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Group therapists: combine alliance building with paying specific attention to the patient’s perception

Published online by Cambridge University Press:  28 April 2020

Beate Muschalla Open the ORCID record for Beate Muschalla [Opens in a new window]
Beate Muschalla*
Affiliation:
Technische Universität Braunschweig, Psychotherapy and Diagnostics, Germany
*
Corresponding author. Email: b.muschalla@tu-bs.de
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Abstract

In slow-open groups as well as therapies of less than ten sessions, each group session holds importance. Patients, therapists and co-therapists have different perspectives and may gain different experiences from a group session. This study investigates the perspectives of patients, therapists and co-therapists on alliance, new insights and therapist techniques in the same group session. Do the three actors perceive these group aspects similarly or differently? Which group aspects are related with the outcome coping? One hundred and forty-nine sessions of a cognitive behaviour therapy group have been investigated. Patients, therapists and co-therapists gave ratings on their perceived alliance, group topics and insights as well as therapists’ technique competency. Concerning new insights, there was concordance between patients and co-therapists (r = .211, p < .05). Concerning alliance, there was a concordance between patients and therapists (r = .327, p < .01). Therapists focusing on alliance building was associated with lower patient outcomes in terms of work coping (β = –.391). The quality of therapeutic techniques was the same in groups with higher and lower outcomes. Patients’ perception of whether they felt good in the group session was explanative for session outcome, while therapists’ perceptions and context conditions (supervision, number of participants) was not. Patients, therapists and co-therapists have different perspectives on the same group therapy session. Patients’ perceptions are associated with session outcomes. A lower session outcome must not be associated with a poor technique performance of the therapist. Therapists should not only be aware of alliance building and correct technical performance, but they must also be aware of patients’ perceptions of the group process and outcome.

Key learning aims

The present research is the first evaluation of group session aspects and session outcomes in rehabilitation patients with work anxieties in slow-open groups. We will learn:

  1. (1) Whether patients’, therapists’ and co-therapists’ perceptions of the same group session are similar or different;

  2. (2) Whether group sessions that result in worse outcomes are different from group sessions resulting in a better outcome;

  3. (3) Which aspects of the group session are predictive for a better outcome.

Keywords

alliancegroup therapytherapist competence
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e11
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

The investigated group therapy has been found to come to a positive outcome in terms of strengthening work-related coping capacities:

Muschalla, B., Linden, M., & Jöbges, M. (2016). Work-anxiety and sickness absence after a short inpatient cognitive behavioral group intervention in comparison to a recreational group meeting. Journal of Occupational and Environmental Medicine, 58, 398–406.CrossRefGoogle Scholar

References

Abbass, A., Town, J., & Driessen, E. (2012). Intensive short-term dynamic psychotherapy: a systematic review and meta-analysis of outcome research. Harvard Review of Psychiatry, 20, 97–108. doi: 10.3109/10673229.2012.677347CrossRefGoogle ScholarPubMed
Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology, 18, 270. doi: 10.3389/fpsyg.2011.00270Google Scholar
Arnow, B. A., Steidtmann, D., Blasey, C., Manber, R., Constantino, M. J., Klein, D. N., Markowitz, J. C., Rothbaum, B. O., Thase, M. E., Fisher, A. J., & Kocsis, J. H. (2013). The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression. Journal of Consulting and Clinical Psychology, 81, 627–638. doi: 10.1037/a0031530CrossRefGoogle ScholarPubMed
Bachelor, A. (2013). Clients’ and therapists’ views of the therapeutic alliance: similarities, differences and relationship to therapy outcome. Clinical Psychology and Psychotherapy, 20, 118–135. doi: 10.1002/cpp.792CrossRefGoogle ScholarPubMed
Barber, J. P., Zilcha-Mano, S., Gallop, R., Barrett, M., McCarthy, K. S., & Dinger, U. (2014). The associations among improvement and alliance expectations, alliance during treatment, and treatment outcome for major depressive disorder. Psychotherapy Research, 24, 257–268. doi: 10.1080/10503307.2013.871080CrossRefGoogle ScholarPubMed
Carpenter, J. K., Sanford, J., & Hofmann, S. G. (2019). The effect of a brief mindfulness training on distress tolerance and stress reactivity. Behavior Therapy, 50, 630–645. doi: 10.1016/j.beth.2018.10.003CrossRefGoogle ScholarPubMed
Cheng, C., Kogan, A., & Chio, J. H. (2012). The effectiveness of a new, coping flexibility intervention as compared with a cognitive-behavioral intervention in managing work stress. Work & Stress, 26, 272–288. doi: 10.1016/j.pec.2014.01.005CrossRefGoogle Scholar
Chui, H., Hill, C. E., Kline, K., Kuo, P., & Mohr, J. J. (2016). Are you in the mood? Therapist affect and psychotherapy process. Journal of Counseling Psychology, 63, 405–418. doi: 10.1037/cou0000155CrossRefGoogle Scholar
Clark, D. A., & Beck, A. T. (2009). Cognitive Therapy of Anxiety Disorders: Science and Practice. New York, USA: Guilford Press.Google Scholar
D’Zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78, 107–126. doi: 10.1037/h0031360CrossRefGoogle ScholarPubMed
Flückiger, C., Grosse Holtforth, M., Znoj, H. J., Caspar, F., & Wampold, B. E. (2013). Is the relation between early post-session reports and treatment outcome as epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy. Psychotherapy Research, 23, 1–13. doi: 10.1080/10503307.2012.693773CrossRefGoogle ScholarPubMed
Frese, M., & Fay, D. (2001). Personal initiative: an active performance concept for work in the 21st century. Research in Organizational Behavior, 23, 133–187CrossRefGoogle Scholar
Ginzburg, D. M., Bohn, C., Höfling, V., Weck, F., Clark, D. M., & Stangier, U. (2012). Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder. Behaviour Research and Therapy, 50, 747–752. doi: 10.1016/j.brat.2012.09.001CrossRefGoogle ScholarPubMed
Gottschling, J., Hahn, E., Maas, H., & Spinath, F.M. (2016). Explaining the relationship between personality and coping with professional demands: where and why do optimism, self-regulation, and self-efficacy matter? Personality and Individual Differences, 100, 49–55. doi: 10.1016/j.paid.2016.03.083CrossRefGoogle Scholar
Haug, T., Nordgreen, T., Ost, L. G., Tangen, T., Kvale, G., Hovland, O. J., Heiervang, E. R., & Havik, O. E. (2012). Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults. Behaviour Research and Therapy, 77, 40–51. doi: 10.1016/j.brat.2015.12.004CrossRefGoogle Scholar
Heinonen, E., Lindfors, O., Härkänen, T., Virtala, E., Jääskeläinen, T., & Knekt, P. (2013). Therapists’ professional and personal characteristics as predictors of working alliance in short-term and long-term psychotherapies. Clinical Psychology and Psychotherapy, 21, 475–494. doi: 10.1002/cpp.1852Google ScholarPubMed
Hendriksen, M., Peen, J., Van, R., Barber, J. P., & Dekker, J. (2014). Is the alliance always a predictor of change in psychotherapy for depression? Psychotherapy Research, 24, 160–170. doi: 10.1080/10503307CrossRefGoogle ScholarPubMed
Kaluza, G. (2004). Stressbewältigung – Trainingsmanual zur psychologischen Gesundheitsförderung. Berlin, Germany: Springer.Google Scholar
Keijsers, G. P., Schaap, C. P., & Hoogduin, C. A. (2000). The impact of interpersonal patient and therapist outcome in cognitive-behavior therapy. A review of empirical studies. Behavior Modification, 24, 264–297.CrossRefGoogle ScholarPubMed
Koch, S., Geissner, E., & Hillert, A. (2007). Berufliche Behandlungseffekte in der stationären Psychosomatik. Der Beitrag einer berufsbezogenen Gruppentherapie im Zwölf Monats-Verlauf. Zeitschrift für Psychiatrie Psychologie und Psychotherapie, 55, 97–109. doi: 10.1024/1661-4747.55.2.97CrossRefGoogle Scholar
Langhoff, C., Baer, T., Zubraegel, D., & Linden, M. (2008). Therapist–patient alliance, patient–therapist alliance, mutual therapeutic alliance, therapist–patient concordance, and outcome of CBT in GAD. Journal of Cognitive Psychotherapy, 22, 68–79.CrossRefGoogle Scholar
Lazarus, R. S. (1993). Coping theory and research: past, present, and future. Psychosomatic Medicine, 55, 234–247.CrossRefGoogle ScholarPubMed
Linden, M., Baumann, K., Lieberei, B., Lorenz, C., & Rotter, M. (2011). Treatment of posttraumatic embitterment disorder with cognitive behaviour therapy based on wisdom psychology and hedonia strategies. Psychotherapy and Psychosomatics, 80, 199–205. doi: 10.1159/000321580CrossRefGoogle ScholarPubMed
Linden, M., Langhoff, C., & Rotter, M. (2007). Definition, operationalization and quality assurance of psychotherapy. An investigation with the Behavior Therapy Competence-Checklist (BTCC). Psychiatria Danubina, 19, 308–316.Google Scholar
Linden, M., & Muschalla, B. (2007). Anxiety disorders and workplace-related anxieties. Journal of Anxiety Disorders, 21, 467–474.CrossRefGoogle ScholarPubMed
Milbrath, C., Bond, M., Cooper, S., Znoj, H. J., Horowitz, M. J., & Perry, J. C. (1999). Sequential consequences of therapists’ interventions. Journal of Psychotherapy Practice and Research, 8, 40–54.Google ScholarPubMed
Muschalla, B. (2017). Work-anxiety coping intervention improves work-coping perception while a recreational intervention leads to deterioration. Results from a randomized controlled trial. European Journal of Work and Organizational Psychology, 26, 858–869.CrossRefGoogle Scholar
Muschalla, B., Linden, M., & Jöbges, M. (2016). Work-anxiety and sickness absence after a short inpatient cognitive behavioral group intervention in comparison to a recreational group meeting. Journal of Occupational and Environmental Medicine, 58, 398–406.CrossRefGoogle Scholar
Newman, C. F. (2010). Competency in conducting cognitive-behavioral therapy: foundational, functional, and supervisory aspects. Psychotherapy, 47, 12–19. doi: 10.1037/a0018849CrossRefGoogle Scholar
Nissen-Lie, H. A., Havik, O. E., Hoeglend, P. A., Roennestad, M. H., & Monsen, J. T. (2015). Patient and therapist perspectives on alliance development: therapists’ practice experiences as predictors. Clinical Psychology and Psychotherapy, 22, 317–327. doi: 10.1002/cpp.1891CrossRefGoogle ScholarPubMed
Prasko, J., Vyskocilová, J., Mozny, P., Novotny, M., & Sleecky, M. (2011). Therapist and supervisor competencies in cognitive behavioural therapy. Neuroendocrinology Letters, 32, 781–789.Google ScholarPubMed
Roos, J., & Werbart, A. (2013). Therapist and relationship factors influencing dropout from individual psychotherapy: a literature review. Psychotherapy Research, 23, 394–418. doi: 10.1080/10503307.2013.775528CrossRefGoogle ScholarPubMed
Rozek, D. C., Serrano, J. L., Marriott, B. R., Scott, K. S., Hickman, L. B., Brothers, B. M., Lewis, C. C., & Simons, A. D. (2018). Cognitive behavioural therapy competency: pilot data from a comparison of multiple perspectives. Behavioural and Cognitive Psychotherapy, 46, 244–250. doi: 10.1017/S1352465817000662CrossRefGoogle ScholarPubMed
Stulz, N., Lutz, W., Kopta, S. M., Minami, T., & Saunders, S. M. (2013). Dose–effect relationship in routine outpatient psychotherapy: does treatment duration matter? Journal of Counseling Psychology, 60, 593–600. doi: 10.1037/a0033589CrossRefGoogle ScholarPubMed
Ulvenes, P. G., Berggraf, L., Hoffart, A., Stiles, T. C., Svartberg, M., McCullogh, L., & Wampold, B. E. (2012). Different processes for different therapies: therapist actions, therapeutic bond, and outcome. Psychotherapy, 49, 291–302. doi: 10.1037/a0027895CrossRefGoogle ScholarPubMed
Weck, F., Grikscheit, F., Höfling, V., Kordt, A., Hamm, A. O., Gerlach, A. L., Alpers, G. W., Arolt, V., Kircher, T., Pauli, P., Rief, W., & Lang, T. (2016). The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia. Journal of Anxiety Disorders, 42, 10–18. doi: 10.1016/j.janxdis.2016.05.007CrossRefGoogle ScholarPubMed
Weck, F., Grikscheit, F., Jakob, M., Höfling, V., & Stangier, U. (2015b). Treatment failure in cognitive-behavioural therapy: therapeutic alliance as a precondition for an adherent and competent implementation of techniques. British Journal of Clinical Psychology, 54, 91–108. doi: 10.1111/bjc.12063CrossRefGoogle ScholarPubMed
Weck, F., Richtberg, S., Jakob, M., Neng, M. J., & Höfling, V. (2015a). Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis). Psychotherapy Research, 228, 53–58. doi: 10.1016/j.psychres.2015.03.042Google Scholar
Zilcha-Mano, S., Solomonov, N., Chui, H., McCarthy, K. S., Barrett, M. S., & Barber, J. P. (2015). Therapist-reported alliance: is it really a predictor of outcome? Journal of Counseling Psychology, 62, 568–578. doi: 10.1037/cou0000106CrossRefGoogle ScholarPubMed
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