The Therapeutic Alliance Supported and Reinforced

Two (2), what I think are important additions to therapeutic alliance literature appeared in the January edition of the Journal of Counseling Psychology (Vol 59, No. 1).  In the first, Fluckiger, Del Re, Wampold, Symonds and Horvath (How central is the alliance) completed a meta-analysis to see if there were moderators to the influence of the working alliance in the context of randomized clinical trials.  They found none with the exception of a slightly higher correlation between outcome and alliance with researchers with a specific interest in the alliance.  As allegiance to a therapy practice contributes to alliance development, this should not be surprising or at all troubling.  

The importance of this research finding lay with the primary role that the alliance plays in therapy outcome and alliance development as the central evidence based practice; if therapeutic bond and agreement on task and goals are not in alignment, it is unlikely that any evidence based practice, including the administration of psychotropic medication, is going to work. 

In the second, Fluckiger, Del Re, Wampold, et al. (valuing clients’ perspective) completed a randomized controlled study to see if inviting clients to provide their therapists with feedback about the therapy process (letter and phone call) would increase the quality of the therapeutic alliance developed; it did and it did over the full course of therapy.  The suggestion was that the feedback requests fostered enhanced client feelings that their therapists were interested in their welfare.  

This study supports Miller, Duncan and Sparks client directed work and the role played by therapy support tools like their Outcome and Session Rating Scales (ORS/SRS) and the How Am I Doing (HAID) and How are We Doing (HAWD) tools being used at New Hope Foundation.  Both sets of instruments solicit client feedback to see if the therapies being applied are having the desired effect and if the therapeutic alliance is sustaining a quality adequate for the effective delivery of an appropriate therapy.  The use of the instruments is also intended to foster client input into correcting for shortfalls in the here and now and improving the process. 

While the alchemy in these processes appears to lay with the fact that we simply ask the questions sincerely and respond or act as called for, the related written communications and instrumentation insure for a consistency that contributes to the overall quality of care.  The instruments or therapy support tools contribute to the structure and thus the context of care and, with respect to this blog, perhaps provide the main sheet and down haul shaping the therapy sails to insure forward progress through what are inevitably shifting winds and waters.