Document Type : Research Paper
Authors
1 Persian Gulf University, Bushehr, Iran
2 Assistant of professor, Department of Psychology, Persian Gulf . iran
Abstract
The premature termination of psychotherapy as a big problem has been found in the work of mental health professionals. Many factors are involved in causing it. The purpose of the present study was compare two groups of patients with successful termination of psychotherapy and premature termination of psychotherapy in the therapeutic alliance. Design of present study was a causal comparative in which to compare two groups in the Study variables were discussed. Statistical population of the present study was all patients referred to Mental Health Clinics, Pain Clinics and Substance Use Treatment Centers in Mashhad that the targeted sampling during 9 months from January 2021 to September 2021, 60 people were selected as sample. The research instruments were included Demographic information questionnaire, Working Alliance Inventory – Short Revised (WAI-SR) and Outcome Questionnaire (OQ®-42.2). For data analysis software was used from SPSS-19, descriptive findings and independent t-test. The mean and standard deviation age of the participants was respectively 37/38 and 6/98. The average of therapeutic alliance was in the group with successful termination of psychotherapy (42) higher than the group with premature termination of psychotherapy (26/13). The results of two independent groups t-test showed that the two groups were statistically significant differences together in therapeutic alliance (P<0/05). Results of this study showed that the therapeutic alliance between the two groups was significantly different. Experts in the field of mental health and psychiatry in order to reduce and prevent premature termination psychotherapy is required have great attention to process of psychotherapy and factors influencing its process.
Keywords
References
Anderson, S. R., Tambling, R., Yorgason, J. B., Rackham, E. (2018). The mediating role of the therapeutic alliance in understanding early discontinuance. Psychotherapy Research, 29(7), 882-893.
Ardito & Rabellino., D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for Research. Frontiers in psychologhy, 2, 1-11.
Barrett, M.S., Chua, W.J., Crits-Christoph, P., Gibbons, M.B., & Thompson, D. (2008). Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45, 247-267.
Berry et al., 2018, K., Salter, A., Morris, R., James, S., Bucks. (2018). assessing therapeutic alliance in the context of mhealth interventions for mental health problems: development of the mobile Agnew relationship measure (MARM) questionnaire. Journal of Medical Internet Research, 19, 20(4), 90.
Bjork et al., 2009 T., Bjork, C., Clinton, D., Solberg, S., & Norming, C. (2009). What happened to the ones who dropped out? Outcome in eating disorder patients who complete or prematurely terminate treatment. European Eating Disorders Review, 17, 109–119.
Borden., E.S. (1994). Theory and research on the therapeutic working alliance: New directions. In Horvath, A.O. & Greenberg, L.S. (Eds.), the working alliance: Theory, research, and practice. New York: Wiley.
Browne et al., 2019, J., Namenda, A., Kurtz, M., Berry, K., Penn, D.L. (2019). The relationship between the therapeutic alliance and client variables in individual treatment for schizophrenia spectrum disorders and early psychosis: narrative review. Clinical Psychology Review, 71, 51-62.
Browne, J., Moser, K.T., Meyer-Kilos, P.,Gottlieb, J. D., Estroff, S.E., Penn, D.L. (2019). The Therapeutic Alliance in Individual Resiliency Training for First Episode Psychosis: Relationship with Treatment Outcomes and Therapy Participation. Journal of Consulting and Clinical Psychology, 87(8), 734–744.
Carpenter et al., 1979, P.J., Del Gaudi, A.C., & Morrow, G.R. (1979). Dropouts and terminators from community mental health center: Their use of other psychiatric services. Psychiatric Quarterly, 51, 271-279.
Connell, J., Grant, S., & Mullin, T. (2006). Client initiated termination of therapy at NHS primary care counseling services. Counseling and Psychotherapy Research, 6, 60–67.
Cooper, M., & Lesser, J. (2008). Clinical social work practice. Boston, MA, Pearson Education, Inc.
Cousinhood, J., RI biro, E., & Saran, J. (2009). Resolution of ruptures in therapeutic alliance: Its role on change processes according to a relational approach. Annalise Psychological, 4, 479-491.
Epperson, D.L., Bush way, D.J., & War man, R.E. (1983). Client self-termination after one counseling session: Effects of problem recognition, counselor gender, and counselor experience. Journal of Counseling Psychology, 30, 307-315.
Eubanks et al., 2018, C. F., Purcell, L. A., & Gold fried, M. R. (2018). Clinical consensus strategies to repair ruptures in the therapeutic alliance. Journal of Psychotherapy Integration, 28(1), 60–76.
Flockier et al., 2018, C., Del Re, A.C., Walpole, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55, 316–340.
Girard et al., 2016 J., Parent-Nichols J., Cleland J.A. (2016). Therapeutic alliance and patient outcomes. Fisioterapia, 38(4), 163-164.
Hamilton et al., 2011 S., Moore, A.M., Crane, D.R., & Payne S.H. (2011). Psychotherapy dropouts: differences by modality, license, and DSM-IV diagnosis. Journal of Marital and Family Therapy, 37(3), 333–343.
Hatcher & Gillaspy., J.A. (2006). Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy Research, 16(1), 12-25.
Henson et al., P., Peck, P., Torous, J. (2019). Considering the therapeutic alliance in digital mental health interventions. Harvard Review of Psychiatry, 27(4), 268-273.
Henson, P., Wisniewski, H., Hollis, C., Keshavan, M., Torous, J. (2019). Digital mental health apps and the therapeutic alliance: initial review. BJPsych Open, 5(1):15.
Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223_/233.
Horvath et al., 2011 A.O., Del Re, A., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy relationships that work (2nd Ed). New York: Oxford University Press.
Jordan, J., Carter, F. A., Joyce, P. R., Frampton, C M. A., McKenzie, J. M., & Bulk, C. M. (2017). Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence. International Journal of Eating Disorder, 50, 979 – 983.
Kivlighan, D. M., Jr., Hill, C. E., Ross, K., Kline, K., Furhmann, A., & Sauber, E. (2019). Testing a mediation model of psychotherapy process and outcome in psychodynamic psychotherapy: Previous client distress, psychodynamic techniques, dyadic working alliance, and current client distress. Psychotherapy Research, 29(5–6), 581–593.
Lambert et al., 1994 M J, Lunnen K, Umphress V, Hansen N, Burlingame GM. Administration and scoring manual for the Outcome Questionnaire (OQ-45.1). Salt Lake City: IHC Center for Behavioral Healthcare Efficacy 1994.
Lambert., 2012 M. (2012). The Outcome Questionnaire-45. Integrating Science and Practice, 2, 24-27.
Lambert, M.J., Bergin A.E., & Garfield, S.L. (2004). "Introduction and Historical Overview". In Lambert M, J. Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (5th Ed.). New York: John Wiley & Sons, 3–15.
Lawton et al., 2016, M., Haddock, G., Conroy, P., Sage, K. (2016). Therapeutic Alliances in Stroke Rehabilitation: A Meta-Ethnography, Archives of Physical Medicine and Rehabilitation. In Press, Corrected Proof.
Liu-Sievert, H., Adams, D.H., & Kino B.J. (2005). Discontinuation of treatment of schizophrenia patients is driven by poor symptoms response: a pooled post-hoc analysis of four atypical. Antipsychotic drugs. BMC Medicine, 3, 21.
McIvor, P.M., Burgess, M.M., & Nathan, P. (2014). The relationship between interpersonal problems, therapeutic alliance, and outcomes following group and individual cognitive behavior therapy. Journal of Affective Disorders, 157, 25-32.
Mendez., A.L. (2020). The Development of a Therapeutic Alliance Focused Intervention. Loma Linda University Electronic Theses, Dissertations & Projects. 1117.
Maunder et al., 2010, T., Wilmer's, F., Leonhard, R., Linter, H.W., & Barth, J. (2010). Working Alliance Inventory-Short Revised (WAI-SR) Psychometric Properties in Outpatients and Inpatients. Clinical Psychology and Psychotherapy, 17, 231-239.
O’Connor et al., 2019 K., Jr., Hill, C. E., & Gels, C. J. (2019). Therapist-client agreement about their working alliance: Associations with attachment styles. Journal of Counseling Psychology, 66(1), 83–93.
Pillage et al., 2018, S., Stenberg, J., Joutsenniemi, K., Mehik, H., Ritola, V., Joffe, G. (2018).Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders - a systematic review. Internet Interventions, 11, 1-10.
Raikes, B.C., McIvor, P.M., Erceg-Hurn, D., Byrne, S.M., Furslanda, A, & Nathan, P. (2014). Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: Probably necessary but definitely insufficient. Behaviour Research and Therapy, 57, 65-71.
Salmoiraghi & Sambh., R. (2010). Early termination of cognitive-behavioural interventions: literature review. The Psychiatrist, 34, 529-532.
Schnur & Montgomery.,2010 G.H. (2010). A Systematic Review of Therapeutic Alliance, Group Cohesion, Empathy, and Goal Consensus/Collaboration in Psychotherapeutic Interventions in Cancer: Uncommon Factors? Clinical Psychology Review, 30(2), 238–247.
Shamir, D., Soar, H., & I lamed, Y. (2010). Dropout Early Termination and Detachment From a public psychiatric clinic. Psychiatric Daubing, 22, 46–50.
Shattuck et al., 2018, L., Berry, K., Deegan, A., Edge, D. (2018). Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: a systematic review. Clinical Psychology & Psychotherapy, 25(1), 60-85.
Sherman & Anderson., 1987 C.A. (1987). Decreasing premature termination from psychotherapy. Journal of social and clinical psychology, 5, 298-312.
Swift, J. K., Spencer, J., & Goode, J. (2018). Improving psychotherapy effectiveness by addressing the problem of premature termination: Introduction to a special section. Psychotherapy Research, 3307, 1–3.
Swift, J.K., Callahan, J.L., & Levine, J.C. (2009). Using clinically significant change to identify premature termination. Psychotherapy: Theory, Research, Practice, Training. Psychotherapy, 46, 328-335.
Term Horne, E. D., Postal, M. G., de Hana, H. A., van der Palin, J., & Dejon, C. A. (2017). Treatment dropout in web-based cognitive behavioral therapy for patients with eating disorders. Psychiatric Research, 247, 182-193.
Tremaine et al., 2020, H., Scenery, Carla Fletcher, K., Murray, G. (2020). The Therapeutic Alliance in Digital Mental Health Interventions for Serious Mental Illnesses: Narrative Review. JMIR Mint Health, 7:7(8).
Tschuschke, V., Koemeda-Lutz, M., von Wyl, A., Crameri, A., & Schulthess, P. (2020). The impact of patients' and therapists' views of the therapeutic alliance on treatment outcome in psychotherapy. Journal of Nervous and Mental Disease, 208(1), 56–64.
Tschuschke et al., 2022, V., Koemeda‑Lutz, M., Wy, A.V., Crameri A., Schulthess P. (2022). The Impact of Clients’ and Therapists’ Characteristics on Therapeutic Alliance and Outcome. Journal of Contemporary Psychotherapy, 52, 145–154.
Turner, H., Bryant-Waughb, R., Marshall, E. (2015). The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders. Behaviour Research and Therapy, 73,165-169.
Uckelstam et al., 2018 C. J., Holmqvist, R., Philips, B., & Falkenström, F. (2018). A relational perspective on the association between working alliance and treatment outcome. Psychotherapy Research. Advance online publication.
Wierzbicki & Pekarik., (1993). A meta-analysis of psychotherapy dropout. Professional Psychology - Research & Practice, 24, 190-195.
Yoo et al., H., Bartle-Haring, S., & Gangamma, R. (2014).redicting premature termination with alliance at sessions 1 and 3: an exploratory study. Journal of Family Therapy, 1-13.
Zilcha-Mano et al., S., Muran, J. C., Eubanks, C. F., Safran, J. D., & Winston, A. (2018). When therapist estimations of the process of treatment can predict clients rating on outcome: The case of the working alliance. Journal of Consulting and Clinical Psychology, 86, 398–402.
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