilitation program: the moderating effect of clinical subpopulations. Addiction, 102: 1960–1970. doi: 10.1111/j.1360-0443.2007.02027.x

Meier, P. S., Donmall, M. C., McElduff, P., Barrowclough, C., & Heller, R. F. (2006). The role      

      of the early therapeutic alliance in predicting drug treatment dropout. Drug and Alcohol

     Dependence, 83(1). 57- 64

 

DRAFT: This module has unpublished changes.