Impact of confrontations by therapists on impairment and utilization of the therapeutic alliance.

Möseneder, Laura; Ribeiro, Eugénia; Muran, John Christopher; Caspar, Franz (2019). Impact of confrontations by therapists on impairment and utilization of the therapeutic alliance. Psychotherapy research, 29(3), pp. 293-305. Routledge 10.1080/10503307.2018.1502897

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OBJECTIVE Striking the balance between creating challenge through confrontation (drawing attention to discrepancies) to encourage change and offering support through the therapeutic relationship to ensure safety for patients represents a central issue for psychotherapists. The aim of the present study was to assess immediate effects of confrontations by therapists on the therapeutic alliance. METHOD We rated video recordings of 77 therapies to measure incidences of alliance ruptures/resolution attempts as well as confrontations by therapists. Change in the therapeutic alliance and therapy outcome were measured through questionnaires filled out by patients. RESULTS Confrontations were significantly associated with ruptures/resolution attempts on the micro level. Changes in the therapeutic alliance moderated the association between confrontations and alliance ruptures on the macro level: The bigger the fraction of a session containing confrontations, the larger the fraction containing ruptures, given a prior positive change in the therapeutic alliance. Therapists' use of confrontation during a resolution attempt was associated with significantly better therapy outcomes than no use of confrontation during or no resolution attempt. CONCLUSIONS Confrontations by therapists may temporarily impair the therapeutic alliance, but might also lead to better therapy outcomes when used to make an alliance rupture explicit as part of a resolution attempt.

Item Type:

Journal Article (Original Article)

Division/Institute:

07 Faculty of Human Sciences > Institute of Psychology > Clinical Psychology and Psychotherapy

UniBE Contributor:

Möseneder, Laura and Caspar, Franz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1050-3307

Publisher:

Routledge

Language:

English

Submitter:

Melanie Best

Date Deposited:

01 Nov 2018 12:36

Last Modified:

30 Mar 2020 14:34

Publisher DOI:

10.1080/10503307.2018.1502897

PubMed ID:

30047304

Uncontrolled Keywords:

alliance cognitive behaviour therapy integrative treatment models outcome research process research

BORIS DOI:

10.7892/boris.120857

URI:

https://boris.unibe.ch/id/eprint/120857

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