Journal of Consulting and Clinical Psychology, 2016
Better alliance is known to predict better psychotherapy outcomes, but the interdependent and int... more Better alliance is known to predict better psychotherapy outcomes, but the interdependent and interactive effects of both therapist- and patient-reported alliance levels have yet to be systematically investigated. Using actor-partner interdependence model analysis the authors estimated actor, partner, and 2 types of interactive effects of alliance on session outcome in a sample of 241 patient-therapist dyads across 30 sessions of cognitive-behavioral and alliance-focused therapy. Findings suggest that the most robust predictors of session outcome are within-treatment changes in patient reports of the alliance, which predict both patient and therapist report on outcome. Within-treatment changes in therapist reports of the alliance, as well as differences between patients and between therapists in their average ratings of alliance levels across treatment, predict outcome as reported by the specific individual. Although alliance was found to be a significant predictor of outcome in both treatments, for therapist-reported alliance and outcome it had a stronger effect in alliance-focused therapy than in cognitive-behavioral therapy. Additionally, dyads with the highest pooled level of alliance from both partners fared best on session outcome. The results are consistent with a 2-person perspective on psychotherapy, demonstrating the importance of considering the interdependent and interactive nature of both patient and therapist alliance levels on session outcome. (PsycINFO Database Record
Based on a definition of mindfulness as actively noticing novelty (Langer, 1989; Langer, Blank, &... more Based on a definition of mindfulness as actively noticing novelty (Langer, 1989; Langer, Blank, & Chanowitz, 1978), the present study sought to examine whether mindfulness training (attention to sensation variability) resulted in better childbirth outcomes for both mother and infant. At Weeks 25-30 of pregnancy, mindful instructions to attend to the variability of their positive and negative physical sensations were given to 1 group of participants and compared with 2 control groups (N = 105). The Langer Mindfulness Scale was used to assess the relationship between trait mindfulness and health outcomes. Findings showed that trait mindfulness predicted the well-being of expecting mothers and better neonatal outcomes. Mindfulness training resulted in better health for the expecting mother. Findings suggest that mindfulness without meditation can be easily taught and may enhance the pregnancy experience for mother and fetus.
Dependency and self-criticism are vulnerability factors for depression. How these personality fac... more Dependency and self-criticism are vulnerability factors for depression. How these personality factors change with treatment for depression and how they relate to symptom change across different types of treatment require further research. In addition, cultural differences that interact with the dependency/self-criticism-depression relation remain underinvestigated. We randomly assigned 149 adults with major depression to receive active medication (MED; n = 50), supportive-expressive therapy (SET; n = 49), or placebo pill (PBO; n = 50). Participants completed the Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) before and after treatment and completed the Hamilton Rating Scale for Depression (Hamilton, 1967) throughout the course of treatment. Self-criticism as measured on the DEQ decreased with treatment similarly across conditions. DEQ Dependency decreased in MED but remained unchanged in SET and PBO. Higher initial dependency, but not higher initi...
Psychotherapy research : journal of the Society for Psychotherapy Research, Jan 2, 2016
The ability of alliance to predict outcome has been widely demonstrated, but less is known about ... more The ability of alliance to predict outcome has been widely demonstrated, but less is known about the effect of the level of congruence between patient and therapist alliance ratings on outcome. In the current study we examined whether the degree of congruence between patient and therapist alliance ratings can predict symptomatic levels 1 month later in treatment. The sample consisted of 127 patient-therapist dyads. Patients and therapists reported on their alliance levels, and patients reported their symptomatic levels 1 month later. Polynomial regression and response surface analysis were used to examine congruence. Findings suggest that when the congruence level of patient and therapist alliance ratings was not taken into account, only the therapist's alliance served as a significant predictor of symptomatic levels. But when the degree of congruence between patient and therapist alliance ratings was considered, the degree of congruence was a significant predictor of symptomati...
The goal of the study was to examine two central theory-driven mechanisms of change, causal attri... more The goal of the study was to examine two central theory-driven mechanisms of change, causal attributions and relational representations, to account for symptomatic improvement in psychodynamic treatment and supportive clinical management, combined with either pharmacotherapy or placebo, in a randomized control trial (RCT) for depression. We used data from an RCT for depression, which reported non-significant differences in outcome among patients (N=149) who received supportive-expressive psychotherapy (SET), clinical management combined with pharmacotherapy (CM+MED), or clinical management with placebo pill (CM+PBO) (Barber et al., 2012). Mechanism and outcome measures were administered at intake, mid-treatment, end of treatment, and at a 4-month follow-up. Improvements in causal attributions and in relational representations were found across treatments. Changes in causal attributions did not predict subsequent symptomatic level when controlling for prior symptomatic level. In contrast, decrease in negative relational representations predicted subsequent symptom reduction across all treatments, and increase in positive relational representations predicted subsequent symptom reduction only in SET. The study is limited by its moderate sample size. Additional studies are needed to examine the same questions using additional treatment orientations, such as cognitive treatments. Findings demonstrate that changes in negative relational representations may act as a common mechanism of change and precede symptom reduction across psychodynamic therapy and supportive case management combined with either pharmacotherapy or placebo, whereas an increase in positive relational representation may be a mechanism of change specific to psychodynamic therapy.
Most of the literature on the alliance-outcome association is based exclusively on differences be... more Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient's contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients' self-reported and dia...
Although the alliance-outcome association is one of the most consistent findings in psychotherapy... more Although the alliance-outcome association is one of the most consistent findings in psychotherapy research, it is also highly heterogeneous. Little is known about the factors explaining this variability, and consequently there is a lack of adequate knowledge about how to utilize this association to improve treatment. The present study had the following objectives: (a) to examine the associations between within- and between-individual variability in alliance and outcome, controlling for previous symptomatic levels; (b) to examine the duration of the alliance-outcome association; and (c) to examine potential moderators of the alliance-outcome association. A total of 547 patients treated in a primary care psychotherapy setting in Chile were randomly assigned to 5 feedback conditions. The alliance-outcome association was analyzed using multilevel models, disentangling changes in alliance within-individuals from alliance between-individuals. Patient and therapist characteristics were examined as potential moderators. Findings suggest that patients who reported a better early alliance also reported a better outcome. Furthermore, patients reporting time-specific improvement in alliance also reported a greater reduction in symptoms. The unique effect of alliance on outcome at one point in time is maintained for a period of 2 weeks. Patients with more severe symptoms and longer treatments benefited more from a good alliance. Therapists identifying themselves as more integrative in their treatment orientation were able to better utilize good alliances for treatment success. Finally, the size of the alliance-outcome association can be manipulated by feedback to therapists.
ABSTRACT In the past few decades, many studies have been conducted on the positive effects of min... more ABSTRACT In the past few decades, many studies have been conducted on the positive effects of mindfulness, a state of openness to novelty in which an individual actively constructs categories and distinctions. The authors tested the applicability of Langer's (1989a) mindfulness theory to Holland's (1997) vocational personalities. Data from 156 Israeli full-time employees were collected. The results link different types of vocational personalities to a mindful mind-set.
Journal of Consulting and Clinical Psychology, 2016
Better alliance is known to predict better psychotherapy outcomes, but the interdependent and int... more Better alliance is known to predict better psychotherapy outcomes, but the interdependent and interactive effects of both therapist- and patient-reported alliance levels have yet to be systematically investigated. Using actor-partner interdependence model analysis the authors estimated actor, partner, and 2 types of interactive effects of alliance on session outcome in a sample of 241 patient-therapist dyads across 30 sessions of cognitive-behavioral and alliance-focused therapy. Findings suggest that the most robust predictors of session outcome are within-treatment changes in patient reports of the alliance, which predict both patient and therapist report on outcome. Within-treatment changes in therapist reports of the alliance, as well as differences between patients and between therapists in their average ratings of alliance levels across treatment, predict outcome as reported by the specific individual. Although alliance was found to be a significant predictor of outcome in both treatments, for therapist-reported alliance and outcome it had a stronger effect in alliance-focused therapy than in cognitive-behavioral therapy. Additionally, dyads with the highest pooled level of alliance from both partners fared best on session outcome. The results are consistent with a 2-person perspective on psychotherapy, demonstrating the importance of considering the interdependent and interactive nature of both patient and therapist alliance levels on session outcome. (PsycINFO Database Record
Based on a definition of mindfulness as actively noticing novelty (Langer, 1989; Langer, Blank, &... more Based on a definition of mindfulness as actively noticing novelty (Langer, 1989; Langer, Blank, & Chanowitz, 1978), the present study sought to examine whether mindfulness training (attention to sensation variability) resulted in better childbirth outcomes for both mother and infant. At Weeks 25-30 of pregnancy, mindful instructions to attend to the variability of their positive and negative physical sensations were given to 1 group of participants and compared with 2 control groups (N = 105). The Langer Mindfulness Scale was used to assess the relationship between trait mindfulness and health outcomes. Findings showed that trait mindfulness predicted the well-being of expecting mothers and better neonatal outcomes. Mindfulness training resulted in better health for the expecting mother. Findings suggest that mindfulness without meditation can be easily taught and may enhance the pregnancy experience for mother and fetus.
Dependency and self-criticism are vulnerability factors for depression. How these personality fac... more Dependency and self-criticism are vulnerability factors for depression. How these personality factors change with treatment for depression and how they relate to symptom change across different types of treatment require further research. In addition, cultural differences that interact with the dependency/self-criticism-depression relation remain underinvestigated. We randomly assigned 149 adults with major depression to receive active medication (MED; n = 50), supportive-expressive therapy (SET; n = 49), or placebo pill (PBO; n = 50). Participants completed the Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) before and after treatment and completed the Hamilton Rating Scale for Depression (Hamilton, 1967) throughout the course of treatment. Self-criticism as measured on the DEQ decreased with treatment similarly across conditions. DEQ Dependency decreased in MED but remained unchanged in SET and PBO. Higher initial dependency, but not higher initi...
Psychotherapy research : journal of the Society for Psychotherapy Research, Jan 2, 2016
The ability of alliance to predict outcome has been widely demonstrated, but less is known about ... more The ability of alliance to predict outcome has been widely demonstrated, but less is known about the effect of the level of congruence between patient and therapist alliance ratings on outcome. In the current study we examined whether the degree of congruence between patient and therapist alliance ratings can predict symptomatic levels 1 month later in treatment. The sample consisted of 127 patient-therapist dyads. Patients and therapists reported on their alliance levels, and patients reported their symptomatic levels 1 month later. Polynomial regression and response surface analysis were used to examine congruence. Findings suggest that when the congruence level of patient and therapist alliance ratings was not taken into account, only the therapist's alliance served as a significant predictor of symptomatic levels. But when the degree of congruence between patient and therapist alliance ratings was considered, the degree of congruence was a significant predictor of symptomati...
The goal of the study was to examine two central theory-driven mechanisms of change, causal attri... more The goal of the study was to examine two central theory-driven mechanisms of change, causal attributions and relational representations, to account for symptomatic improvement in psychodynamic treatment and supportive clinical management, combined with either pharmacotherapy or placebo, in a randomized control trial (RCT) for depression. We used data from an RCT for depression, which reported non-significant differences in outcome among patients (N=149) who received supportive-expressive psychotherapy (SET), clinical management combined with pharmacotherapy (CM+MED), or clinical management with placebo pill (CM+PBO) (Barber et al., 2012). Mechanism and outcome measures were administered at intake, mid-treatment, end of treatment, and at a 4-month follow-up. Improvements in causal attributions and in relational representations were found across treatments. Changes in causal attributions did not predict subsequent symptomatic level when controlling for prior symptomatic level. In contrast, decrease in negative relational representations predicted subsequent symptom reduction across all treatments, and increase in positive relational representations predicted subsequent symptom reduction only in SET. The study is limited by its moderate sample size. Additional studies are needed to examine the same questions using additional treatment orientations, such as cognitive treatments. Findings demonstrate that changes in negative relational representations may act as a common mechanism of change and precede symptom reduction across psychodynamic therapy and supportive case management combined with either pharmacotherapy or placebo, whereas an increase in positive relational representation may be a mechanism of change specific to psychodynamic therapy.
Most of the literature on the alliance-outcome association is based exclusively on differences be... more Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient's contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients' self-reported and dia...
Although the alliance-outcome association is one of the most consistent findings in psychotherapy... more Although the alliance-outcome association is one of the most consistent findings in psychotherapy research, it is also highly heterogeneous. Little is known about the factors explaining this variability, and consequently there is a lack of adequate knowledge about how to utilize this association to improve treatment. The present study had the following objectives: (a) to examine the associations between within- and between-individual variability in alliance and outcome, controlling for previous symptomatic levels; (b) to examine the duration of the alliance-outcome association; and (c) to examine potential moderators of the alliance-outcome association. A total of 547 patients treated in a primary care psychotherapy setting in Chile were randomly assigned to 5 feedback conditions. The alliance-outcome association was analyzed using multilevel models, disentangling changes in alliance within-individuals from alliance between-individuals. Patient and therapist characteristics were examined as potential moderators. Findings suggest that patients who reported a better early alliance also reported a better outcome. Furthermore, patients reporting time-specific improvement in alliance also reported a greater reduction in symptoms. The unique effect of alliance on outcome at one point in time is maintained for a period of 2 weeks. Patients with more severe symptoms and longer treatments benefited more from a good alliance. Therapists identifying themselves as more integrative in their treatment orientation were able to better utilize good alliances for treatment success. Finally, the size of the alliance-outcome association can be manipulated by feedback to therapists.
ABSTRACT In the past few decades, many studies have been conducted on the positive effects of min... more ABSTRACT In the past few decades, many studies have been conducted on the positive effects of mindfulness, a state of openness to novelty in which an individual actively constructs categories and distinctions. The authors tested the applicability of Langer's (1989a) mindfulness theory to Holland's (1997) vocational personalities. Data from 156 Israeli full-time employees were collected. The results link different types of vocational personalities to a mindful mind-set.
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