An Examination of Changes in Therapist Expressed Empathy and Therapist-client Interpersonal Patterns during and After Alliance Rupture, and their Contributions to Outcome in the Treatment of Depression
Notice bibliographique
Résumé
The primary objective of the current study was to examine changes in therapist expressed empathy and therapist-client interpersonal patterns in order to uncover the processes through which alliance ruptures and resolutions occur, as well as their contributions to post-rupture session working alliance and post-treatment outcome. The data included 20 clients who received 16-weeks of treatment for depression and 11 therapists who provided either cognitive-behavioural or process-experiential/emotion-focused therapy. The Working Alliance Inventory was used to identify pre-rupture, rupture, and post-rupture sessions for each client. The selected sessions were then coded on the Measure of Expressed Empathy and the Structural Analysis of Social Behaviour. Results revealed that therapist empathy and therapist-client positive interpersonal patterns significantly declined from pre-rupture session to rupture session, whereas negative and mixed interpersonal patterns significantly increased. Results further showed that clients often deferred to the therapist during rupture, while therapists most commonly pursued their own agenda or controlled the therapy process by adhering to psychoeducation or technique. Therapists also contributed to rupture by listening passively, merely following the client without offering any guidance, not heeding the client’s expressed emotions or needs, illogically initiating a new topic of discussion, or (less frequently) blaming or criticizing the client. The post-rupture session for clients who reported rupture resolution showed a significant increase in therapist empathy and therapist-client positive interpersonal patterns and a significant decrease in negative and mixed interpersonal patterns. Specifically, therapists attempted to respond to the client in more empathic and nurturing ways and were less neglectful. Clients also appeared more connected to and trusting of the therapist at post-rupture and less frequently deferred, withdrew, or asserted and separated. In contrast, negative interpersonal patterns, including therapist controlling behaviours and client protesting and distancing behaviours, remained at a significantly higher level at post-rupture for clients who did not report immediate rupture resolution. Contrary to the study hypotheses, no significant relationship was found between the process variables and post-treatment outcome. However, changes in therapist empathy as well as therapist-client positive and negative interpersonal patterns strongly predicted post-rupture session working alliance. Implications for clinical practice and recommendations for future research are discussed.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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