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Flashcards by Jo Gledhill, updated more than 1 year ago
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Created by Jo Gledhill
over 9 years ago
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| Question | Answer |
| What is the most robust predictor of successful therapy? | The working alliance |
| Poor therapeutic outcomes show more negative ---- processes | interpersonal (Henry et al., 1986) |
| Some therapists are more helpful than others, independent of ---- | modality (Bordin, 1994) |
| How did Bordin (1979) define the therapeutic alliance? | The collaborative relationship between patient and therapist in the common fight to overcome the patient’s suffering and self-destructive behaviour |
| The therapeutic alliance is made up of three elements. What are these? | (Bordin, 1979): Agreement on the goals of treatment Agreement on the tasks of treatment Development of a personal bond |
| Define alliance goals and give an example? | Therapist and client mutually endorse the same target outcomes example: Working towards being less depressed and returning to work |
| Define alliance tasks and give an example? | Both endorse the same ideas about what makes up therapeutic process and see these as useful Both take responsibility for these tasks Example: Both happy to increase activity levels/Both encourage challenging of unhelpful thoughts |
| Define alliance bonds and give an example? | Positive personal attachment between client and therapist Mutual trust, acceptance and confidence Example: Trust in therapist Compassion and empathy to client Get on well! |
| What is the difference between technique and process? | Technique= The tasks of therapy A therapist’s tool box (e.g. thought records, interpretations) Overt and conscious Process=The dynamics of the therapy How the relationship is over time Unconscious emotions Relational themes Often covert and unconscious |
| Outline Freud's Psychodynamic approach to the therapetic alliance | Freud (1912) – you need to maintain a “serious interest” in and “sympathetic understanding” of the client. This allows a positive attachment to the analyst Later on Freud emphasised the importance of transference and countertransference and how these can be part of the therapeutic process |
| Define transference? | The client’s feelings and behaviour toward the therapist We respond to every new relationship according to patterns of the past We transfer our old internalised models of relationships onto new ones Therefore the client’s key early relationships will be played out within the therapeutic relationship |
| Define counter-transference? | The therapist’s feelings and behaviour towards the client Can be a result of being pulled into the client’s internalised relational models Can be a result of the therapist’s own relational models (or a combination of both) |
| According to Freud, how would having a warm and positive early relationship with the mother affect the client's later relationship with a therapist? | Warm loving mother--->positive internal fema model---->positive relationships and positive relationship with therapist |
| Some psychodynamic therapists see developing a ----- as one of the key goals of therapy | positive, need-gratifying relationship with the therapist (Bowlby, 1988) |
| According to the psychodynamic view what must be done to ensure a positive relationship with the client? | Understanding and discussing of the transference and counter-transference as a key therapeutic task |
| who was champion of the person centred approach to therapy? | Carl Rogers |
| The person centred approach is a ---- approach which states that people have a desire to ----- which can be facilitated by ---- | Humanistic grow (self actualise) a positive environment |
| According to Carl Rogers' person centred approach, therapy can help people meet... | their own goals |
| What are the core conditions of the person centred approach? | Empathy (Sensitively follow client’s emotions and communicate these) Congruence (Therapist is genuine, open and transparent. How you behave matches how you feel) Unconditional positive regard (Acceptance and love for who the person is right now) |
| OUtline evidence for the importance of the core conditions? | Therapists who embodied the core conditions were more successful than those who did not (Barrett-Lennard, 1985; Rogers et al., 1967) The client perception of the therapist as an empathic individual might be more important than therapist behaviour (Mitchell et al., 1977) Client-perceived empathy may be particularly important in developing a positive alliance (Moseley, 1983). |
| Which part of the therapeutic alliance do the core conditions particularly have an effect on? | the bond |
| How is a good alliance developed? | By remembering the core conditions: empathy, genuineness, unconditional positive regard Be explicit about different aspects of the alliance – particularly the tasks and goals of therapy. Decide these collaboratively. Be mindful of the possible transference – what kind of early relationships has your client had? Be mindful of your countertransference – are you being pulled into a re-enactment of your client’s early relationships? What are you bringing in terms of your own early relationships? |
| Occasionally ruptures in an alliance can occur, outline the different types of ruptures? | Disagreements on tasks and goals For example: Client is unclear on the rationale of therapy Client does not see the tasks set by the therapist as useful Client and therapist have a different goal in mind (usually not explicit) Problems with the relational bond Client mistrusts the therapist Client does not feel understood by the therapist. Client feels let down by the therapist |
| describe different types of withdrawal rupture? | Denial of a manifestly evident state (“no I’m not angry”) Minimal response (short answers to Qs) Shifting the topic (client suddenly shifts focus) Intellectualisation (discusses an emotional topic in a deatched manner) Storytelling (client weaves overly elaborate anecdotes) Talking about other (client talks about others not themselves) |
| describe different types of confrontation, more recently called control, ruptures? | Complains about.... therapist as person (you're too passive) Therapist as competent (e.g. “you are a useless therapist”) Activities of therapy (“why is this task relevant?”) Being in therapy (“is it worth coming to therapy?”) Parameters of therapy (“it’s really difficult getting all the way here”) Progress in therapy (“we haven’t really got anywhere, have we?”) |
| How did Safran suggest that ruptures should be dealt with? | Safran suggests a key method is therapeutic metacommunication His stage process model suggests a way you can work with these ruptures to move the therapy forward This model centres on being aware of your own internal state as a therapist, what is happening in the room between you and the client The next step is to comment on it without being punitive – i.e. metacommunication The therapist must be able to step back from the situation (disembed) and discuss in an empathic and compassionate way |
| OUtline how Safran's model would deal with a withdrawal rupture? | |
| How does Safran's model suggest that you would deal with a confrontation rupture? | |
| What did KIRSCHENBAUM and Jourdan (2005) use to assess the current status of the person centred approach? | three indices: the number of publications in the field, the proliferation of the person centered approach around the world, and current research on the client-centered approach and psychotherapy outcomes. |
| What was found by KIRSCHENBAUM and Jourdan (2005) regarding the number of publications about the person centred approach? | Since Carl Rogers' death (1987) and up until 2004, 777 books, chapters, and articles on Rogers and the client-centered/personcentered approach were found |
| What did KIRSCHENBAUM and Jourdan (2005) find regarding the proliferation of the person centred approach? | Currently, there are approximately 200 organizations and training centers located around the world dedicated to researching and applying the principles developed by Rogers |
| What did KIRSCHENBAUM and Jourdan (2005) find regarding current research on the person centred approach? | In spite of some equivocal reviews in the 70s, most research in the 1980s and 90s continued to support the importance of the core conditions |
| What did Kirshenbaum and Jourdan (2005) conclude? | The number of publications on Rogers and the clientcentered/person-centered approach has increased substantially since Rogers’s death. Personcentered associations, organizations, and training Current Status of Carl Rogers and P-C Approach institutes have proliferated around the world. Research on psychotherapy process and outcomes has validated the importance of empathy, unconditional positive regard, and probably congruence. Rogers’s core conditions for an effective therapeutic relationship. By all these indicators, the person- centered approach, which holds the therapeutic relationship as central and essential to effective counseling and psychotherapy, is alive and well. Although relatively few therapists describe themselves as primarily client-centered in their orientation, client-centered principles permeate the practice of many, if not most, therapists. |
| Give a summary of Bohart et al (2002) | They conducted possibly the largest meta-analysis of research on empathy, including 47 studies from 1961–2000, involving 3,026 clients, with 190 separate empathy outcome associations studied. They found a weighted, unbiased effect size of .32, which is considered a medium effect size. In the context of psychotherapy outcome research, this would be considered a meaningful correlation between empathy and positive therapeutic outcomes |
| Safran et al (2001) reviewed the literature and criticised it in what way? | Much of the research thus far consists of small samples or qualitative studies. In many respects, such research should be considered in the early stages of development. |
| Outline Rennie (1994)'s findings about therapeutic relationships, and the consequences of this for fixing ruptures? | Rennie (1994), using a qualitative research methodology, discovered that patients' deference to their therapists played a significant role in therapeutic interactions. If, as Rennie's findings suggest, patients believe protecting their therapists is the best way to maintain the relationship, it is understandable that they would be reluctant to talk openly with them about their concerns regarding treatment. It is thus critical for therapists to be able to pick up on cues that the alliance is in trouble and address them in a way that allows the patient to participate without undue anxiety. |
| Outline Lansford (1986) | Lansford (1986) looked at several short-term therapy cases, identifying weakening and repairs in the alliance, and found that segments when therapists and patients took direct action to repair weakened alliances were followed by the highest levels of patient alliance ratings, and the degree of success in addressing weaknesses was predictive of outcome. |
| What therapeutic practices do Safran et al (2001) recommend following their literature review? | 4.Therapists should be aware that patients often have negative feelings about the therapy/therapeutic relationship, which they are reluctant to broach for fear of the therapist's reactions. It is important for therapists to be attuned to subtle indications of ruptures in the alliance and to take the initiative in exploring what is transpiring in the relationship when they suspect that a rupture has occurred. 2. It is important for patients to have the experience of expressing negative feelings about the therapy to the therapist, should they emerge, or to assert their perspective on what has transpired when it differs from the therapist's perspective. 3. When this takes place, it is important for therapists to respond in an open and nondefensive fashion, and to accept responsibility for their contribution to the interaction 4. There is some evidence to suggest that the process of exploring the patient's fears and expectations that make it difficult for them to assert their negative feelings about the treatment may contribute to the process of resolving the alliance rupture |
| Give a reference for this statement: The alliance functions both as an early treatment predictor of patient change and as a focus of therapeutic intervention, such as when a breakdown occurs or an impasse is reached between patient and therapist | (Horvath & Greenberg, 1994) |
| A therapeutic alliance rupture is broadly defined as.... | a negative shift in the quality of the existing alliance or as difficulty establishing one. It is thought to be an inevitable event in treatment that is contributed to by both patient and therapist (Safran, Crocker, McMain, & Murray, 1990). |
| OUtline Hilliard, Henry and Strupp (2000) | Hilliard, Henry, and Strupp (2000) evaluated patient, therapist, and observer ratings of interpersonal behaviors in Session 3 using Structural Analysis of Social Behavior assessments (SASB; Benjamin, 1974), as well as self report introject assessments from the patient and therapist in their early parental relationships and in the therapeutic relationship. Hilliard et al. (2000) found that both patient and therapist early parental relationships had an indirect impact on overall patient outcome (i.e., change in symptomatology and introject), which was mediated by the therapeutic process (i.e., what the patient and therapist actually did to foster or impede the alliance). |
| Give a reference for the two categories of ruptures (withdrawal and confrontation/control) | Samstag, Muran & Safran (2004) |
| Outline Raskin (1974) | The ideal therapist is empathic. When 83 practising therapists of at least eight different therapeutic approaches described their concept of the ideal therapist, the therapist they would like to become, they are in high agreement in giving empathy the highest ranking out of twelve variables. |
| The review by Prasko et al (2010) concluded what? | Both the literature and our experience underscore the importance of careful and open examination of both transference and counter-transference issues in CBT and their necessary incorporation in the complete management of all patients undergoing CBT. |
| What advice is given by Prasko et al (2010) regarding transference and countertransference in CBT, following their review of the literature? | Transference. The therapist should pay attention to negative or positive reactions towards him/ her but should not deliberately provoke or ignore them. He/she should be vigilant for signs of strong negative emotions, such as a disappointment, anger, and frustration experienced in the therapeutic relationship by the patient. Similarly he/ she should be alert to exaggerated positive emotions such as love, excessive idealization, praise or attempts to divert the attention of therapy onto the therapist. These reactions open space for understanding the patient's past and actual relations outside the therapy. Countertransference. The therapist should be aware of countertransference schemas as they apply to him/her. He/she should monitor his/her own feelings that indicate countertransference. Further, the assistance of and discussion with supervisors and colleagues is useful in regard to countertransference even in experienced therapists. Countertransference can be used as an open window into the interpersonal relations of the patient. |
| Outline the review by Ackerman and Hilsenroth (2003) | This review is a comprehensive examination of the therapist's personal attributes and in-session activities that positively influence the therapeutic alliance from a broad range of psychotherapy perspectives. Therapist's personal attributes such as being flexible, honest, respectful, trustworthy, confident, warm, interested, and open were found to contribute positively to the alliance. Therapist techniques such as exploration, reflection, noting past therapy success, accurate interpretation, facilitating the expression of affect, and attending to the patient's experience were also found to contribute positively to the alliance. This review reveals how these therapist personal qualities and techniques have a positive influence on the identification or repair of ruptures in the alliance |
| Outline the study by Krupnick et al (1996) | The relationship between therapeutic alliance and treatment outcome was examined for depressed outpatients who received interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Outcome was assessed from patients' and clinical evaluators' perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy. Ratings of patient contribution to the alliance were significantly related to treatment outcome; ratings of therapist contribution to the alliance and outcome were not significantly linked. These results indicate that the therapeutic alliance is a common factor with significant influence on outcome. |
| OUtline Piper et al (1999) | Predictors of dropping out were investigated for patients who participated in time-limited, interpretive individual psychotherapy in a randomized clinical trial. A sample of 22 dropouts was compared with a sample of 22 matched completers on both pretherapy and therapy process variables. Several of the therapy process variables, including the therapeutic alliance, work, patient exploration, and a focus on transference, significantly differentiated dropouts from completers. For dropouts, there was a weaker alliance, less work, less exploration, and greater focus on transference. Examination of the last session of dropouts revealed a nonproductive pattern characterized by resistance and transference interpretation (by both client and patient). In the last session of dropouts, The patient and therapist appeared to be caught up in an unproductive power struggle that increased the frustration of both. Persistent use of transference interpretations on the therapist's part was not successful in resolving the impasse. |
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