Therapeutic Alliance Tensions and Repair in Psychotherapy Practices
- Conditions
- PsychotherapyTherapeutic Alliance
- Interventions
- Other: Professional development program
- Registration Number
- NCT03453957
- Lead Sponsor
- University of Ottawa
- Brief Summary
This study evaluates a professional development program intended to improve the relationship or alliance between therapists and patients/clients who are receiving psychotherapy in the community. Half of the participating therapists will receive training to detect and improve alliance with new patients while half will not. The professional development training is expected to improve therapists effectiveness in identifying and correcting alliance tensions which will, in turn, improve therapeutic outcomes for patients/clients.
- Detailed Description
Psychotherapy is the treatment of choice for many mental disorders, yet there is a gap between research and practice. Research indicates that: the therapist-patient alliance is important to reduce patient symptoms, alliance tensions are detrimental to patients, and those therapists who identify and repair alliance tensions can improve patient outcomes. In this study we will use state of the art research to train community-based therapists in evidence-based interventions to identify and repair alliance tensions. Trained therapists and their patients will be compared to therapists who provide usual care to their patients. Improvement in therapists' skills in identifying and repairing alliance tensions and how this is associated with better patient mental health outcomes will be measured. Trained therapists will be interviewed to identify the best ways of improving the training and disseminating the findings to psychotherapists across Canada. Research to improve practicing therapists' ability to identify and repair therapeutic alliance tensions will result in better mental health outcomes for patients.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 81
- regulated health professional
- in good standing with a Canadian provincial regulatory college
- scope of practice includes psychotherapy
- ability to add 3 or more new, English speaking clients to caseload over 6 to 9 months
- ability to obtain timely permission to conduct research from therapist's employing institution or health group when applicable
- none
Patient/Client
Inclusion Criteria:
- 18 years of age or older
- will participate in psychotherapy sessions in English
- will see the study-affiliated therapist for a minimum of 6 sessions in the next 6 months
Exclusion Criteria:
- already seeing another therapist
- diagnosed with a neurocognitive disorder
- diagnosed with a psychotic disorder
- expressed suicidal behaviour in the past six months as assessed by their participating therapist
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Professional Development Program Professional development program Therapists who participate in workshops and consultation sessions with study trainers during study-related therapy sessions and their participating patients/clients.
- Primary Outcome Measures
Name Time Method Mean tension resolution rating scale 6 therapy sessions over 6 weeks up to 6 months depending on the frequency of therapy The Rupture Resolution Rating System (3RS) is an observer-based measure to identify alliance tensions and resolution processes. Independent blind reliable trained judges will rate video recordings of 6 psychotherapy session recorded with participating clients. A mean tension score will be assigned per client which will be the average of the 6 session scores.
score ranges from 1 (withdrawal/confrontation rupture(s) did not occur; not significant for the alliance) to 5 (withdrawal/confrontation rupture(s) occurred; significant for the alliance).
- Secondary Outcome Measures
Name Time Method Generalized Anxiety Disorder 7-item scale (GAD-7) change from baseline baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy Self-report measurement of severity of anxiety using the GAD-7 scale. A change in anxiety scores will be assess following 6 therapy session with data collected before therapy(baseline) and again after all 6 sessions of therapy have been completed. Scores range from 0 (low anxiety) to 27 (high anxiety) with scores over 10 being of clinical significance.
Patient Health Questionnaire 9-item scale (PHQ-9) change from baseline baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy Self-report measurement of depression symptoms using the PHQ-9 scale. A change in depression symptom scores will be assess following 6 therapy session with data collected before therapy and again after all 6 sessions of therapy have been completed. Scores range from 0 (low) to 27 (high) with scores over 10 being of clinical significance.
Trial Locations
- Locations (2)
University of Ottawa
🇨🇦Ottawa, Ontario, Canada
Mt. Sinai Hospital
🇨🇦Toronto, Ontario, Canada