How To Understand The Therapeutic Alliance In Therapy Research

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Britton Barnett
5 years ago
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1 Complementary Results: How Qualitative & Quantitative Methods Work Together in PsychoTherapy Research Jason Murray, Educational Psychology Counselling

2 Today we will: Take a brief look at some of the essential elements of qualitative research. Illustrate how each method contributes valuable knowledge to our understanding of a particular research topic using the concept of the Therapeutic Alliance.

3 Today we won t: Get detailed information about qualitative methods. Debate which is better. Directly compare the basic nature of each by contrasting ontology, epistemology, and methodology.

4 What are your pre-understandings of qualitative research?

5 Qualitative Research...is multi-method in focus, involving a interpretive, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them. - Denzin & Lincoln, 1994

6 Qualitative Research Data is collected via naturalistic methods like interviews, observation, participantobservation, hermeneutic methods, etc. Raw data are anecdotes, stories, descriptions, texts, narratives, and the like. Data analysis methods vary widely, but essentially focus on interpreting/describing a phenomena based on similarities and differences in meanings found in participant data.

7 Qualitative Research Results are typically presented or reported as a thematic analysis, and/or as a narrative about the phenomena. The essential purpose of all qualitative research is to provide a more adequate understanding of a phenomena. Just as in quantitative research, multiple sources of results help to provide a more adequate understanding.

8 What is the Therapeutic Alliance? The relationship that is created between a counsellor/therapist and the client. This relationship is characterized in therapy research a variety of ways, including: Agreement about the content and goals of therapy, and the bond that forms between client and therapist. Degree to which the client perceives the therapist as being supportive, non-judgemental, empathic, collaborative, and characterizes the relationship as safe and trusting.

9 Let s take a look at one measure of the Alliance, derived from Horvath and Greenburg (1995), as well as your own understandings.

10 The Quantitative Contribution The therapeutic alliance accounts for between 25-35% of variance in outcome. The client is a better predictor of the alliance than the therapist, although both are accurate. Neutral trained observers are the worst. A weak therapeutic alliance is highly predictive of poor outcome and drop-out. The first 4 therapy sessions are most predictive of both outcome and future Alliance scores.

11 Qualitative Contribution The first conceptualizations of the key elements in the therapeutic alliance were derived from qualitative research, and refined through further testing. The two sources of data for this qualitative research on alliance included: Clinical experience of theorists and practitioners. Qualitative research with clients.

12 Qualitative Contribution This highlights one of the strengths of qualitative research: the inductive generation of conceptualizations about a phenomena (such as the core elements of a therapeutic relationship), in which key variables for future research may be identified.

13 Qualitative Contribution While quantitative research gives us evidence that the therapeutic alliance does contribute to client change, it doesn t provide us with a clear understanding of how to create an alliance. Another contribution of qualitative research is that it can illustrate how content and process merge. This can include similarities as well as diversity in the process.

14 Let s take a look at the narratives of a strong and weak therapeutic alliance.

15 Pacing the client. Working from the client s agenda before suggesting your own. Listening, communicating that you understand, not judging or evaluating. Respecting differences.

These core elements are included in three increasingly detailed levels of definition:

These core elements are included in three increasingly detailed levels of definition: A Definition of Motivational Interviewing The definition of Motivational Interviewing (MI) has evolved and been refined since the original publications on its utility as an approach to behavior change.