Therapeutic relationship influences on treatment effectiveness

Shavonne J Moore, Purdue University

Abstract

In this study, I examined clients' views of how three different therapeutic relationship conceptualizations (i.e., working alliance, real relationship, and attachment-caregiving) contributed uniquely to treatment effectiveness and value and power. There were two hypotheses: (a) the working alliance, real relationship, and therapist-attachment would contribute unique variance to explaining treatment effectiveness, with therapist-attachment explaining the most unique variance; and (b) the working alliance, real relationship, and therapist-attachment would contribute unique variance to explaining treatment's value and power, with therapist-attachment explaining the most unique variance. The participants (N = 385) were volunteer college students enrolled at a large Midwestern public university. All participants had previously been therapy clients. They responded to five instruments based on their most recent therapy experience. The instruments were: (a) Working Alliance Inventory – Short Form, Client Version (WAI-S; Tracey & Kokotovic, 1989); (b) Real Relationship Inventory – Client Form (RRI-C; Kelley, Gelso, Fuertes, Marmarosh, & Lanier, 2010), comprised of Genuineness and Realism; (c) Client Attachment to Therapist Scale (CATS; Mallinckrodt, Gantt, & Coble, 1995), comprised of Secure, Avoidant/Fearful (A/F), and Preoccupied/Merger (P/M) therapist-attachment; (d) Session Impact Scale (SIS; Elliott & Wexler, 1994), comprised of Helpful and Hindering Impacts; and (e) Session Evaluation Questionnaire (SEQ; Stiles, Gordon, & Lani, 2005; Stiles & Snow, 1984), comprised of Depth (i.e., power and value) and Smoothness. I used four hierarchical regression analyses to test the two hypotheses. Because a preliminary MANOVA analysis revealed sex differences for the treatment value and power variables, I controlled for sex in analyzing the second hypothesis. All hypotheses were partially supported. Overall, the working alliance, real relationship, and therapist-attachment variables contributed unique variance to treatment effectiveness (i.e., helpful and hindering impacts) and to treatment value and power (i.e., depth and smoothness). Additionally, therapist-attachment contributed more unique variance than the working alliance or real relationship in explaining some, but not all, components of treatment effectiveness, value, and power. The results suggest that different therapeutic relationship conceptualizations make different contributions to treatment outcomes. I discuss limitations of the study as well as the implications for research and practice.

Degree

Ph.D.

Advisors

Pistole, Purdue University.

Subject Area

Counseling Psychology|Psychology

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