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The Therapeutic Relationship in CBT for Psychosis: Client, Therapist and Therapy Factors

Published online by Cambridge University Press:  04 September 2009

Catherine Evans-Jones ,
Emmanuelle Peters  and
Chris Barker
Catherine Evans-Jones
Affiliation:
Wokingham Community Mental Health Team, Berkshire, UK
Emmanuelle Peters*
Affiliation:
King's College London, Institute of Psychiatry, and South London and Maudsley NHS Foundation Trust, UK
Chris Barker
Affiliation:
University College London, UK
*
Reprint requests to Emmanuelle Peters, Psychology, PO77, HWB, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: [email protected] Supplementary files are available online in the table of contents for this issue: http://journals.cambridge.org/jid_BCP
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Abstract

Background: This study investigated which factors are associated with the therapeutic relationship in Cognitive-Behavioural Therapy for psychosis (CBTp). Method: Measures were taken between sessions two to nine in 24 therapist-client dyads. Clients and therapists completed the Working Alliance Inventory and measures of client (gender, age, ethnicity, positive and negative symptoms of psychosis, length of illness, admissions, social contacts, employment, cognitive insight, reaction to hypothetical contradiction), therapist (empathy, expertness, attractiveness, trustworthiness, number of years qualified and previous CBTp clients seen, confidence in CBTp), and therapy (number of sessions and CBTp interventions carried out, presentation of a formulation) factors. Results: On average, clients and therapists rated the therapeutic relationship as good, with clients giving higher ratings. None of the client variables was related significantly to the quality of the relationship. However, a number of therapist and therapy factors were linked to a better therapeutic relationship, namely clients' ratings of therapist empathy, expertness, attractiveness, and trustworthiness and, at trend level, a greater number of sessions and of CBTp interventions, and the presentation of a formulation. Conclusions: These results suggest that therapists are able to develop a good therapeutic relationship with clients with psychosis, regardless of the severity of the psychosis and the confidence and experience of the therapist, although non-significant findings need interpreting with caution due to the lack of a full range of therapeutic alliances. The findings also suggest that the basic tenets of CBTp, such as empathy and collaborative goals, may be important factors for the development of the therapeutic relationship.

Keywords

Cognitive behavioural therapytherapeutic relationshippsychosis
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 37 , Issue 5 , October 2009 , pp. 527 - 540
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

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References

Ackerman, S. J. and Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1–33.CrossRefGoogle ScholarPubMed
Andreasen, N. C. (1984). The Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA: University of Iowa.Google Scholar
Andreasen, N. C. (1989). The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. British Journal of Psychiatry Supplement, 7, 49–58.CrossRefGoogle Scholar
Andreasen, N. C., Arndt, S., Alliger, R., Miller, D. and Flaum, M. (1995a). Symptoms of schizophrenia: methods, meaning, and mechanisms. Archives of General Psychiatry, 52, 341–351.CrossRefGoogle ScholarPubMed
Andreasen, N. C., Arndt, S., Miller, D., Flaum, M. and Nopoulos, P. (1995b). Correlational studies of the SANS and the SAPS: an overview and update. Psychopathology, 28, 7–17.CrossRefGoogle Scholar
Barak, A. & Dell, D. M. (1977). Differential perceptions of counselor behaviour: replication and extension. Journal of Counseling Psychology, 24, 288–292.CrossRefGoogle Scholar
Barak, A. and LaCrosse, M. B. (1975). Multidimensional perception of counselor behaviour. Journal of Counseling Psychology, 22, 471–476.CrossRefGoogle Scholar
Barrett-Lennard, G. T. (1986). The Relationship Inventory now: issues and advances in theory, method, and use. In Greenberg, L. S. and Pinsof, W. M. (Eds.), The Psychotherapeutic Process: a research handbook (pp. 439–476). New York: Guilford.Google Scholar
Beck, A. T., Baruch, E., Balter, J. M., Steer, R. A. and Warman, D. M. (2004). A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophrenia Research, 68, 319–329.CrossRefGoogle ScholarPubMed
Bentall, R. P., Lewis, S., Tarrier, N., Haddock, G., Drake, R. and Day, J. (2003). Relationships matter: the impact of the therapeutic alliance on outcome in schizophrenia. Schizophrenia Research, 60, 319.CrossRefGoogle Scholar
Beutler, L. E., Clarkin, J. F., Crago, M. and Bergan, J. (1991). Client-therapist matching. In Snyder, C. R. and Forsyth, D. R. (Eds.), Handbook of Social and Clinical Psychology: the health perspective. (pp. 699–716). New York: Pergamon Press.Google Scholar
Bordin, E. S. (1979). The generalisability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.CrossRefGoogle Scholar
Brett-Jones, J. R., Garety, P. A. and Hemsley, D. R. (1987). Measuring delusional experience: a method and its application. British Journal of Clinical Psychology, 26, 257–265.CrossRefGoogle ScholarPubMed
Chadwick, P. and Lowe, C. F. (1990). Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology, 58, 225–232.CrossRefGoogle ScholarPubMed
Chadwick, P., Williams, C. and Mackenzie, J. (2003). Impact of case formulation in cognitive behaviour therapy for psychosis. Behaviour Research and Therapy, 41, 671–680.CrossRefGoogle ScholarPubMed
Clarkin, J. F. & Crilly, J. L. (1987). Therapeutic alliance and hospital treatment outcome. Hospital and Community Psychiatry, 38, 871–875.Google ScholarPubMed
Dow, R. M. (2003). First Sessions of CBT for Psychosis: a description of process and a report on the development and validation of a measure of affective response. Unpublished Clinical Psychology Doctoral Dissertation, The University of East Anglia.Google Scholar
Engh, J. A., Friis, S., Birkenaes, A. B., Jónsdóttir, H., Ringen, P. A., Ruud, T., Sundet, K. S., Opjordsmoen, S. and Andreassen, O. A. (2007).Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study. BMC Psychiatry, 7, 71.CrossRefGoogle ScholarPubMed
Favrod, J., Zimmerman, G., Raffard, S., Pomini, V. and Khazaal, Y. (2008). Beck Cognitive Insight Scale in outpatients with psychotic disorders: further evidence from a French-speaking sample. The Canadian Journal of Psychiatry, 53, 783–787.CrossRefGoogle ScholarPubMed
Fiorentine, R. and Hillhouse, M. P. (1999). Drug treatment effectiveness and client-counselor empathy. Journal of Drug Issues, 29, 59–74.CrossRefGoogle Scholar
Fowler, D., Garety, P., A. and Kuipers, L. (1995). Cognitive Behavioural Therapy for People with Psychosis: a clinical handbook. Chichester: Wiley.Google Scholar
Frank, A. F. and Gunderson, J. G. (1990). The role of the therapeutic alliance in the treatment of schizophrenia. Archives of General Psychiatry, 47, 228–235.CrossRefGoogle ScholarPubMed
Gehrs, M. and Goering, P. (1994). The relationship between the working alliance and rehabilitation outcomes in schizophrenia. Psychosocial Rehabilitation Journal, 18, 43–54.CrossRefGoogle Scholar
Gilbert, P. (2007). Evolved minds and compassion in the therapeutic relationship. In Gilbert, P. and Leahy, R. (Eds.), The Therapeutic Relationship in the Cognitive Behavioural Psychotherapies. London: Routledge.Google Scholar
Granholm, E., McQuaid, J. R., McClure, F. S., Pedrelli, P. and Beck, A. T. (2002). A Randomised Control Trial of Cognitive-Behavioural Therapy for Older Patients with Schizophrenia: improved insight in associated symptom change. 17th Annual Society for Research in Psychopathology Convention, San Francisco, CA.Google Scholar
Gurman, A. S. (1977). The patient's perception of the therapeutic relationship. In Gurman, A. S. and Razin, A. M. (Eds.), Effective Psychotherapy:a handbook of research. Oxford and New York: Pergamon.Google Scholar
Haddock, G., McCarron, J., Tarrier, N. and Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions. the Psychotic Symptom Rating Scale (PSYRATS). Psychological Medicine, 29, 879–889.CrossRefGoogle ScholarPubMed
Hammond, K. (2004). Treatment Integrity, Therapeutic Alliance and Outcome: an evaluation of the relationship in cognitive behaviour therapy and befriending for psychosis. Unpublished Clinical Psychology Doctoral Dissertation, University of East Anglia.Google Scholar
Hardy, G. E., Cahill, J. and Barkham, M. (2007). Active ingredients of the therapeutic relationship that promote client change: a research perspective. In Gilbert, P. and Leahy, R. (Eds.), The Therapeutic Relationship in the Cognitive Behavioural Psychotherapies. London: Routledge.Google Scholar
Horvath, A. O. (1994). Empirical validation of Bordin's pantheoretical model of the alliance: the working alliance inventory perspective. In Horvath, A. O. and Greenberg, L. S. (Eds.), The Working Alliance: theory, research and practice. New York: John Wiley & Sons.Google Scholar
Horvath, A. O. (2000). The therapeutic relationship: from transference to alliance. Psychotherapy in Practice, 56, 163–173.Google ScholarPubMed
Horvath, A. O. and Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counselling Psychology, 36, 223–233.CrossRefGoogle Scholar
Hurn, G., Gray, N. S. and Hughes, I. (2002). Independence of “reaction to hypothetical contradiction” from other measures of delusional belief. British Journal of Clinical Psychology, 41, 349–360.CrossRefGoogle Scholar
Jolley, S., Garety, P., Craig, T., Dunn, G., White, J. and Aitken, M. (2003). Cognitive therapy in early psychosis: a pilot randomised controlled trial. Behavioural and Cognitive Psychotherapy, 31, 473–478.CrossRefGoogle Scholar
Klein, D. N., Schwartz, J. E., Santiago, N. J., Vivian, D., Vocisano, C., Costonguay, L. G., Arnow, B. A., Blalock, J. A., Markowitz, J. C., Rothbaum, B. O. and McCullough, J. P. (2003). Therapeutic alliance in depression treatment: controlling for prior change and patient characteristics. Journal of Consulting and Clinical Psychology, 71, 997–1006.CrossRefGoogle ScholarPubMed
Krawiecka, M., Goldberg, D. and Vaughn, M. (1977). A standardised psychiatric assessment scale for rating chronic psychotic patients. Acta Psychiatrica Scandinavica, 55, 299–308.CrossRefGoogle ScholarPubMed
Kuipers, E., Garety, P., Fowler, D., Dunn, G., Bebbington, P., Freeman, D. and Hadley, C. (1997). London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis: I. effects of the treatment phase. British Journal of Psychiatry, 171, 319–327.CrossRefGoogle ScholarPubMed
LaCrosse, M. B. and Barak, A. (1976). Differential perception of counselor behaviour. Journal of Counseling Psychology, 23, 170–172.CrossRefGoogle Scholar
Mak, W. W. S. and Wu, C. F. M. (2006). Cognitive insight and causal attribution in the development of self-stigma among individuals with schizophrenia. Psychiatric Services, 57, 1800–1802.CrossRefGoogle ScholarPubMed
Malla, K., Norman, R. M. and Williamson, P. (1993). Stability of positive and negative symptoms in schizophrenia. Canadian Journal of Psychiatry, 38, 617–621.CrossRefGoogle ScholarPubMed
Martin, D. J., Garske, J. P. and Davis, M. K. (2000). Relation of the therapeutic relationship with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438–450.CrossRefGoogle ScholarPubMed
Mohl, P. C., Martinez, D., Ticknor, C., Huang, M. and Cordell, L. (1991). Early dropouts from psychotherapy. Journal of Nervous and Mental Disease, 172, 417–423.Google Scholar
Pierson, H. and Hayes, S. C. (2007). Using acceptance and commitment therapy to empower the therapeutic relationship. In Gilbert, P. and Leahy, R. (Eds.), The Therapeutic Relationship in the Cognitive Behavioural Psychotherapies. London: Routledge.Google Scholar
Plotnicov, K. H. (1990). Early termination from counselling: the client's perspective. Dissertation Abstracts International.Google Scholar
Safran, J. D. and Wallner, L. K. (1991). The relative predictive validity of two therapeutic alliance measures in cognitive therapy. Journal of Consulting and Clinical Psychology, 3, 188–195.Google Scholar
Selten, J. P. C., Sijben, N. E., Van Den Bosch, R. J., Omloo-Visser, J. and Warnerdam, H. (1993). The subjective experience of negative symptoms: a self-rating scale. Comprehensive-Psychiatry, 34, 192–197.CrossRefGoogle ScholarPubMed
Strauss, J. S. and Carpenter, W. T. (1972). The prediction of outcome in schizophrenia. II. Relationships between predictor and outcome variables: a report from the WHO International Pilot Study of Schizophrenia. Archives of General Psychiatry, 31, 37–42.CrossRefGoogle Scholar
Strong, S. R. (1968). Counseling: an interpersonal influence process. Journal of Counseling Psychology, 15, 215–224.CrossRefGoogle Scholar
Svensson, B. and Hansson, L. (1999). Relationships among patient and therapist ratings of the therapeutic alliance and patient assessments of therapeutic process. Journal of Nervous and Mental Disorders, 187, 579–585.CrossRefGoogle ScholarPubMed
Svensson, B. and Hansson, L. (1999). Therapeutic alliance in cognitive therapy for schizophrenic and other long-term mentally ill patients: development and relationship to outcome in an in-patient treatment programme. Acta Psychiatrica Scandinavica, 99, 281–287.CrossRefGoogle Scholar
Tracey, T. J. (1986). The stages of influence in counselling and psychotherapy. In Dorn, F. J. (Eds.), The Social Influence Process in Counselling and Psychotherapy. Springfield, IL: Charles C Thomas.Google Scholar
Zuroff, D. C. and Blatt, S. J. (2006). The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced capacities. Journal of Consulting and Clinical Psycholosgy, 74, 130–140.CrossRefGoogle Scholar
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