Between Therapist and Client

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The California Scales comprise the CALTARS (California Therapeutic Alliance Rating Scale) and the CALPAS (California Psychotherapy Alliance Scale). The former derives from the TARS and focuses on the affective and attitudinal aspects of the alliance rather than on specific therapeutic interventions. The CALPAS is a revised version of the CALTARS and was designed to rate the four aspects of the alliance identified by Gaston ( 1990): patient working capacity, patient commitment, therapist understanding and involvement, patient–therapist agreement on goals, and strategies.

Strong support for the reliability of the WAI scales and some support for its validity. Several studies have demonstrated the predictive validity of this instrument in a variety of treatments (Horvath, 1994; Horvath and Greenberg, 1989; Howard et al., 2006; Klein et al., 2003; Martin et al., 2000; Safran and Wallner, 1991). The bond between the therapist and client is formed from trust and confidence that the selected tasks will move the client toward their goals. The PSR was not developed following a specific theoretical viewpoint and evaluates the patient’s in-therapy behaviour that may point to the existence of a therapeutic alliance: collaborative and active participation, spontaneous and full agreement, affective involvement, desire to achieve goals, confidence, clear, and realistic representation of the therapeutic relationship.Gilliéron E. (1989). Short psychotherapy interventions (four sessions). Psychother. Psychosom. 51, 32–37 10.1159/000288131 [ PubMed] [ CrossRef] [ Google Scholar] Safran J. D., Muran J. C. (2000). Negotiating the Therapeutic Alliance: A Relational Treatment Guide. New York: Guilford Press [ Google Scholar]

For the past 80 years, psychotherapists have advocated that nonspecific common factors are responsible for the success of their work (Groth-Marnat, 2009). Within the field of psychology, the therapeutic alliance is foundational to these common factors. The KAS was developed to rate the quality of the therapeutic alliance from the patient’s perspective. The scale comprises the three dimension of the alliance originally proposed by Bordin ( 1979) plus a fourth dimension: the patient’s empowerment, i.e., the patient becoming more responsible for his/her own care and more involved in making choices. Suh C. S., Strupp H. H., O’Malley S. S. (1986). “The Vanderbilt process measures: the psychotherapy process scale (VPPS) and the negative indicators scale (VNIS),” in The Psychotherapeutic Process: A Research Handbook, eds Greenberg L. S., Pinsof W. M. (New York: Guilford Press; ), 285–323 [ Google Scholar]

Burlingame G. M., McClendon D. T., Alonso J. (2011). Cohesion in group therapy. Psychotherapy 48, 34–42 10.1037/a0022063 [ PubMed] [ CrossRef] [ Google Scholar] The patient-therapist relationship is generally representative of the nature of all other relationships you have, and so learning to resolve problems while maintaining connection provides skills that are widely applicable. To experience conflict with a therapist and learn to resolve it is often the path out of depression. Strupp H. H., Hadley S. W. (1979). Specific versus non specific factors in psychotherapy: a controlled study of outcome. Arch. Gen. Psychiatry 36, 1125–1136 [ PubMed] [ Google Scholar] When it’s clear to both therapist and patient that it’s time to stop, use the last few sessions to discuss any issues that have not received closure and summarize the progress that’s been made, says Tishby. Therapists shouldn’t be afraid to share some of their own feelings: If you are saddened by the ending of a relationship, for example, share that with your patient and how much you’ve valued your work together, she advises. The therapeutic alliance is dynamic in nature. A healthy alliance will include ruptures and repairs throughout the stages of therapy.

This applies to all forms of counselling and psychotherapy, and regardless of the theoretical orientation of your therapist or counsellor, the relationship developed between you will be considered of high importance.Pinsof W. M. (1988). The therapist-client relationship: an integrative system perspective. J. Integr. Eclect. Psychother. 7, 303–313 [ Google Scholar] Horvath A. O., Greenberg L. S. (1986). “The development of the working alliance inventory,” in The Psychotherapeutic Process: A Research Handbook, eds Greenberg L. S., Pinsof W. M. (New York: Guilford Press; ), 529–556 [ Google Scholar] The TSR is a 145-item structured-response instrument. Most of the item are scored in a binary fashion or on a 0–2 scale. Martin D. J., Garske J. P., Davis M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J. Consult. Clin. Psychol. 68, 438–450 10.1037/0022-006X.68.3.438 [ PubMed] [ CrossRef] [ Google Scholar]

According to their meta-analysis based on the results of 24 studies, Horvath and Symonds ( 1991) demonstrate the existence of a moderate but reliable association between good therapeutic alliance and positive therapeutic outcome. More recent meta-analyses of studies examining the linkage between alliance and outcomes in both adult and youth psychotherapy (Martin et al., 2000; Shirk and Karver, 2003; Karver et al., 2006) have confirmed these results and also indicated that the quality of the alliance was more predictive of positive outcome than the type of intervention (but for slightly different results in youth psychotherapy see McLeod, 2011). Elvins R., Green J. (2008). The conceptualization and measurement of therapeutic alliance: an empirical review. Clin. Psychol. Rev. 28, 1167–1187 10.1016/j.cpr.2008.04.002 [ PubMed] [ CrossRef] [ Google Scholar] Do they know how to resuscitate you when you're pulled to shore and feel you can barely breathe from fear or pain? It is interesting to note that although almost all of these scales were originally designed to examine the perspective of only one member of the patient–therapist–observer triad, they were later extended or modified to rate perspectives that were not previously considered. In short, some scales analyses specific theoretical concepts of the alliance (Penn scales, WAI, CALPAS, TBS), whereas others use a more eclectic construct (VPPS, VTAS, TARS). The number of items included in the scales varies considerably (between 6 and 145 items), as do the dimensions of the alliance investigated (e.g., two in the Penn scales; three in the WAI, TSR, and TBS; four in the CALPAS and KAS; and five in the ARM). According to Martin et al. ( 2000), the most frequently used scales in individual psychotherapy are the WAI, CALPAS, and Penn scales, followed by the Vanderbilt scales, TARS, and TBS.As with other key moments in therapy, the psychologist should discuss termination openly, even if a patient is simply toying with the idea—for example, if the patient actually wants to stay but is scared to dive into a difficult topic, Tishby adds. Such conversations may include talking about those feelings or about changing aspects of treatment to better accommodate the patient, she says. Research on the power of the therapeutic relationship has accumulated over 1,000 findings that include its ability to predict adherence, compliance, concordance, and outcomes across a wide range of diagnoses and treatment settings (Orlinsky, Ronnestad, & Willutski, 2004).