Abstract/Results: | ABSTRACT:
The current dissertation is grounded on the assumption that the first treatment sessions are crucial to build therapy alliance, which, in its turn, accounts for therapeutic progress and outcome. With this in mind, our project was structured in the three following studies: first, we addressed the relation between alliance and symptoms improvements in the first four sessions of therapy, based on the answers of 40 clients to the Working Alliance Inventory (WAI), and their symptomatic changes, as measured by the Outcome Questionnaire 10.2 (OQ-10.2). A Hierarchical linear modeling (HLM) showed a significant association between the values of alliance and the slope of symptoms decrease, in cognitive behavioral therapy (CBT). In narrative therapy (NT) no significant relation was found. Results underline the relevance of early alliance to symptomatic changes in CBT, suggesting that alliance formation may differ between treatments. In the second study we investigated the effect of the therapist-client collaborative interactions on alliance building. We analyzed interactions at a micro-level, based on the transcripts of the first four therapeutic sessions of 11 good and 9 poor outcome cases, with the Therapeutic Collaboration Coding System (TCCS). Using a statistical HLM approach, we found a positive relationship between interactions that promote client’s advance toward change and the formation of alliance, in good outcome cases. However, exchanges involving supporting problem and resulting in a safety experience had a negative impact on alliance. No significant effect was detected in poor outcome cases. These findings indicate that therapeutic exchanges where clients responded with tolerable risk affected positively the alliance creation. Finally, in the third study we examined the dynamic unfolding of the therapist-client conversational interactions. Using the general linear modeling (GLM) it was analyzed the data from the TCCS. The findings reported that in the good outcome group, therapists tended to make a more balanced use of supporting problem and challenging interventions, in comparison with poor outcome cases. In this sample, it was observed a general trend of safety responses, regardless of the previous therapist intervention. Regarding the Therapeutic Zone of Proximal Development (TZPD), these results suggest that the dyad dialogue tended to occur within the limits of the TZPD. Nonetheless, therapists in the good outcome group exhibited greater capacity to attend and adjust their interventions to clients’ experiences, suggesting higher responsiveness. This dissertation was concluded by discussing the results in light of the existing literature and implications to clinical practice, such as the need to further explore the skills for therapy alliance formation in the training of young therapists.
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