The therapeutic alliance, dropout from psychotherapy and the role of formal feedback in repairing alliance ruptures

Thesis

The therapeutic or ‘working’ alliance in psychotherapy has consistently been shown to be an important factor in patient outcome from psychotherapy. Poor alliance has been suggested to be a factor in patients dropping out or prematurely terminating therapy. Developing a strong alliance and identifying and resolving any tension or difficulties between therapist and patient, described as therapeutic alliance ‘ruptures’, has been suggested as a means of retaining patients in therapy so that they can derive a benefit from it and as a potential mechanism of change.

The systematic review evaluates the links between the strength of the therapeutic alliance and dropout from individual psychotherapy for adults. A moderate link was found between with stronger alliance being associated with a reduction in the risk of dropout from psychotherapy.

The empirical paper used a Task Analytic design to validate a previously developed model of repairing ruptures in the therapeutic alliance using a ‘formal feedback’ tool to aid patients in giving feedback on the alliance to their therapists and to provide a basis for the dyad to identify, discuss and attempt to resolve ruptures. Dyads were observed to complete the model stages and more model stages being completed was linked to greater observed resolution of ruptures. However, rupture resolution did not appear to link to the session being found more helpful for the patient from either the patient or therapist perspective. Rupture resolution was also not found to link to the overall clinical outcome for patients. The limitations of the study, possible implications for clinical practice and further research are discussed.

Authors: Harvey, AN

• Type of award: D.Clin.Psych
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: Dropout in Psychotherapy; Task Analysis; Therapeutic Alliance; Feedback Informed Therapy; Alliance Ruptures
• Subjects: Psychotherapy