The conceptualization and measurement of therapeutic alliance: An empirical review
Section snippets
Introduction — strengths and shortcomings of the alliance concept
Gathering evidence within empirical studies of mental health interventions suggest that the therapeutic alliance constitutes an important variable in explaining the outcome of treatment (Priebe & McCabe, 2006). Meta-analysis of studies in both adult (Martin, Garske, & Davis, 2000) and child (Shirk & Karver, 2003) mental health research have shown a consistent if modest association between measures of therapeutic alliance, and treatment outcome; particularly when alliance is measured at early
Genealogy
Treatment alliance (TA) is a summary term referring to a number of interpersonal processes at play in psychological treatment which can generally be considered to act in parallel to (and theoretically independently of) specific manualized treatment techniques (Green, 2006). Hypothesis testing and modeling of such effects depends in the end on the robustness of the concepts being measured. The plethora of measures in current use may reflect an uncertainty about this conceptualization.
A genealogy
Analysis of alliance in treatment
Measurement of therapeutic alliance has been approached both by external observation of relevant interpersonal behaviors (e.g. rating video or audio tapes of treatment sessions) or by eliciting attitudes of the client and therapist at various time points during treatment. Each of these measurement methods raises methodological problems.
Summary
Available evidence supports that view that alliance is an important concept and that its measurement should be part of future well designed treatment trails in mental health across the age range (Green, 2006). The purpose of this review has been to take a critical look at current concepts and measurement in alliance with a view to identifying how the investigation of alliance should proceed in future treatment research.
The review makes clear the diversity of measures available to measure
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