Kapitel 6

Cooper, M. (2010). Essential Research Findings in Counselling and psychotherapy.London: SAGE

According to Lamberts pie 30 % of the clients outcome from therapy is dependent of the therapeutic relationship. The therapeutic alliance has 20 % importance for the outcome and this is independent of whether it is a person-centred approach or CBT. There is a disagreement about how much the relation influence the outcome of therapy. Additionally some believes that the causality can be conversely so the bettering in symptoms has an importance for the relation. The client’s assessment of the relation correlates more with the outcome than the therapist’s assessment despite the fact that the therapist’s ability to relate are more important than the client’s. it can be difficult to identify the factors in the relationship that has an importance for the outcome of therapy.

There is a difference between the quality of the therapeutic relationship and the degree to which the therapist expresses their relational abilities.

– Therapeutic alliance: goal agreement, task agreement (behaviour and processes), bond, the quality and strength of the cooperating relation between client and therapist. It correlates about 0.21-0.25 with the outcome of therapy. This is about d = 0.45 – 5 % of the outcome. Specially the alliance in the first few sessions is important for outcome and this must therefore be of first priority for the therapist.

– Goal consensus and cooperation: agreement about the therapeutic goal and the expectations and mutual involvement in the helping relation. Most studies have found that goal consensus correlates with outcome, but some have not. Goal consensus correlates negatively with problems in therapy. The clients involvement is one of the strongest predicators for outcome.

– Empathy: is to step into the private perceptual world of the other and have an accurate, felt understanding of their experience. Empathy is measured on the BLRI (Barrett-Lennard relationship inventory) and correlates 0.32 with the outcome of therapy, about d = 0.68 – medium to large effect size. The relation between empathy and outcome is strongest in CBT versus experiential or humanistic therapy (effect size 1.12 versus 0.52). additionally empathy are most important for outcome when it is an inexperienced therapist. Different components of empathy can have a different effect on different clients.

– Positive regard: is warm accept of the other and his experiences without conditions. A promising and possible effective element of the therapeutic relation. Some indications suggests that positive regard are associated with outcome regardless of the therapeutic orientation.

– Congruence: is to be freely and deeply oneself in a relationship, with ones experiences accurately represented in consciousness, opposed to a façade. A promising and possible effective element of the therapeutic relationship. Ambivalent scientific results have found this, however the therapist’s credibility is important for the clients.

– Countertransference: the therapists reactions towards the client which are based on the therapist’s unresolved conflicts. It is associated with a weaker client-therapist bond. The degree of the therapist’s ability to handle his counter-transference can be important for the outcome of therapy, specially if the therapy does not work well. Counter-transference can be positive as well as negative.

– Self-disclosure: is therapeutic statements that reveal something personal about the therapist. This can be positive as well as negative. The technique are mostly used by humanistic therapists are behavioural therapists and least by analytical therapists. Studies have found that clients are happy about the therapeutic self-disclosures as it gives a good relationship with more warmth and understanding. It is a promising and possible effective element of the therapeutic relationship. The statements of non-personal character are assessed as more positive than personal statements.

– Feedback: information to a person, from an external source, about the persons behaviour and the effect of the behaviour. This could be observation or description of behaviour, emotional reactions to clients, inferences or mirroring. It can be a positive or negative technique. Good feedback can increase the client’s improvement. It is a promising element of the therapeutic relationship. There is difference to how positive and negative feedback are taken in, specially by depressive clients.

– Repairing alliance ruptures: tension or collapse of the cooperating relationship between the client and the therapist. It happens in 11-38 % of sessions. To repair these collapses gives good results for the outcome of therapy and less drop-outs, as it is a critical developmental task that the client can use in their next relationships.

– Transference interpretations: perceptions that tries to help the client understand the relationship between their interactions with the therapist and the interaction they experience with others. High frequency of transference interpretations correlates with lower outcome and higher drop-out rates. However accurate transference interpretations correlates with better outcome. It is a promising and possible effective element of the therapeutic relationship. Clients with primitive relational abilities have an even poorer outcome of frequent transference interpretations than mature clients, dependent of their attachment style. In addition this works best in therapy with a strong therapeutic alliance.

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