The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders.

PubMed

Turner, Hannah; Bryant-Waugh, Rachel; Marshall, Emily

2015-10-01

The present study explored the impact of early symptom change (cognitive and behavioural) and the early therapeutic alliance on treatment outcome in cognitive-behavioural therapy (CBT) for the eating disorders. Participants were 94 adults with diagnosed eating disorders who completed a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment, following the 6th session and at the end of treatment. They also completed a measure of therapeutic alliance following the 6th session. Greater early reduction in dietary restraint and eating concerns, and smaller levels of change in shape concern, significantly predicted later reduction in global eating pathology. The early therapeutic alliance was strong across the three domains of tasks, goals and bond. Early symptom reduction was a stronger predictor of later reduction in eating pathology than early therapeutic alliance. The early therapeutic alliance did not mediate the relationship between early symptom reduction and later reduction in global eating pathology. Instead, greater early symptom reduction predicted a strong early therapeutic alliance. Early clinical change was the strongest predictor of treatment outcome and this also facilitated the development of a strong early alliance. Clinicians should be encouraged to deliver all aspects of evidence-based CBT, including behavioural change. The findings suggest that this will have a positive impact on both the early therapeutic alliance and later change in eating pathology. Copyright © 2015 Elsevier Ltd. All rights reserved.

Neutrality, abstinence, and the therapeutic alliance.

PubMed

Meissner, W W

1998-01-01

Concepts of neutrality and abstinence are discussed in terms of the variant opinions about them, pro and con, with particular reference to efforts to dispense with them based on the unavoidable role of the analyst's personal influence and subjectivity in the analytic process. Stereotypes of both neutrality and abstinence are examined, and the therapeutic alliance established as the most appropriate context within which to articulate the essential and constructive role of effective analytic neutrality and abstinence. The alliance is not possible without the persistent exercise of both neutrality and abstinence; conversely, other components of the alliance are intended to facilitate and preserve neutrality and abstinence on the part of both analyst and analysand. These elements are essential factors in effective analytic practice.

Patient-Rated Alliance as a Measure of Therapist Performance in Two Clinical Settings

ERIC Educational Resources Information Center

Imel, Zac E.; Hubbard, Rebecca A.; Rutter, Carolyn M.; Simon, Gregory

2013-01-01

Objective: The ability to form a strong therapeutic alliance is considered a foundational skill across psychotherapies. Patient-rated measures of the alliance are now being used to make judgments about a therapist's tendency to build alliances with their patients. However, whether a patient-rated alliance measure provides a useful index of a…

Therapeutic alliance, illness awareness, and number of hospitalizations for schizophrenia.

PubMed

Prince, Jonathan D

2007-02-01

While persons with multiple hospitalizations for schizophrenia have been found to differ from those with fewer, it remains unclear whether differences exist in illness awareness (personal understanding of psychopathology) or therapeutic alliance with inpatient staff (treatment involvement). This cross-sectional descriptive study therefore examined whether inpatients with more extensive hospitalization history 1) have less illness awareness and therapeutic alliance (perhaps contributing to the recidivism), 2) have more awareness and alliance (possibly because they have learned from experience), or 3) do not differ relative to persons with fewer inpatient stays. Results from staff and patient interviews (N=307) suggest that illness awareness is greater in persons with more hospitalizations, while therapeutic alliance appears to weaken. Individuals with greater recidivism may therefore need less help than others in building a self-knowledge of psychopathology that may already have developed. Instead, enhanced engagement in care may be more important after multiple disappointing relapses.

Effect of questions used by psychiatrists on therapeutic alliance and adherence.

PubMed

Thompson, Laura; Howes, Christine; McCabe, Rose

2016-07-01

Psychiatrists' questions are the mechanism for achieving clinical objectives and managing the formation of a therapeutic alliance - consistently associated with patient adherence. No research has examined the nature of this relationship and the different practices used in psychiatry. Questions are typically defined in binary terms (e.g. 'open' v 'closed') that may have limited application in practice. To undertake a detailed examination of the types of questions psychiatrists ask patients and explore their association with the therapeutic alliance and patient adherence. A coding protocol was developed to classify questions from 134 out-patient consultations, predominantly by syntactic form. Bivariate correlations with measures of patient adherence and the therapeutic alliance (psychiatrist-rated) were examined and assessed using generalised estimating equations, adjusting for patient symptoms, psychiatrist identity and amount of speech. Psychiatrists used only four of ten question types regularly: yes/no auxiliary questions, 'wh-' questions, declarative questions and tag questions. Only declarative questions predicted better adherence and perceptions of the therapeutic relationship. Conversely, 'wh-' questions - associated with positive symptoms - predicted poorer perceptions of the therapeutic relationship. Declarative questions were frequently used to propose an understanding of patients' experiences, in particular their emotional salience for the patient. A refined defining of questioning practices is necessary to improve communication in psychiatry. The use of declarative questions may enhance alliance and adherence, or index their manifestation in talk, e.g. better mutual understanding. The function of 'so'-prefaced declaratives, also used in psychotherapy, is more nuanced than negatively connotated 'leading' questions. Hearable as displays of empathy, they attend closely to patient experience, while balancing the tasks of assessment and treatment. © The

Correlates of Therapeutic Alliance and Treatment Outcomes among Israeli Female Methadone Patients

ERIC Educational Resources Information Center

Schiff, Miriam; Levit, Shabtay

2010-01-01

Objectives: This study examines potential predictors (e.g., attachment style, frequency of therapeutic treatment sessions) of client-rated therapeutic alliance between the social worker and client. The relationship between therapeutic alliance and client's psychological outcomes (hope and posttraumatic stress symptoms [PTS's]) was also assessed.…

Treatment Preferences Affect the Therapeutic Alliance: Implications for Randomized Controlled Trials

ERIC Educational Resources Information Center

Iacoviello, Brian M.; McCarthy, Kevin Scott; Barrett, Marna S.; Rynn, Moira; Gallop, Robert; Barber, Jacques P.

2007-01-01

The influence of treatment preferences on the development of the therapeutic alliance was investigated. Seventy-five patients were followed while participating in a randomized controlled trial comparing supportive-expressive psychotherapy with sertraline or pill placebo in the treatment of major depressive disorder. Therapeutic alliance was…

Clinicians' perspectives of therapeutic alliance in face-to-face and telepractice speech-language pathology sessions.

PubMed

Freckmann, Anneka; Hines, Monique; Lincoln, Michelle

2017-06-01

To investigate the face validity of a measure of therapeutic alliance for paediatric speech-language pathology and to determine whether a difference exists in therapeutic alliance reported by speech-language pathologists (SLPs) conducting face-to-face sessions, compared with telepractice SLPs or in their ratings of confidence with technology. SLPs conducting telepractice (n = 14) or face-to-face therapy (n = 18) completed an online survey which included the Therapeutic Alliance Scales for Children - Revised (TASC-r) (Therapist Form) to rate clinicians' perceptions of rapport with up to three clients. Participants also reported their overall perception of rapport with each client and their comfort with technology. There was a strong correlation between TASC-r total scores and overall ratings of rapport, providing preliminary evidence of TASC-r face validity. There was no significant difference between TASC-r scores for telepractice and face-to-face therapy (p = 0.961), nor face-to-face and telepractice SLPs' confidence with familiar (p = 0.414) or unfamiliar technology (p = 0.780). The TASC-r may be a promising tool for measuring therapeutic alliance in speech-language pathology. Telepractice does not appear to have a negative effect on rapport between SLPs and paediatric clients. Future research is required to identify how SLPs develop rapport in telepractice.

The relationship between therapeutic alliance and patient's suicidal thoughts, self-harming behaviours and suicide attempts: A systematic review.

PubMed

Dunster-Page, Charlotte; Haddock, Gillian; Wainwright, Laura; Berry, Katherine

2017-12-01

Suicidality is a common concern for people with mental health problems. The interpersonal nature of suicidality suggests that therapeutic alliance may be important when working clinically with suicidal patients. This paper is a systematic review of studies investigating the association between alliance and treatment outcome relating to suicidal ideation and behaviours. Systematic searches of PsychINFO, MEDLINE, AMED, EMBASE, Web of Science and CINAHL were completed using words that captured the concepts of alliance and suicidality. Eligible studies: involved participants aged 18-years-old or over; used a validated measure of therapeutic alliance; and reported associations between alliance and suicidality. Abstracts, qualitative studies and articles not written in English were excluded. Twelve studies were included. Findings indicated that alliance is associated with suicidality. Alliance was related to suicidality in eleven of the papers. Self-harming behaviours had the strongest association with patient-rated alliance. Suicide attempts had the weakest association, possibly due to the infrequency of suicide attempts in the studies reviewed. The twelve studies were heterogeneous in terms of the measure of alliance used, method of assessing suicidality, clinical setting and professional-type. This variability limited the degree to which findings could be synthesised. Therapists, care-coordinators and mental health teams should recognise the importance of building a strong therapeutic alliance with suicidal patients. Researchers should use consistent methods of measuring alliance and assessing suicidality in future studies. Clinicians and researchers should note that suicidal thoughts, self-harm and suicide attempts may be related to alliance in different ways and therefore should be assessed as separate constructs. Copyright © 2017 Elsevier B.V. All rights reserved.

Psychometric Properties of the Therapeutic Alliance Scale for Caregivers and Parents

ERIC Educational Resources Information Center

Accurso, Erin C.; Hawley, Kristin M.; Garland, Ann F.

2013-01-01

This study examined the psychometric properties of the Therapeutic Alliance Scale for Caregivers and Parents (TASCP) in a sample of 209 caregivers whose children (4-13 years of age) presented with disruptive behavior problems to a publicly funded outpatient mental health clinic in San Diego County. Information about therapeutic alliance was…

The Therapeutic Alliance: Clients' Categorization of Client-Identified Factors

ERIC Educational Resources Information Center

Simpson, Arlene J.; Bedi, Robinder P.

2012-01-01

Clients' perspectives on the therapeutic alliance were examined using written descriptions of factors that clients believed to be helpful in developing a strong alliance. Fifty participants sorted previously collected statements into thematically similar piles and then gave each set of statements a title. Multivariate concept mapping statistical…

Therapist self-disclosure and the therapeutic alliance in the treatment of eating problems.

PubMed

Simonds, Laura M; Spokes, Naomi

2017-01-01

Evidence is mixed regarding the potential utility of therapist self-disclosure. The current study modelled relationships between perceived helpfulness of therapist self-disclosures, therapeutic alliance, patient non-disclosure, and shame in participants (n = 120; 95% women) with a history of eating problems. Serial multiple mediator analyses provided support for a putative model connecting the perceived helpfulness of therapist self-disclosures with current eating disorder symptom severity through therapeutic alliance, patient self-disclosure, and shame. The analyses presented provide support for the contention that therapist self-disclosure, if perceived as helpful, might strengthen the therapeutic alliance. A strong therapeutic alliance, in turn, has the potential to promote patient disclosure and reduce shame and eating problems.

Therapeutic alliance in schizophrenia: the role of recovery orientation, self-stigma, and insight.

PubMed

Kvrgic, Sara; Cavelti, Marialuisa; Beck, Eva-Marina; Rüsch, Nicolas; Vauth, Roland

2013-08-30

The present study examined variables related to the quality of the therapeutic alliance in out-patients with schizophrenia. We expected recovery orientation and insight to be positively, and self-stigma to be negatively associated with a good therapeutic alliance. We expected these associations to be independent from age, clinical symptoms (i.e. positive and negative symptoms, depression), and more general aspects of relationship building like avoidant attachment style and the duration of treatment by the current therapist. The study included 156 participants with DSM-IV diagnoses of schizophrenia or schizoaffective disorder in the maintenance phase of treatment. Therapeutic alliance, recovery orientation, self-stigma, insight, adult attachment style, and depression were assessed by self-report. Symptoms were rated by interviewers. Hierarchical multiple regressions revealed that more recovery orientation, less self-stigma, and more insight independently were associated with a better quality of the therapeutic alliance. Clinical symptoms, adult attachment style, age, and the duration of treatment by current therapist were unrelated to the quality of the therapeutic alliance. Low recovery orientation and increased self-stigma might undermine the therapeutic alliance in schizophrenia beyond the detrimental effect of poor insight. Therefore in clinical settings, besides enhancing insight, recovery orientation, and self-stigma should be addressed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Therapeutic Alliance and Treatment Outcome in the Outpatient Treatment of Urban Adolescents: The Role of Callous-Unemotional Traits

PubMed Central

Mattos, Laurel A.; Schmidt, Adam T.; Henderson, Craig E.; Hogue, Aaron

2016-01-01

Callous-unemotional (CU) traits designate a unique subset of youth with externalizing psychopathology who have a severe pattern of aggressive behavior and tend to have worse outcomes in treatment. However, little research has addressed how CU traits relate to different components of psychotherapy, such as the therapeutic alliance. The current study examined the role of CU traits in predicting therapeutic alliance in 59 adolescents (M age = 15.3, 51% female, 64% Hispanic American, 15% African American) who were part of a larger randomized naturalistic trial of outpatient behavioral psychotherapy. Multilevel regression analysis further investigated the role of therapeutic alliance in predicting treatment outcome (as measured by self-reported delinquency) and the moderating role of CU traits. Results suggested that regardless of the severity of their externalizing problems, youth with higher levels of CU traits reported more positive ratings of therapeutic alliance. In addition, a positive therapeutic alliance predicted reductions in delinquent behavior, and this association was even stronger for youth higher in CU traits. Our results suggest that CU traits are related to improvement in the formation of the therapeutic alliance among youth with externalizing psychopathology, perhaps because these youth lack many of the social and emotional deficits that other youth with conduct problems possess. Adolescents high in CU traits should not be viewed as untreatable. Indeed, the therapeutic alliance may be an important mechanism for affecting meaningful change in these adolescents’ lives. PMID:27831697

Relating Therapist Characteristics to Client Engagement and the Therapeutic Alliance in an Adolescent Custodial Group Substance Misuse Treatment Program.

PubMed

Daniels, Rachael Anne; Holdsworth, Emma; Tramontano, Carlo

2017-07-29

Client engagement in substance misuse treatment programs is directly associated with positive treatment outcomes. The nature of these programs means there are often difficulties engaging and retaining clients, but authors have consistently found a strong therapeutic alliance is associated with client engagement. While research has focused on the association between the alliance and engagement, the factors that influence the therapeutic alliance have received less attention. To examine therapists' characteristics, namely therapists' stress and empathy levels, as potential predictors of client engagement and the therapeutic alliance, within an adolescent substance misuse group treatment program. The sample included 84 adolescent clients and 14 therapists from a Secure Training Centre in England. Client engagement in the treatment program was observed, while self-reporting measures assessed the therapeutic alliance (client and therapist-rated), and therapists' stress and empathy levels. Multiple regression analysis revealed that therapists' stress levels negatively influenced the therapeutic alliance and had a curvilinear relationship with client engagement, indicating that stress is not exclusively negatively related to engagement. Although stress was found to negatively impact both cognitive and affective empathy, neither cognitive nor affective empathy were significantly related to client engagement or the therapeutic alliance. This study demonstrates the importance of therapist characteristics on client engagement and the therapeutic alliance. Within practice stress can have a positive impact on clients' engagement. Nevertheless, therapists may need additional support to deal with stress effectively. Therapists' empathy may too be fundamental to client engagement, but only it if is perceived by clients.

The therapeutic alliance in internet interventions: A narrative review and suggestions for future research.

PubMed

Berger, Thomas

2017-09-01

Research on Internet interventions has grown rapidly over the recent years and evidence is growing that Internet-based treatments often result in similar outcomes as conventional face-to-face psychotherapy. Yet there are still unanswered concerns such as whether a therapeutic alliance can be established over the Internet and whether the alliance is important in this new treatment format. A narrative review of studies formally assessing the therapeutic alliance in Internet interventions was conducted. It is the first review summarizing findings on the therapeutic alliance that (i) distinguishes between different forms of Internet interventions and (ii) does not restrict itself to specific Internet-based treatment formats such as guided self-help treatments, e-mail or videoconferencing therapies. Independent of communication modalities, diagnostic groups and amount of contact between clients and therapists, client-rated alliance scores were high, roughly equivalent to alliance ratings found in studies on face-to-face therapy. Mixed results were found regarding the therapist-rated alliance and alliance-outcome associations. The review points to the limitations of the available evidence and identifies unanswered questions. It is concluded that one of the major tasks for future research is to identify unique characteristics of the therapeutic alliance in the different treatment formats.

Does the cognitive dispute of psychotic symptoms do harm to the therapeutic alliance?

PubMed

Wittorf, Andreas; Jakobi, Ute E; Bannert, Kerstin K; Bechdolf, Andreas; Müller, Bernhard W; Sartory, Gudrun; Wagner, Michael; Wiedemann, Georg; Wölwer, Wolfgang; Herrlich, Jutta; Buchkremer, Gerhard; Klingberg, Stefan

2010-07-01

We examined whether the cognitive dispute of psychotic symptoms has a negative impact on the course of the therapeutic alliance. Sixty-seven patients with persistent psychotic symptoms received either cognitive behavioral therapy (CBT) or supportive therapy. Questionnaire-based alliance ratings were repeatedly obtained throughout the course of therapy. Patient and therapist alliance ratings were examined separately. Data analyses comprised repeated measurement analyses of variance and cluster analytic procedures. Neither patient nor therapist alliance ratings showed a differential course throughout the treatments. This was despite the implementation of disputing strategies in later stages of CBT. Irrespective of the treatment condition a cluster with a positive alliance rating and a cluster with a poorer rating were found for therapist and patient ratings, respectively. Baseline symptoms and insight differentiated between the types of clusters. In conclusion, CBT-specific interventions that challenge psychotic symptoms do not necessarily negatively influence the course of the alliance.

The relationship between patient object relations and the therapeutic alliance in a naturalistic psychotherapy sample.

PubMed

Errázuriz, Paula; Constantino, Michael J; Calvo, Esteban

2015-09-01

This study examined the relationship between patients' object relations and interpersonal process in psychotherapy. Namely, we tested the hypothesis that the quality of patients' object relations is positively associated with both patient- and therapist-rated alliance quality. Psychotherapy was administered naturalistically, with quantitative data collection before and during treatment. Participants included 73 adult outpatients and 23 therapists at two mental health clinics. Using the Bell Object Relations and Reality Testing Inventory, we measured four dimensions of patients' object relations at baseline-alienation, insecure attachment, egocentricity, and social incompetence. Using the Working Alliance Inventory, we measured alliance from patient and therapist perspectives. Control variables included time, patient demographics, symptom severity, and clinic. We employed hierarchical linear modelling to analyse data with a nested structure, with 138 sessions at Level 1, 73 patients at Level 2, and 23 therapists at Level 3. Patient alienation and insecure attachment were associated with lower patient-rated alliance, while egocentricity was associated with higher patient-rated alliance. Patients' object relations were not significantly associated with therapist-rated alliance. On average, patients perceived the alliance more positively than their therapists, with a weak positive correlation between the alliance perspectives. The results suggest that object relation dimensions may be important patient characteristics for forecasting therapeutic relationship quality. They also call for more attention to differences between alliance rating perspectives. Treatment may benefit from more attention to the quality of patients' object relations. If patients present with high levels of alienation and insecure attachment, therapists may need to pay especially close attention to the therapeutic alliance, and prudently address any ruptures in its quality. When monitoring the

Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis).

PubMed

Weck, Florian; Richtberg, Samantha; Jakob, Marion; Neng, Julia M B; Höfling, Volkmar

2015-07-30

The role of treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) is rarely investigated in psychotherapeutic treatment for health anxiety. This study aimed to investigate the role of the assessment perspective for the evaluation of treatment delivery factors and their relevance for treatment outcome. Therapist adherence, therapist competence, and therapeutic alliance were evaluated by independent raters, therapists, patients, and supervisors in 68 treatments. Patients with severe health anxiety (hypochondriasis) were treated with cognitive therapy or exposure therapy. Treatment outcome was assessed with a standardized interview by independent diagnosticians. A multitrait-multimethod analysis revealed a large effect for the assessment perspective of therapist adherence, therapist competence, and therapeutic alliance. The rater perspective was the most important for the prediction of treatment outcome. Therapeutic alliance and therapist competence accounted for 6% of the variance of treatment outcome while therapist adherence was not associated with treatment outcome. Therapist competence was only indirectly associated with treatment outcome, mediated by therapeutic alliance. Both therapeutic alliance and therapist competence demonstrated to be important treatment delivery factors in psychotherapy for health anxiety. A stronger consideration of those processes during psychotherapy for health anxiety might be able to improve psychotherapy outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Therapeutic Alliance: A Concept for the Childbearing Season

PubMed Central

Doherty, Mary Ellen

2009-01-01

This analysis was conducted to describe the concept of therapeutic alliance and its appropriateness for health-care provider-client interactions during the childbearing season. The concept has been defined in other disciplines. A universal definition suggested a merging of efforts directed toward health. A simple and concise definition evolved, which is applicable to the childbearing season as well as to health-care encounters across the life span. This definition states: Therapeutic alliance is a process within a health-care provider-client interaction that is initiated by an identified need for positive client health-care behaviors, whereby both parties work together toward this goal with consideration of the client's current health status and developmental stage within the life span. PMID:20514120

Therapeutic Alliances in Stroke Rehabilitation: A Meta-Ethnography.

PubMed

Lawton, Michelle; Haddock, Gillian; Conroy, Paul; Sage, Karen

2016-11-01

To synthesize qualitative studies exploring patients' and professionals' perspectives and experiences of developing and maintaining therapeutic alliances in stroke rehabilitation. A systematic literature search was conducted using the following electronic databases: PsycINFO, CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, and ComDisDome from inception to May 2014. This was supplemented by hand searching, reference tracking, generic web searching, and e-mail contact with experts. Qualitative peer reviewed articles reporting experiences or perceptions of the patient or professional in relation to therapeutic alliance construction and maintenance in stroke rehabilitation were selected for inclusion. After a process of exclusion, 17 publications were included in the synthesis. All text identified in the results and discussion sections of the selected studies were extracted verbatim for analysis in a qualitative software program. Studies were critically appraised independently by 2 reviewers. Articles were synthesized using a technique of meta-ethnography. Four overarching themes emerged from the process of reciprocal translation: (1) the professional-patient relationship: degree of connectedness; (2) asymmetrical contributions; (3) the process of collaboration: finding the middle ground; and (4) system drivers. The findings from the meta-ethnography suggest that the balance of power between the patient and professional is asymmetrically distributed in the construction of the alliance. However, given that none of the studies included in the review addressed therapeutic alliance as a primary research area, further research is required to develop a conceptual framework relevant to stroke rehabilitation, in order to determine how this construct contributes to treatment efficacy. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Two Aspects of the Therapeutic Alliance: Differential Relations with Depressive Symptom Change

ERIC Educational Resources Information Center

Webb, Christian A.; Derubeis, Robert J.; Amsterdam, Jay D.; Shelton, Richard C.; Hollon, Steven D.; Dimidjian, Sona

2011-01-01

Objective: The therapeutic alliance has been linked to symptom change in numerous investigations. Although the alliance is commonly conceptualized as a multidimensional construct, few studies have examined its components separately. The current study explored which components of the alliance are most highly associated with depressive symptom…

Therapeutic Alliance in Telephone-Administered Cognitive-Behavioral Therapy for Hematopoietic Stem Cell Transplant Survivors

ERIC Educational Resources Information Center

Applebaum, Allison J.; DuHamel, Katherine N.; Winkel, Gary; Rini, Christine; Greene, Paul B.; Mosher, Catherine E.; Redd, William H.

2012-01-01

Objective: A strong therapeutic alliance has been found to predict psychotherapeutic treatment success across a variety of therapeutic modalities and patient populations. However, only a few studies have examined therapeutic alliance as a predictor of psychotherapy outcome among cancer survivors, and none have examined this relation in…

Therapeutic alliance mediates the association between personality and treatment outcome in patients with major depressive disorder.

PubMed

Kushner, Shauna C; Quilty, Lena C; Uliaszek, Amanda A; McBride, Carolina; Bagby, R Michael

2016-09-01

Patient personality traits have been shown to influence treatment outcome in those with major depressive disorder (MDD). The trait agreeableness, which reflects an interpersonal orientation, may affect treatment outcome via its role in the formation of therapeutic alliance. No published studies have tested this hypothesis in patients with MDD. Participants were 209 outpatients with MDD who were treated in a randomized control trial. Mediation analyses were conducted to examine the role of therapeutic alliance in the association between pretreatment personality and the reduction of depression symptom severity during treatment. Separate models were estimated for patient- versus therapist-rated therapeutic alliance. We found a significant indirect effect of agreeableness on the reduction of depression severity via patient-rated therapeutic alliance. Results were replicated across two well-validated measures of depression symptom severity. Results also partially supported indirect effects for extraversion and openness. Therapist ratings of alliance did not mediate the association between personality and treatment outcomes. Patients were recruited as part of a randomized control trial, which may limit the generalizability of results to practice-based clinical settings. Due to constraints on statistical power, intervention-specific mediation results were not examined. These results highlight the importance of personality and the role it plays in treatment process as well as outcome. Copyright © 2016 Elsevier B.V. All rights reserved.

The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders

PubMed Central

Cronin, Elisabeth; Brand, Bethany L.; Mattanah, Jonathan F.

2014-01-01

Background Research has shown that the therapeutic alliance plays an important role in enhancing treatment outcome among individuals with a variety of disorders, including posttraumatic stress disorder (PTSD). However, the therapeutic alliance and treatment outcome has not yet been studied in dissociative disorders (DD). Objectives The current study sought to investigate the impact of alliance on treatment outcome for DD patients. Methods Data from a naturalistic, longitudinal international treatment study of DD patients and their therapists were analyzed to determine if the alliance, as reported by patients and therapists, was associated with treatment outcome. Results Patients with higher self-rated alliance had fewer symptoms of dissociation, PTSD, and general distress, as well as higher levels of therapist-rated adaptive functioning. Over time, self-rated alliance scores predicted better outcomes, after controlling for patient adaptive capacities including symptom management at the time when the alliance ratings were made. Patient-rated alliance was more strongly associated with outcome than therapist-rated alliance. Conclusion Therapists who work with DD patients should understand the importance of the alliance on treatment outcome. These findings are consistent with previous literature demonstrating the importance of developing and maintaining a strong therapeutic alliance, although the effect sizes of individuals with DD were stronger than what has been found in many other patient groups. A greater understanding of the impact of the alliance in traumatized individuals may contribute to better outcomes for these individuals. PMID:24616755

The Role of Therapeutic Alliance in Therapy Outcomes for Youth in Residential Care

ERIC Educational Resources Information Center

Handwerk, Michael L.; Huefner, Jonathan C.; Ringle, Jay L.; Howard, Brigid K.; Soper, Stephen H.; Almquist, Julie K.; Chmelka, M. Beth

2008-01-01

This study examined the impact of therapeutic alliance (TA) on therapy outcomes for youth with behavioral and emotional problems residing in residential care. Study participants were 71 youth in an out-of-home family-style residential treatment facility who were referred to an onsite psychotherapy clinic. A therapeutic alliance scale was completed…

Effects of video-based therapy preparation targeting experiential acceptance or the therapeutic alliance.

PubMed

Johansen, Ayna B; Lumley, Mark; Cano, Annmarie

2011-06-01

Preparation for psychotherapy may enhance the psychotherapeutic process, reduce drop-outs, and improve outcomes, but the effective mechanisms of such preparation are poorly understood. Previous studies have rarely targeted specific processes that are associated with positive therapy outcomes. This randomized experiment compared the effects of preparatory videos that targeted either the Therapeutic Alliance, Experiential Acceptance, or a Control video on early therapeutic process variables in 105 patients seen in individual therapy. Participants watched the videos just before their first therapy session. No significant differences were found between the Alliance and Experiential Acceptance videos on patient recommendations, immediate affective reactions, or working alliance and attrition after the first session. However, the Therapeutic Alliance video produced an immediate increase in negative mood relative to the Control video, whereas the Experiential acceptance video produced a slight increase in positive mood relative to the Alliance video. Surprisingly, patients who viewed the Alliance video were rated significantly lower than the control group on therapist-rated alliance after the first session. These findings suggest there may be specific process effects in the early phase of treatment based on the type of pretraining material used, and also indicate that video-based pretraining efforts could be counterproductive. Furthermore, this research contributes to the literature by providing insights into methodological considerations for future work on the use of technology in psychotherapy and challenges associated with preparing people for successful psychotherapy.

Religiosity and Therapeutic Alliance among Youth Who Commit Sexual Crimes

ERIC Educational Resources Information Center

Yoder, Jamie; Bovard-Johns, Rian M.

2017-01-01

Background: Delinquency research argues that youth religion and spirituality are associated with desistence. The therapeutic alliance has been shown to be partially responsible for the influence of religiosity in therapeutic services. Asceticism within religious doctrine coupled with Social Bonding Theory, suggests perhaps existential and secular…

Relation of Patient Pretreatment Characteristics to the Therapeutic Alliance in Diverse Psychotherapies.

ERIC Educational Resources Information Center

Gaston, Louise; And Others

1988-01-01

Investigated prediction of therapeutic alliance from patient pretreatment characteristics among 60 elderly depressed outpatients treated in behavioral, cognitive, and brief dynamic psychotherapy. Found that higher degree of patient defensiveness was related to lower patient contribution to alliance as reflected in patient commitment and working…

Effects of transference work in the context of therapeutic alliance and quality of object relations.

PubMed

Høglend, Per; Hersoug, Anne Grete; Bøgwald, Kjell-Petter; Amlo, Svein; Marble, Alice; Sørbye, Øystein; Røssberg, Jan Ivar; Ulberg, Randi; Gabbard, Glen O; Crits-Christoph, Paul

2011-10-01

Transference interpretation is considered as a core active ingredient in dynamic psychotherapy. In common clinical theory, it is maintained that more mature relationships, as well as a strong therapeutic alliance, may be prerequisites for successful transference work. In this study, the interaction between quality of object relations, transference interpretation, and alliance is estimated. One hundred outpatients seeking psychotherapy for depression, anxiety, and personality disorders were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment, but without the use of transference interpretation. Quality of Object Relations (QOR)-lifelong pattern was evaluated before treatment (P. Høglend, 1994). The Working Alliance Inventory (A. O. Horvath & L. S. Greenberg, 1989; T. J. Tracey & A. M. Kokotovic, 1989) was rated in Session 7. The primary outcome variable was the Psychodynamic Functioning Scales (P. Høglend et al., 2000), measured at pretreatment, posttreatment, and 1 year after treatment termination. A significant Treatment Group × Quality of Object Relations × Alliance interaction was present, indicating that alliance had a significantly different impact on effects of transference interpretation, depending on the level of QOR. The impact of transference interpretation on psychodynamic functioning was more positive within the context of a weak therapeutic alliance for patients with low quality of object relations. For patients with more mature object relations and high alliance, the authors observed a negative effect of transference work. The specific effects of transference work was influenced by the interaction of object relations and alliance, but in the direct opposite direction of what is generally maintained in mainstream clinical theory.

Perceptions Among Psychiatric Staff of Creating a Therapeutic Alliance With Patients on Community Treatment Orders.

PubMed

Jansson, Susanne; Fridlund, Bengt

2016-10-01

A therapeutic alliance with a continuing collaboration between a patient and psychiatric staff is a resource for helping patients cope with the demands of coercive legislation. Knowledge exists describing coercion in inpatient care while the knowledge regarding the perceptions of creating a therapeutic alliance with patients on Community Treatment Orders (CTO) among psychiatric staff is scarce. To describe perceptions among psychiatric staff of creating a therapeutic alliance with patients on CTOs, an exploratory design using a phenomenographic method was employed. Thirteen semi-structured audio-taped interviews were conducted with psychiatric staff responsible for patients on CTOs. The staff worked in five different outpatient clinics and the interviews were conducted at their workplaces. The analysis resulted in in four metaphors: the persevering psychiatric staff, the learning psychiatric staff, the participating psychiatric staff, and the motivating psychiatric staff. Patients on CTOs were more time-consuming for psychiatric staff in care and treatment. Long-term planning is required in which the creation of a therapeutic alliance entails the patient gradually gaining greater self-awareness and wanting to visit the outpatient clinic. The professional-patient relationship is essential and if a therapeutic alliance is not created, the patient's continued care and treatment in the community is vulnerable.

Convergence in Patient-Therapist Therapeutic Alliance Ratings and Its Relation to Outcome in Chronic Depression Treatment

PubMed Central

Laws, Holly B.; Constantino, Michael J.; Sayer, Aline G.; Klein, Daniel N.; Kocsis, James H.; Manber, Rachel; Markowitz, John C.; Rothbaum, Barbara O.; Steidtmann, Dana; Thase, Michael E.; Arnow, Bruce A.

2016-01-01

Objective This study tested whether discrepancy between patients' and therapists' ratings of the therapeutic alliance, as well as convergence in their alliance ratings over time, predicted outcome in chronic depression treatment. Method Data derived from a controlled trial of partial or non-responders to open-label pharmacotherapy subsequently randomized to 12 weeks of algorithm-driven pharmacotherapy alone or pharmacotherapy plus psychotherapy (Kocsis et al., 2009). The current study focused on the psychotherapy conditions (N = 357). Dyadic multilevel modeling was used to assess alliance discrepancy and alliance convergence over time as predictors of two depression measures: one pharmacotherapist-rated (Quick Inventory of Depressive Symptoms-Clinician; QIDS-C), the other blind interviewer-rated (Hamilton Rating Scale for Depression; HAMD). Results Patients' and therapists' alliance ratings became more similar, or convergent, over the course of psychotherapy. Higher alliance convergence was associated with greater reductions in QIDS-C depression across psychotherapy. Alliance convergence was not significantly associated with declines in HAMD depression; however, greater alliance convergence was related to lower HAMD scores at 3-month follow-up. Conclusions The results partially support the hypothesis that increasing patient-therapist consensus on alliance quality during psychotherapy may improve treatment and longer-term outcomes. PMID:26829714

Speech and language therapists' perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post-stroke.

PubMed

Lawton, Michelle; Sage, Karen; Haddock, Gillian; Conroy, Paul; Serrant, Laura

2018-05-01

Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change. To explore speech and language therapists' perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post-stroke. Twenty-two, in-depth, semi-structured interviews were conducted with speech and language therapists working with people with aphasia post-stroke. Qualitative data were analysed using inductive thematic analysis. Analysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists' responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patient's family, relational continuity and organizational drivers. The findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non-verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in

The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: a meta-analytic review.

PubMed

Diener, Marc J; Monroe, Joel M

2011-09-01

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p < .001 (95% confidence interval = .10-.23). Publication bias analyses did not indicate any cause for concern regarding the results. The data were not demonstrably heterogeneous (Q = 6.10, df = 16, p = .99), and all between-study moderator analyses were nonsignificant (p values > .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved). (c) 2011 APA, all rights reserved.

Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire.

PubMed

Berry, Katherine; Salter, Amy; Morris, Rohan; James, Susannah; Bucci, Sandra

2018-04-19

Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. This study presented the first attempt to (1) explore service users' views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word "therapist" with the word "app." In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and

Therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis.

PubMed

Berry, Katherine; Gregg, Lynsey; Lobban, Fiona; Barrowclough, Christine

2016-05-01

This paper examines the role of therapeutic alliance in predicting outcomes in a Randomized Controlled Trial of Motivational Interviewing and Cognitive Behavioral Therapy (MICBT) for problematic cannabis use in recent onset psychosis. All clients were participating in a three arm pragmatic rater-blind randomized controlled trial of brief MICBT plus standard care compared with longer term MICBT plus standard care and standard care alone. Participants completed measures to assess clinical symptoms, global functioning and substance misuse at baseline, 4.5months, 9months and 18months. Clients and therapists completed the Working Alliance Inventory approximately one month into therapy. Client alliance data was available for 35 participants randomized to therapy and therapist alliance data was available for 52 participants randomized to therapy. At baseline, poorer client-rated alliance was associated with more negative symptoms, poorer insight and greater cannabis use, whereas poorer therapist-rated alliance was only associated with amount of cannabis used per cannabis using day. Alliance ratings were also positively associated with amount of therapy: client-rated alliance was higher in the longer compared to the briefer therapy; therapist-rated alliance was associated with greater number of sessions attended (controlling for type of therapy) and therapy completion. In predicting outcome, client-rated alliance predicted total symptom scores and global functioning scores at follow-up. Neither client nor therapist alliance predicted changes in substance misuse at any time point. Findings demonstrate that individuals with psychosis and substance misuse who form better alliances with their therapists gain greater benefits from therapy, at least in terms of improvements in global functioning. Copyright © 2016 Elsevier Inc. All rights reserved.

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

PubMed Central

Sweeney, Angela; Fahmy, Sarah; Nolan, Fiona; Morant, Nicola; Fox, Zoe; Lloyd-Evans, Brynmor; Osborn, David; Burgess, Emma; Gilburt, Helen; McCabe, Rosemarie; Slade, Mike; Johnson, Sonia

2014-01-01

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute

The relationship between therapeutic alliance and service user satisfaction in mental health inpatient wards and crisis house alternatives: a cross-sectional study.

PubMed

Sweeney, Angela; Fahmy, Sarah; Nolan, Fiona; Morant, Nicola; Fox, Zoe; Lloyd-Evans, Brynmor; Osborn, David; Burgess, Emma; Gilburt, Helen; McCabe, Rosemarie; Slade, Mike; Johnson, Sonia

2014-01-01

Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from

A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

PubMed

Graves, Tiffany A; Tabri, Nassim; Thompson-Brenner, Heather; Franko, Debra L; Eddy, Kamryn T; Bourion-Bedes, Stephanie; Brown, Amy; Constantino, Michael J; Flückiger, Christoph; Forsberg, Sarah; Isserlin, Leanna; Couturier, Jennifer; Paulson Karlsson, Gunilla; Mander, Johannes; Teufel, Martin; Mitchell, James E; Crosby, Ross D; Prestano, Claudia; Satir, Dana A; Simpson, Susan; Sly, Richard; Lacey, J Hubert; Stiles-Shields, Colleen; Tasca, Giorgio A; Waller, Glenn; Zaitsoff, Shannon L; Rienecke, Renee; Le Grange, Daniel; Thomas, Jennifer J

2017-04-01

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments. © 2017 Wiley Periodicals, Inc.

Early Therapeutic Alliance and Treatment Outcome in Individual and Family Therapy for Adolescent Behavior Problems

ERIC Educational Resources Information Center

Hogue, Aaron; Dauber, Sarah; Stambaugh, Leyla Faw; Cecero, John J.; Liddle, Howard A.

2006-01-01

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive-behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and…

The Role of Therapeutic Alliance in Treatment for People with Mild to Moderate Alcohol Dependence

ERIC Educational Resources Information Center

Richardson, Deirdre F.; Adamson, Simon J.; Deering, Daryle E. A.

2012-01-01

In an exploratory study of Therapeutic Alliance (TA) in brief outpatient treatment for alcohol dependence the relationship was investigated between TA and treatment outcome (measured at 6 weeks and 6 months) for 69 alcohol dependent clients participating in a randomised control trial between Motivational Enhancement Therapy and Non Directive…

How the interpersonal and attachment styles of therapists impact upon the therapeutic alliance and therapeutic outcomes.

PubMed

Wongpakaran, Tinakon; Wongpakaran, Nahathai

2012-12-01

Explore how therapist's interpersonal and attachment styles have an impact upon both the therapeutic alliance formed and therapy outcomes. One hundred twenty one outpatients attending for routine psychiatric services were monitored for symptom outcomes, comprising depression, anxiety, and interpersonal problems. Patients were also asked about the level of therapeutic alliance that had been formed, covering goals, tasks, and the bond developed, using the working alliance inventory (WAI). At the same time, the participating therapists reported upon their interpersonal styles by categorizing them into domineering or submissive styles using the IIP-32 questionnaire and their attachment styles by categorizing them into secure or preoccupied styles using the ECR-R. To explore therapist factors such as interpersonal and attachment styles, as well as to establish the presence of gender matching, the working alliance was used as a dependent variable. Multivariate analysis revealed that neither the gender of the therapist nor the gender of the patient, or the therapists' styles, had an effect on the Working alliance or working outcomes. The multivariate test for WAI-goal (Wilks' Lambda F (3, 134) = 4.24, p = 0.007), interpersonal style (Wilks 'Lambda F (3, 134) = 2.77, p = 0.044), attachment style (Wilks' LambdaF (3, 134) = 2. 76, p = 0.045) and IIP-Style*Attachment Style (Wilks' Lambda F (3, 134) = 3.13, p = 0.028) produced statistically significant results, while working alliance-goal was the only predictor of the level of anxiety and depression in patients (p = 0.014 and p = 0.002, respectively). Submissive style was positively correlated to anxiety (p = 0.011) and interpersonal difficulties (p = 0.006), whilst surprisingly, a secure attachment style was found to have a positive correlation with anxiety and depression. However when both styles were combined, the resulting style negatively predicted anxiety (p = 0.002). Therapist factors were found to have no effect on

Culturally Adapted Skill Use as a Therapeutic Alliance Catalyst

ERIC Educational Resources Information Center

Lewicki, Todd

2015-01-01

Purpose: In this article, I explore how the therapeutic alliance, along with culturally competent and adapted skill use can be positively correlated with treatment outcome when using the ecological validity model as the frame. The ecological validity model refers to the degree to which there is consistency between the environment as experienced by…

A Measure of the Parent-Team Alliance in Youth Residential Psychiatry: The Revised Short Working Alliance Inventory

ERIC Educational Resources Information Center

Lamers, Audri; Delsing, Marc J. M. H.; van Widenfelt, Brigit M.; Vermeiren, Robert R. J. M.

2015-01-01

Background: The therapeutic alliance between multidisciplinary teams and parents within youth (semi) residential psychiatry is essential for the treatment process and forms a promising process variable for Routine Outcome Monitoring (ROM). No short evaluative instrument, however, is currently available to assess parent-team alliance. Objective: In…

Investigating Supervisory Relationships and Therapeutic Alliances Using Structural Equation Modeling

ERIC Educational Resources Information Center

DePue, Mary Kristina; Lambie, Glenn W.; Liu, Ren; Gonzalez, Jessica

2016-01-01

The authors used structural equation modeling to examine the contribution of supervisees' supervisory relationship levels to therapeutic alliance (TA) scores with their clients in practicum. Results showed that supervisory relationship scores positively contributed to the TA. Client and counselor ratings of the TA also differed.

The therapeutic alliance and family psychoeducation in the treatment of schizophrenia: an exploratory prospective change process study.

PubMed

Smerud, Phyllis E; Rosenfarb, Irwin S

2008-06-01

Although family psychoeducation has been shown to be highly efficacious in the treatment of schizophrenia, the mechanisms underlying the treatment's success are poorly understood. The therapeutic alliance in behavioral family management (BFM) was examined to determine whether the alliance plays a role in the efficacy of this treatment. One early BFM session (mean session = 6.5) involving 28 schizophrenia patients and their relatives who participated in the National Institute of Mental Health's Treatment Strategies in Schizophrenia study was coded using the System for Observing Family Therapy Alliances. Results indicated that when relatives developed a positive therapeutic alliance, patients were less likely to show prodromal signs of relapse and be rehospitalized over a 2-year follow-up period. When patients developed a positive alliance, relatives became less rejecting and were less likely to feel burdened over a 2-year period. The data suggest that the development of a positive therapeutic alliance within family psychoeducation may play an important role in preventing the escalation of psychotic symptoms and improving family relationships. (PsycINFO Database Record (c) 2008 APA, all rights reserved). (c) 2008 APA, all rights reserved

A Measure of the Parent-Team Alliance in Youth Residential Psychiatry: The Revised Short Working Alliance Inventory.

PubMed

Lamers, Audri; Delsing, Marc J M H; van Widenfelt, Brigit M; Vermeiren, Robert R J M

The therapeutic alliance between multidisciplinary teams and parents within youth (semi) residential psychiatry is essential for the treatment process and forms a promising process variable for Routine Outcome Monitoring (ROM). No short evaluative instrument, however, is currently available to assess parent-team alliance. In this study, the Working Alliance Inventory-Short Version (WAV-12), a widely used alliance questionnaire, was adjusted to assess parent-team alliance from both a parent and team perspective within a youth residential setting. Psychometric properties, including factor structure and validity of the subscales, were explored. A sample of youth with mainly complex developmental disorders admitted to 11 inpatient and day patient units of a child and adolescent psychiatric institute participated in this study. The case manager involved with the youth and the primary caregiver of 87 youth completed the revised WAV-12 (WAV-12R). The team version of the WAV-12R showed a good fit to the original conceptualized model, and distinguished Bond, Task and Goal scales. For the parents' version an adjusted model with Insight, Bond and combined Task/Goal scales had the best fit. The reliability and validity of the scales were shown to be good. This paper presents preliminary evidence that the parent and treatment team versions of the WAV-12R are psychometrically sound for assessing parent-team alliance within youth (semi) residential psychiatry in the Netherlands. The team and parents' versions of the WAV-12R are recommended instruments to complement outcome measures in ROM.

Therapeutic Alliance and Retention in Brief Strategic Family Therapy: A Mixed-Methods Study.

PubMed

Sheehan, Alyson H; Friedlander, Myrna L

2015-10-01

We explored how the therapeutic alliance contributed to retention in Brief Strategic Family Therapy by analyzing videotapes of eight-first sessions in which four therapists worked with one family that stayed in treatment and one family that dropped out. Although behavioral exchange patterns between clients and therapists did not differ by retention status, positive therapist alliance-related behavior followed negative client alliance behavior somewhat more frequently in the retained cases. In the qualitative aspect of the study, four family therapy experts each viewed two randomly assigned sessions and commented on their quality without knowing the families' retention status. A qualitative analysis of the audiotaped commentaries revealed 18 alliance-related themes that were more characteristic of either the retained or the nonretained cases. © 2015 American Association for Marriage and Family Therapy.

Heart rate variability and the anxious client: cardiac autonomic and behavioral associations with therapeutic alliance.

PubMed

Stratford, Trisha; Meara, Alan; Psychotherapy, M Gestalt; Lal, Sara

2014-08-01

This exploratory study was designed to investigate the link between a client's heart rate variability (HRV) and the forming of a therapeutic alliance (TA) during psychotherapy. Change in HRV is associated with many psychological and physiological situations, including cardiac mortality. Cardiac effects were evaluated during therapy in 30 symptomatically anxious clients using HRV during six weekly 1-hour therapy sessions (S1-S6). Therapeutic index (TI), a measure of TA, was evaluated using skin conductance resonance between client and therapist. The Working Alliance Inventory provides a subjective measure of TA. State and trait anxiety and mood states were also assessed. Most HRV parameters were highest during S4. The sympathovagal balance was highest in S1 but stabilized after S2. In S4, TI was linked to high HRV parameters. Overall higher anxiety levels seem to be associated to lower HRV parameters. Conversely, in S4, high HRV parameters were linked to higher mood scores. This study found that a subjective measure of TA contradicted the physiological outcome. Results suggest that physiological data collected during therapy are a more accurate barometer of TA forming. These research findings suggest a need for further research identifying physiological markers in clients with a variety of mental health disorders over long-term therapy.

Association between therapeutic alliance, care satisfaction, and pharmacological adherence in bipolar disorder.

PubMed

Sylvia, Louisa G; Hay, Aleena; Ostacher, Michael J; Miklowitz, David J; Nierenberg, Andrew A; Thase, Michael E; Sachs, Gary S; Deckersbach, Thilo; Perlis, Roy H

2013-06-01

We sought to understand the association of specific aspects of care satisfaction, such as patients' perceived relationship with their psychiatrist and access to their psychiatrist and staff, and therapeutic alliance with participants' likelihood to adhere to their medication regimens among patients with bipolar disorder. We examined data from the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder, an effectiveness study investigating the course and treatment of bipolar disorder. We expected that participants (n = 3037) with positive perceptions of their relationship with their psychiatrist and quality of psychopharmacologic care, as assessed by the Helping Alliance Questionnaire and Care Satisfaction Questionnaire, would be associated with better medication adherence. We utilized logistic regression models controlling for already established factors associated with poor adherence. Patients' perceptions of collaboration, empathy, and accessibility were significantly associated with adherence to treatment in individuals with bipolar disorder completing at least 1 assessment. Patients' perceptions of their psychiatrists' experience, as well as of their degree of discussing medication risks and benefits, were not associated with medication adherence. Patients' perceived therapeutic alliance and treatment environment impact their adherence to pharmacotherapy recommendations. This study may enable psychopharmacologists' practices to be structured to maximize features associated with greater medication adherence.

Cumulative Childhood Trauma and Therapeutic Alliance: The Moderator Role of Attachment in Adult Patients Consulting in Sex Therapy.

PubMed

Lafrenaye-Dugas, Anne-Julie; Godbout, Natacha; Hébert, Martine

2018-03-05

While it is documented that clients consulting in sex therapy tend to report high rates of childhood interpersonal traumas (e.g., physical, psychological and sexual abuse), which are associated to insecure attachment and poorer therapeutic alliance, the interrelations of these variables have not yet been evaluated in this specific population. This study examined the associations between attachment, cumulative trauma and therapeutic alliance in 278 sex therapy patients who filled out self-report questionnaires. Results revealed that avoidant attachment acted as a moderator between cumulative trauma and the agreement on tasks dimension of therapeutic alliance. Results suggests the relevance for sex therapists to investigate past traumas and current attachment representations to guide interventions and optimize treatment benefits.

Synchrony in Psychotherapy: A Review and an Integrative Framework for the Therapeutic Alliance.

PubMed

Koole, Sander L; Tschacher, Wolfgang

2016-01-01

During psychotherapy, patient and therapist tend to spontaneously synchronize their vocal pitch, bodily movements, and even their physiological processes. In the present article, we consider how this pervasive phenomenon may shed new light on the therapeutic relationship- or alliance- and its role within psychotherapy. We first review clinical research on the alliance and the multidisciplinary area of interpersonal synchrony. We then integrate both literatures in the Interpersonal Synchrony (In-Sync) model of psychotherapy. According to the model, the alliance is grounded in the coupling of patient and therapist's brains. Because brains do not interact directly, movement synchrony may help to establish inter-brain coupling. Inter-brain coupling may provide patient and therapist with access to another's internal states, which facilitates common understanding and emotional sharing. Over time, these interpersonal exchanges may improve patients' emotion-regulatory capacities and related therapeutic outcomes. We discuss the empirical assessment of interpersonal synchrony and review preliminary research on synchrony in psychotherapy. Finally, we summarize our main conclusions and consider the broader implications of viewing psychotherapy as the product of two interacting brains.

The Association Between Patient Characteristics and the Therapeutic Alliance in Cognitive-Behavioral and Interpersonal Therapy for Bulimia Nervosa

ERIC Educational Resources Information Center

Constantino, Michael J.; Arnow, Bruce A.; Blasey, Christine; Agras, W. Stewart

2005-01-01

The therapeutic alliance is an established predictor of psychotherapy outcome. However, alliance research in the treatment of eating disorders has been scant, with even less attention paid to correlates of alliance development. The goal of this study was to examine the relation between specific patient characteristics and the development of the…

Medication adherence in schizophrenia: The role of insight, therapeutic alliance and perceived trauma associated with psychiatric care.

PubMed

Tessier, Arnaud; Boyer, Laurent; Husky, Mathilde; Baylé, Franck; Llorca, Pierre-Michel; Misdrahi, David

2017-11-01

Medication non adherence in schizophrenia is a major cause of relapse and hospitalization and remains for clinicians an important challenge. This study investigates the associations between insight, therapeutic alliance, perceived trauma related to psychiatric treatment and medication adherence in patients with schizophrenia. In this multicenter study, 72 patients were assessed regarding symptomatology, self-reported adherence with medication, insight, medication side-effects, therapeutic alliance and perceived trauma related to psychiatric treatment. Structural Equation Modeling (SEM) was used to test predicted paths among these variables. The data fit a model in which medication adherence was directly predicted by insight, therapeutic alliance and perceived trauma related to psychiatric treatment. Perceived trauma moderates the role of insight on medication adherence. The final model showed good fit, based on four reliable indices. Greater adherence was correlated with higher insight, higher therapeutic alliance and lower perceived trauma. These three variables appear to be important determinants of patient's medication adherence. Medication adherence could be enhanced by reducing perceived trauma and by increasing insight. The need for mental health providers to acknowledge patients' potentially traumatic experience with psychiatric treatment and the need to encourage greater involvement in care are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Moderating Effects of Alexithymia on Associations between the Therapeutic Alliance and the Outcome of Brief Psychodynamic-Interpersonal Psychotherapy for Multisomatoform Disorder.

PubMed

Probst, Thomas; Sattel, Heribert; Gündel, Harald; Henningsen, Peter; Kruse, Johannes; Schneider, Gudrun; Lahmann, Claas

2017-01-01

This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT) for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y), self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS) of the SF-36 Health Survey. The potential moderator (M) alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20) at pre-treatment and the predictor (X) the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ) at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients' alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists' alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome ( p  < 0.05): a stronger alliance in the therapists' perspective was beneficial for the outcome only for patients scoring above 61 on the TAS-20. This moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9) as a covariate to the moderation model. The results underline the importance of a good therapists' view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.

Therapeutic Alliance in Family Therapy for Adolescents with Epilepsy: An Exploratory Study.

ERIC Educational Resources Information Center

Glueckauf, Robert L.; Liss, Heidi J.; McQuillen, Diane E.; Webb, Pat M.; Dairaghi, Jeanne; Carter, Carol B.

2002-01-01

Adolescents (N=19) with epilepsy and their families assigned to either issue-specific single-family counseling (IFCM) or to a multi-family psychoeducational group (PG) were studied for problem improvement through therapeutic alliance. While no overall differences were found between IFCM and PG, IFCM adolescents reported significantly stronger…

The Therapeutic Alliance and Family Psychoeducation in the Treatment of Schizophrenia: An Exploratory Prospective Change Process Study

ERIC Educational Resources Information Center

Smerud, Phyllis E.; Rosenfarb, Irwin S.

2008-01-01

Although family psychoeducation has been shown to be highly efficacious in the treatment of schizophrenia, the mechanisms underlying the treatment's success are poorly understood. The therapeutic alliance in behavioral family management (BFM) was examined to determine whether the alliance plays a role in the efficacy of this treatment. One early…

Relapses in recurrent depression 1 year after maintenance cognitive-behavioral therapy: the role of therapist adherence, competence, and the therapeutic alliance.

PubMed

Weck, Florian; Rudari, Visar; Hilling, Christine; Hautzinger, Martin; Heidenreich, Thomas; Schermelleh-Engel, Karin; Stangier, Ulrich

2013-11-30

The prevention of relapse in recurrent depression is considered a central aim in cognitive-behavioral therapy, given the high risk of relapse. In this study, patients with recurrent major depressive disorder (currently remitted) received 16 sessions of Maintenance Cognitive-Behavioral Therapy (M-CBT) over a period of 8 months, in order to prevent relapse. Therapist adherence and competence, as well as the therapeutic alliance, were investigated as predictors for reducing the risk of recurrence in depression. Videotapes of 80 participants were analyzed in order to evaluate therapist adherence and competence. Additionally, the therapeutic alliance was assessed by questionnaire. No associations were found between therapist adherence or competence, and the risk of relapse 1 year after treatment. By contrast, the therapeutic alliance was a significant predictor of the time to relapse. Moreover, we found that the number of previous depressive episodes (≥ 5 vs. ≤ 4) was a significant moderator variable. This indicates that the alliance-outcome relationship was particularly important when patients with five or more previous depressive episodes were taken into account, in comparison to patients with four or fewer episodes. For the psychotherapeutic treatment of recurrent depression and the prevention of relapse, sufficient attention should be paid to the therapeutic alliance. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Recovery Journeys of Counselors and Clients: A Case Study of the Therapeutic Alliance in a Drug Treatment and Rehabilitation Center in Malaysia

ERIC Educational Resources Information Center

Amat, Mohamad Isa

2013-01-01

The therapeutic alliance is a significant research area in counseling. The understanding of the therapeutic alliance, particularly in drug treatment settings helps counselors and clients to increase the treatment outcomes and its treatment process. The present study investigated the journeys of recovering counselors and clients in a private…

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

PubMed Central

Thompson, Sanna J.; Bender, Kimberly; Lantry, Janet; Flynn, Patrick M.

2010-01-01

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members. PMID:20556209

Psychodynamic group psychotherapy: impact of group length and therapist professional characteristics on development of therapeutic alliance.

PubMed

Lorentzen, Steinar; Bakali, Jan Vegard; Hersoug, Anne Grete; Hagtvet, Knut A; Ruud, Torleif; Høglend, Per

2012-09-01

Little research has been done on therapeutic alliance in group psychotherapy, especially the impact of treatment duration and therapist professional characteristics. Therapeutic alliance was rated by patients on the Working Alliance Inventory-Short Form at three time points (sessions 3, 10 and 17) in a randomized controlled trial of short-term and long-term psychodynamic group psychotherapy. As predictors we selected therapist clinical experience and length of didactic training, which have demonstrated ambiguous results in previous research. Linear latent variable growth curve models (structural equation modeling) were developed for the three Working Alliance Inventory-Short Form subscales bond, task and goal. We found a significant variance in individual growth curves (intercepts and slopes) but no differential development due to group length. Longer therapist formal training had a negative impact on early values of subscale task in both treatments. There was an interaction between length of the therapists' clinical experience and group length on early bond, task and goal: therapists with longer clinical experience were rated lower on initial bond in the long-term group but less so in the short-term group. Longer clinical experience influenced initial task and goal positively in the short-term group but was unimportant for task or significantly negative for goal in the long-term group. There was no mean development of alliance, and group length did not differentially impact the alliance during 6 months. Early ratings of the three Working Alliance Inventory-Short Form subscales partly reflected different preparations of patients in the two group formats, partly therapist characteristics, but more research is needed to see how these aspects impact alliance development and outcome. Therapists should pay attention to all three aspects of the alliance, when they prepare patients for group therapy. In psychodynamic groups, length of therapy does not differentiate the

The impact of computer use on therapeutic alliance and continuance in care during the mental health intake.

PubMed

Rosen, Daniel C; Nakash, Ora; Alegría, Margarita

2016-03-01

Advances in information technology within clinical practice have rapidly expanded over recent years. Despite the documented benefits of using electronic health records, which often necessitate computer use during the clinical encounter, little is known about the impact of computer use during the mental health visit and its effect on the quality of the therapeutic alliance. We investigated the association between computer use and quality of the working alliance and continuance in care in 104 naturalistic mental health intake sessions. Data were collected from 8 safety-net outpatient clinics in the Northeast offering mental health services to a diverse client population. All intakes were video recorded. Use of computer during the intake session was ascertained directly from the recording of the session (n = 22; 22.15% of intakes). Working alliance was assessed from the session videotapes by independent reliable coders, using the Working Alliance Inventory, Observer Form-bond scale. Therapist computer use was significantly associated with the quality of the observer-rated therapeutic alliance (Coefficient = -6.29, SE = 2.2, p < .01; Cohen's effect size of d = -0.76), and client's continuance in care (Odds ratio = .11, CI = 0.03-0.38; p < .001). The quality of the observer-rated working alliance and client's continuance in care were significantly lower in intakes in which the therapist used a computer during the session. Findings indicate a cautionary call in advancing computer use within the mental health intake, and demonstrate the need for future research to identify the specific behaviors that promote or hinder a strong working alliance within the context of psychotherapy in the technological era. (c) 2016 APA, all rights reserved).

Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients.

PubMed

Villalobos, Bianca T; Bridges, Ana J; Anastasia, Elizabeth A; Ojeda, Carlos A; Rodriguez, Juventino Hernandez; Gomez, Debbie

2016-02-01

The discrepancy between the growing number of Spanish speakers in the U.S. and the availability of bilingual providers creates a barrier to accessing quality mental health care. Use of interpreters provides one strategy for overcoming this linguistic barrier; however, concerns about whether sessions with interpreters, versus bilingual providers, impede therapeutic alliance remain. The current study explored associations between the use of interpreters and therapeutic alliance in a sample of 458 Spanish-speaking patients seen for integrated behavioral health visits at primary care clinics. Patients completed a brief (4 item) therapeutic alliance scale at their behavioral health appointment. In addition, to supplement the quantitative study data, a pilot study of 30 qualitative interviews was conducted with a new sample of 10 Spanish-speaking patients, 10 behavioral health consultants (BHCs), and 10 trained interpreters. Quantitative results showed that interpreter use did not relate to therapeutic alliance, even when controlling for relevant demographic variables. However, qualitative interviews suggested major themes regarding the relative benefits and challenges of using interpreters for patients, interpreters, and BHCs. In interviews, patients expressed a strong preference for bilingual providers. Benefits included greater privacy, sense of trust, and accuracy of communication. However, in their absence, interpreters were seen as increasing access to services and facilitating communication with providers, thereby addressing the behavioral health needs of patients with limited English proficiency. BHCs and interpreters emphasized the importance of interpreter training and a good collaborative relationship with interpreters to minimize negative effects on the quality of care. (c) 2016 APA, all rights reserved).

Synchrony in Psychotherapy: A Review and an Integrative Framework for the Therapeutic Alliance

PubMed Central

Koole, Sander L.; Tschacher, Wolfgang

2016-01-01

During psychotherapy, patient and therapist tend to spontaneously synchronize their vocal pitch, bodily movements, and even their physiological processes. In the present article, we consider how this pervasive phenomenon may shed new light on the therapeutic relationship– or alliance– and its role within psychotherapy. We first review clinical research on the alliance and the multidisciplinary area of interpersonal synchrony. We then integrate both literatures in the Interpersonal Synchrony (In-Sync) model of psychotherapy. According to the model, the alliance is grounded in the coupling of patient and therapist’s brains. Because brains do not interact directly, movement synchrony may help to establish inter-brain coupling. Inter-brain coupling may provide patient and therapist with access to another’s internal states, which facilitates common understanding and emotional sharing. Over time, these interpersonal exchanges may improve patients’ emotion-regulatory capacities and related therapeutic outcomes. We discuss the empirical assessment of interpersonal synchrony and review preliminary research on synchrony in psychotherapy. Finally, we summarize our main conclusions and consider the broader implications of viewing psychotherapy as the product of two interacting brains. PMID:27378968

In-Session Exposure Tasks and Therapeutic Alliance across the Treatment of Childhood Anxiety Disorders

ERIC Educational Resources Information Center

Kendall, Philip C.; Comer, Jonathan S.; Marker, Craig D.; Creed, Torrey A.; Puliafico, Anthony C.; Hughes, Alicia A.; Martin, Erin D.; Suveg, Cynthia; Hudson, Jennifer

2009-01-01

The study examined the shape of therapeutic alliance using latent growth curve modeling and data from multiple informants (therapist, child, mother, father). Children (n = 86) with anxiety disorders were randomized to family-based cognitive-behavioral treatment (FCBT; N = 47) with exposure tasks or to family education, support, and attention…

Relationships among alexithymia, therapeutic alliance, and psychotherapy outcome in major depressive disorder.

PubMed

Quilty, Lena C; Taylor, Graeme J; McBride, Carolina; Bagby, R Michael

2017-08-01

Previous studies have found that alexithymia predicts process and outcome of psychodynamic psychotherapy across a range of psychiatric disorders. There is preliminary evidence that alexithymia may exert its effects on outcome through the therapist. Other studies have found that alexithymia does not influence outcome of cognitive-behavioral therapy (CBT). The aim of the current study was to investigate the capacity of alexithymia to predict therapist- and patient-rated therapeutic alliance and response to CBT and interpersonal psychotherapy (IPT) for major depressive disorder. A total of 75 adults with major depressive disorder were randomized to receive weekly sessions of manualized individual CBT or IPT for a period of 16 weeks. Pre-treatment alexithymia exhibited a positive direct effect on depression change, and a negative indirect effect on depression change via patient-rated alliance at week 13. There was no mediating role of therapist-rated alliance. Although these findings are preliminary, they suggest that pre-treatment alexithymia has meaningful links to psychotherapy process and outcome, and that nuanced analyses incorporating intervening variables are necessary to elucidate the nature of these links. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

The therapeutic alliance and therapist adherence as predictors of dropout from cognitive therapy for depression when combined with antidepressant medication.

PubMed

Cooper, Andrew A; Strunk, Daniel R; Ryan, Elizabeth T; DeRubeis, Robert J; Hollon, Steven D; Gallop, Robert

2016-03-01

Previous psychotherapy research has examined the therapeutic alliance and therapist adherence as correlates or predictors of symptom change. While some initial evidence suggests the alliance is associated with risk of dropout in cognitive behavioral treatment for depression, evidence of such relations has been limited to date. We examined the relation of these psychotherapy process variables and dropout in the context of cognitive therapy for depression when provided in combination with pharmacotherapy. Patients were randomized to the CT plus pharmacotherapy condition of a clinical trial for chronic or recurrent depression. Consistent with the spirit of personalized medicine, patients were treated until they met remission and recovery criteria (or reached the maximum allowable time in the study). In a sample of 176 patients, we examined observer-rated alliance and therapist adherence in the first three CT sessions as potential predictors of treatment dropout. The therapeutic alliance and one facet of therapist adherence (i.e., Behavioral Methods/Homework) predicted reduced odds of dropout. Therapist use of Negotiating/Structuring predicted greater likelihood of dropout, but only when other variables were included in the model. Process ratings were not available for concurrent pharmacotherapy sessions. A minority of patients did not have session recordings available. Results are consistent with the possibility that the therapeutic alliance and therapists' focus on homework and behavioral methods promote treatment retention in combined treatment for depression. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Therapeutic Alliance and Therapist Adherence as Predictors of Dropout from Cognitive Therapy for Depression when Combined with Antidepressant Medication

PubMed Central

Cooper, Andrew A.; Strunk, Daniel R.; Ryan, Elizabeth T.; DeRubeis, Robert J.; Hollon, Steven D.; Gallop, Robert

2015-01-01

BACKGROUND Previous psychotherapy research has examined the therapeutic alliance and therapist adherence as correlates or predictors of symptom change. While some initial evidence suggests the alliance is associated with risk of dropout in cognitive behavioral treatment for depression, evidence of such relations has been limited to date. We examined the relation of these psychotherapy process variables and dropout in the context of cognitive therapy for depression when provided in combination with pharmacotherapy. METHODS Patients were randomized to the CT plus pharmacotherapy condition of a clinical trial for chronic or recurrent depression. Consistent with the spirit of personalized medicine, patients were treated until they met remission and recovery criteria (or reached the maximum allowable time in the study). In a sample of 176 patients, we examined observer-rated alliance and therapist adherence in the first three CT sessions as potential predictors of treatment dropout. RESULTS The therapeutic alliance and one facet of therapist adherence (i.e., Behavioral Methods/Homework) predicted reduced odds of dropout. Therapist use of Negotiating/Structuring predicted greater likelihood of dropout, but only when other variables were included in the model. LIMITATIONS Process ratings were not available for concurrent pharmacotherapy sessions. A minority of patients did not have session recordings available. CONCLUSIONS Results are consistent with the possibility that the therapeutic alliance and therapists’ focus on homework and behavioral methods promote treatment retention in combined treatment for depression. PMID:26164110

Alliance and Outcome in Cognitive-Behavioral Therapy for Adolescent Depression

ERIC Educational Resources Information Center

Shirk, Stephen R.; Gudmundsen, Gretchen; Kaplinski, Heather Crisp; McMakin, Dana L.

2008-01-01

This study examined predictive relations between therapeutic alliance and treatment outcomes in manual-guided, cognitive-behavioral therapy for adolescent depression. Fifty-four adolescents met criteria for a depressive disorder and were treated in school-based clinics. Alliance was measured after the third session from both therapist and…

The Integrative Psychotherapy Alliance: Family, Couple and Individual Therapy Scales.

ERIC Educational Resources Information Center

Pinsof, William M.; Catherall, Donald R.

1986-01-01

Presents an integrative definition of the therapeutic alliance that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this concept for therapy reserach are examined. Three new systematically oriented scales to measure the alliance are presented along with some preliminary data…

Social climate along the pathway of care in women's secure mental health service: variation with level of security, patient motivation, therapeutic alliance and level of disturbance.

PubMed

Long, C G; Anagnostakis, K; Fox, E; Silaule, P; Somers, J; West, R; Webster, A

2011-07-01

Social climate has been measured in a variety of therapeutic settings, but there is little information about it in secure mental health services, or how it may vary along a gender specific care pathway. To assess social climate in women's secure wards and its variation by level of security and ward type, therapeutic alliance, patient motivation, treatment engagement and disturbed behaviour. Three-quarters (80, 76%) of staff and nearly all (65, 92%) of patients in the two medium-security wards and two low-security wards that comprised the unit completed the Essen Climate Evaluation Schema (EssenCES) and the California Psychotherapy Alliance Scale (CALPAS); patients also completed the Patient Motivation Inventory (PMI). Pre-assessment levels of disturbed behaviour and treatment engagement were recorded. Social climate varied according to ward type and level of security. EssenCES ratings indicative of positive social climate were associated with lower levels of security; such ratings were also associated with lower behavioural disturbance and with higher levels of motivation, treatment engagement and therapeutic alliance. This serial cross-sectional survey indicated that use of the EssenCES alone might be a good practical measure of treatment progress/responsivity. A longitudinal study would be an important next step in establishing the extent to which it would be useful in this regard. Copyright © 2010 John Wiley & Sons, Ltd.

Effects of Transference Work in the Context of Therapeutic Alliance and Quality of Object Relations

ERIC Educational Resources Information Center

Hoglend, Per; Hersoug, Anne Grete; Bogwald, Kjell-Petter; Amlo, Svein; Marble, Alice; Sorbye, Oystein; Rossberg, Jan Ivar; Ulberg, Randi; Gabbard, Glen O.; Crits-Christoph, Paul

2011-01-01

Objective: Transference interpretation is considered as a core active ingredient in dynamic psychotherapy. In common clinical theory, it is maintained that more mature relationships, as well as a strong therapeutic alliance, may be prerequisites for successful transference work. In this study, the interaction between quality of object relations,…

Validity of the Working Alliance Inventory within Child Protection Services

ERIC Educational Resources Information Center

Killian, Michael; Forrester, Donald; Westlake, David; Antonopoulou, Paraskevi

2017-01-01

The Working Alliance Inventory remains a widely studied measure of quality of therapeutic relationships between the practitioner and client. No prior study has examined the psychometrics and validity of the Working Alliance Inventory-Short (WAI-S) in a sample of families, social workers, and trained observers within child protection services.…

The Impact of Interpersonal Style on Ruptures and Repairs in the Therapeutic Alliance Between Offenders and Therapists in Sex Offender Treatment.

PubMed

Watson, Rachael; Thomas, Stuart; Daffern, Michael

2017-10-01

The therapeutic relationship is a critical component of psychological treatment. Strain can occur in the relationship, particularly when working with offenders, and more specifically, those offenders with interpersonal difficulties; strain can lead to a rupture, which may affect treatment participation and performance. This study examined ruptures in the therapeutic relationship in sexual offenders participating in offense-focused group treatment. Fifty-four sex offenders rated the therapeutic alliance at the commencement and completion of treatment; at the completion of treatment, they also reported on the occurrence of ruptures and whether they believed these ruptures were repaired. Ruptures were separated by type, according to severity-Each relationship was therefore characterized as experiencing no rupture, a minor rupture, or a major rupture. Offender characteristics including interpersonal style (IPS) and psychopathy were assessed at the commencement of treatment; their relationship with ruptures was examined. Results revealed that more than half of the offenders (approximately 55%) experienced a rupture in the therapeutic alliance, with one in four of these ruptures remaining unresolved. Offenders who did not report a rupture rated the therapeutic alliance significantly higher at the end of treatment compared with those offenders who reported a rupture that was not repaired. Offenders who reported a major rupture in the therapeutic relationship were higher in interpersonal hostility and hostile-dominance. No interpersonal or offense-specific factors affected the likelihood of a rupture repair.

The Therapeutic Alliance in Schema-Focused Therapy and Transference-Focused Psychotherapy for Borderline Personality Disorder

ERIC Educational Resources Information Center

Spinhoven, Philip; Giesen-Bloo, Josephine; van Dyck, Richard; Kooiman, Kees; Arntz, Arnoud

2007-01-01

This study investigated the quality and development of the therapeutic alliance as a mediator of change in schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder. Seventy-eight patients were randomly allocated to 3 years of biweekly SFT or TFP. Scores of both therapists and patients for the…

The Working Alliance in Online Therapy with Young People: Preliminary Findings

ERIC Educational Resources Information Center

Hanley, Terry

2009-01-01

This paper examines the quality of the working alliance in online counseling relationships with young people. A mixed method approach has been adopted which combines the completion of a self-report quantitative measure (the "Therapeutic Alliance Quality Scale") and qualitative interviews with service users of a UK-based service…

Therapeutic Alliance and Treatment Adherence in Two Interventions for Bulimia Nervosa: A Study of Process and Outcome

ERIC Educational Resources Information Center

Loeb, Katharine L.; Wilson, G. Terence; Labouvie, Erich; Pratt, Elizabeth M.; Hayaki, Jumi; Walsh, B. Timothy; Agras, W. Stewart; Fairburn, Christopher G.

2005-01-01

The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome…

How Central Is the Alliance in Psychotherapy? A Multilevel Longitudinal Meta-Analysis

ERIC Educational Resources Information Center

Fluckiger, Christoph; Del Re, A. C.; Wampold, Bruce E.; Symonds, Dianne; Horvath, Adam O.

2012-01-01

Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial…

Working alliance inventory applied to virtual and augmented reality (WAI-VAR): psychometrics and therapeutic outcomes

PubMed Central

Miragall, Marta; Baños, Rosa M.; Cebolla, Ausiàs; Botella, Cristina

2015-01-01

This study examines the psychometric properties of the Working Alliance Inventory-Short (WAI-S) adaptation to Virtual Reality (VR) and Augmented Reality (AR) therapies (WAI-VAR). The relationship between the therapeutic alliance (TA) with VR and AR and clinically significant change (CSC) is also explored. Seventy-five patients took part in this study (74.7% women, Mage = 34.41). Fear of flying and adjustment disorder patients received VR therapy, and cockroach phobia patients received AR therapy. Psychometric properties, CSC, one-way ANOVA, Spearman’s Correlations and Multiple Regression were calculated. The WAI-VAR showed a unidimensional structure, high internal consistency and adequate convergent validity. “Not changed” patients scored lower on the WAI-VAR than “improved” and “recovered” patients. Correlation between the WAI-VAR and CSC was moderate. The best fitting model for predicting CSC was a linear combination of the TA with therapist (WAI-S) and the TA with VR and AR (WAI-VAR), due to the latter variable slightly increased the percentage of variability accounted for in CSC. The WAI-VAR is the first validated instrument to measure the TA with VR and AR in research and clinical practice. This study reveals the importance of the quality of the TA with technologies in achieving positive outcomes in the therapy. PMID:26500589

Working alliance inventory applied to virtual and augmented reality (WAI-VAR): psychometrics and therapeutic outcomes.

PubMed

Miragall, Marta; Baños, Rosa M; Cebolla, Ausiàs; Botella, Cristina

2015-01-01

This study examines the psychometric properties of the Working Alliance Inventory-Short (WAI-S) adaptation to Virtual Reality (VR) and Augmented Reality (AR) therapies (WAI-VAR). The relationship between the therapeutic alliance (TA) with VR and AR and clinically significant change (CSC) is also explored. Seventy-five patients took part in this study (74.7% women, M age = 34.41). Fear of flying and adjustment disorder patients received VR therapy, and cockroach phobia patients received AR therapy. Psychometric properties, CSC, one-way ANOVA, Spearman's Correlations and Multiple Regression were calculated. The WAI-VAR showed a unidimensional structure, high internal consistency and adequate convergent validity. "Not changed" patients scored lower on the WAI-VAR than "improved" and "recovered" patients. Correlation between the WAI-VAR and CSC was moderate. The best fitting model for predicting CSC was a linear combination of the TA with therapist (WAI-S) and the TA with VR and AR (WAI-VAR), due to the latter variable slightly increased the percentage of variability accounted for in CSC. The WAI-VAR is the first validated instrument to measure the TA with VR and AR in research and clinical practice. This study reveals the importance of the quality of the TA with technologies in achieving positive outcomes in the therapy.

The parent-child-therapist alliance: A case study using a strategic approach.

PubMed

Naidu, Thirusha; Behari, Sheethal

2010-06-01

In this paper we present a single case study of a clinical approach that addresses the needs of parents and their children in psychotherapy. The approach begins by addressing the child's and parent's concerns separately at first by establishing strong therapeutic alliances with each, and then proceeds to address the concerns of the parent-child dyad. The basic premise is that the therapeutic alliance is the central element to successful outcomes in psychotherapy. The nature of alliance-building and its associated methods and techniques have been extensively considered for adult therapy. However, there is considerably less written on the therapeutic alliance with children and adolescents in the context of family interventions. We briefly examine some theoretical dimensions and applications of the therapeutic alliance in psychotherapy with children/adolescents and their parents. A three-phase alliance-building psychotherapy strategy, founded on the idea that each therapeutic relationship warrants an effective working alliance, is proposed. The case of a single mother and her adolescent daughter is employed to illustrate the strategy.

Good versus poor therapeutic alliances with non-accepting parents of same-sex oriented adolescents and young adults: a qualitative study.

PubMed

Shpigel, Maya S; Diamond, Gary M

2014-01-01

Therapeutic themes and processes associated with five good versus five poor parent-therapist alliances among a sample of non-accepting parents of sexual minority youth/young adults participating in family therapy were examined. The Consensual Qualitative Research approach was used to analyse of therapy notes and follow-up interviewsfrom good and poor alliances. In good alliances, parents adopted relationship building as a goal, considered essentialist causal attributions of same-sex orientation, acknowledged positive aspects of their child, and perceived the therapist as empathic and accepting. Parents with poor alliances rejected relationship building as a goal, rebuffed essentialist causal attributions, dismissed the possibility of their own coming out, nullified positive aspects of their child, sought to change their child's sexual orientation, blamed therapists for validating their child's same-sex orientation, and pressured therapists for information about their child. Clinical implications are discussed.

Measurement properties of the Brazilian version of the Working Alliance Inventory (patient and therapist short-forms) and Session Rating Scale for low back pain.

PubMed

Araujo, Amanda Costa; Filho, Rúben Negrão; Oliveira, Crystian B; Ferreira, Paulo H; Pinto, Rafael Z

2017-01-01

In the low back pain (LBP) field, therapeutic alliance is considered a non-specific factor of interventions associated with improvements in clinical outcomes. However, there is a paucity of studies aimed to evaluate measurement properties of tools used to objectively quantify the alliance between therapist and patients, such as the Working Alliance Inventory (WAI) and Session Rating Scale (SRS). To translate and cross-culturally adapt the short-form version of WAI - therapist and SRS into Brazilian Portuguese; to investigate the measurement properties, of the WAI-Patient, WAI-Therapist and SRS in patients with LBP and their physical therapists, respectively. One hundred patients with LBP and 18 physical therapists were recruited from physical therapy clinics in Brazil. Therapeutic alliance measures were collected at the initial assessment, prior to the second session, and at 2-month follow-up. The measurement properties investigated were reproducibility, internal consistency, ceiling/floor effects and responsiveness. Although WAI-Patient, WAI-Therapist and SRS were considered to have acceptable test-retest reliability (ICC2,1 > 0.70), these questionnaires showed problems with other measurement properties. WAI-Patient showed problems with internal consistency (i.e. Cronbach's alpha < 0.70 for all subscales). Presence of ceiling effect (i.e. > 15% of participants with the maximum score) and poor internal responsiveness were found for the WAI-Patient (Effect size = 0.15; 84% CI: 0.04 to 0.29) and for the SRS (Effect size = 0.05; 84% CI: -0.22 to 0.11). The WAI-Therapist revealed slightly better measurement properties. We identified psychometric limitations with most measurement properties of the WAI questionnaires and SRS. Future studies are needed to refine these tools.

Effectiveness of the addition of therapeutic alliance with minimal intervention in the treatment of patients with chronic, nonspecific low back pain and low risk of involvement of psychosocial factors: a study protocol for a randomized controlled trial (TalkBack trial).

PubMed

Fagundes, Felipe Ribeiro Cabral; de Melo do Espírito Santo, Caique; de Luna Teixeira, Francine Mendonça; Tonini, Thaís Vanelli; Cabral, Cristina Maria Nunes

2017-01-31

The stratified model of care has been an effective approach for the treatment of low back pain. However, the treatment of patients with low risk of psychosocial-factor involvement is unclear. The addition of the therapeutic alliance to a minimal intervention may be an option for the treatment of low back pain. This paper reports on the rationale, design and protocol for a randomized controlled trial with blind assessor to assess the effectiveness of the addition of therapeutic alliance with minimal intervention on pain and disability in patients with chronic, nonspecific low back pain. Two hundred and twenty-two patients with chronic, nonspecific low back pain and low risk of involvement of psychosocial factors will be assessed and randomly allocated into three groups (n = 74 patients per group). The Positive Therapeutic Alliance group will receive counseling and guidance with an emphasis on therapeutic alliance and empathy. The Usual Treatment group will receive the same information and counseling with limited interaction with the therapist. The Control group will not receive any intervention. The treatment will be composed by two intervention sessions with a 1-week interval. A blinded assessor will collect the following outcomes at baseline, 1 month, 6 months and 12 months after randomization: pain intensity (Pain Numerical Rating Scale), specific disability (Patient-specific Functional Scale), general disability (Oswestry Disability Index), global perceived effect (Global Perceived Effect Scale), empathy (Consultation and Relational Empathy Measure), credibility and expectations related to treatment. The analysis will be performed using linear mixed models. This will be the first study to understand the effect of combining enhanced therapeutic alliance to a treatment based on counseling, information and advice (minimal intervention). The addition of the therapeutic alliance to minimal intervention may improve the treatment of chronic, nonspecific low back

Understanding and Measuring Coach–Teacher Alliance: A Glimpse Inside the ‘Black Box’

PubMed Central

Pas, Elise T.; Bradshaw, Catherine P.

2016-01-01

Coaching models are increasingly used in schools to enhance fidelity and effectiveness of evidence-based interventions; yet, little is known about the relationship between the coach and teacher (i.e., coach–teacher alliance), which may indirectly enhance teacher and student outcomes through improved implementation quality. There is also limited research on measures of coach–teacher alliance, further hindering the field from understanding the active components for successful coaching. The current study examined the factor structure and psychometric characteristics of a measure of coach–teacher alliance as reported by both teachers and coaches and explored the extent to which teachers and coaches reliably rate their alliance. Data come from a sample of 147 teachers who received implementation support from one of four coaches; both the teacher and the coach completed an alliance questionnaire. Separate confirmatory factor analyses for each informant revealed four factors (relationship, process, investment, and perceived benefits) as well as an additional coach-rated factor (perceived teacher barriers). A series of analyses, including cross-rater correlations, intraclass correlation coefficients, and Kuder-Richardson reliability estimates suggested that teachers and coaches provide reliable, though not redundant, information about the alliance. Implications for future research and the utilization of the parallel coach–teacher alliance measures to increase the effectiveness of coaching are discussed. PMID:26872479

Fluctuations in alliance and use of techniques over time: A bidirectional relation between use of "common factors" techniques and the development of the working alliance.

PubMed

Solomonov, Nili; McCarthy, Kevin S; Keefe, John R; Gorman, Bernard S; Blanchard, Mark; Barber, Jacques P

2018-01-01

The aim of this study was twofold: (a) Investigate whether therapists are consistent in their use of therapeutic techniques throughout supportive-expressive therapy (SET) and (b) Examine the bi-directional relation between therapists' use of therapeutic techniques and the working alliance over the course of SET. Thirty-seven depressed patients were assigned to 16 weeks of SET as part of a larger randomized clinical trial (Barber, Barrett, Gallop, Rynn, & Rickels, ). Working Alliance Inventory-Short Form (WAI-SF) was collected at Weeks 2, 4, and 8. Use of therapeutic interventions was rated by independent observers using the Multitheoretical List of Therapeutic Interventions (MULTI). Intraclass correlation coefficients assessed therapists' consistency in use of techniques. A cross-lagged path analysis estimated the working alliance inventory- Multitheoretical List of Therapeutic Interventions bidirectional relation across time. Therapists were moderately consistent in their use of prescribed techniques (psychodynamic, process-experiential, and person-centred). However, they were inconsistent, or more flexible, in their use of "common factors" techniques (e.g., empathy, active listening, hope, and encouragements). A positive bidirectional relation was found between use of common factors techniques and the working alliance, such that initial high levels of common factors (but not prescribed) techniques predicted higher alliance later on and vice versa. Therapists tend to modulate their use of common factors techniques across treatment. Additionally, when a strong working alliance is developed early in treatment, therapists tend to use more common factors later on. Moreover, high use of common factors techniques is predictive of later improvement in the alliance. Copyright © 2017 John Wiley & Sons, Ltd.

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

PubMed

Taylor, Holly A; McDonald, Erin L; Moon, Margaret; Hughes, Mark T; Carrese, Joseph A

2009-10-01

Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and their preceptors seeing patients in an out-patient general paediatrics clinic. Our objectives were to describe the everyday ethics-related issues paediatrics residents encounter as they interact with patients. Our ultimate goal is to use this knowledge to enhance current efforts to teach ethics to paediatrics residents. The study team directly observed paediatrics residents discussing patients with their faculty preceptors (19 half-day sessions, 76 hours) in an out-patient general paediatrics clinic located in an urban academic medical centre. Each interaction between resident and preceptor about a single patient was considered a case for further analysis. A total of 247 cases were recorded. Forty-one of the cases were coded as having ethics-related content. A constant comparative method of qualitative data analysis revealed that residents were most likely to encounter ethical issues when engaged in the following activities: (i) maintaining a therapeutic alliance with the caregiver (e.g. the parent); (ii) prioritising patient or family needs; (iii) adjusting to the power embodied by the role of doctors, and (iv) distinguishing suboptimal care from abuse or neglect. In addition, our findings indicate that it is through their efforts to maintain the therapeutic alliance with the caregivers of their patients that residents engage in and integrate three processes: developing their medical knowledge; adhering to professional norms, and balancing the power inherent in the doctor's role with their responsibility to serve the patient's interests. Medical faculty tasked with teaching ethics to paediatrics residents can utilise the results

Exclusion-Proneness in Borderline Personality Disorder Inpatients Impairs Alliance in Mentalization-Based Group Therapy.

PubMed

Euler, Sebastian; Wrege, Johannes; Busmann, Mareike; Lindenmeyer, Hannah J; Sollberger, Daniel; Lang, Undine E; Gaab, Jens; Walter, Marc

2018-01-01

Interpersonal sensitivity, particularly threat of potential exclusion, is a critical condition in borderline personality disorder (BPD) which impairs patients' social adjustment. Current evidence-based treatments include group components, such as mentalization-based group therapy (MBT-G), in order to improve interpersonal functioning. These treatments additionally focus on the therapeutic alliance since it was discovered to be a robust predictor of treatment outcome. However, alliance is a multidimensional factor of group therapy, which includes the fellow patients, and may thus be negatively affected by the exclusion-proneness of BPD patients. The aim of this pilot study was to examine the predictive value of threat of social exclusion for the therapeutic alliance in MBT-G. In the first part of the study, social exclusion was experimentally induced in 23 BPD inpatients and 28 healthy subjects using the Cyberball paradigm, a virtual ball tossing game. The evoked level of threat was measured with the Need-Threat Scale (NTS) which captures four dimensions of fundamental human needs, i.e., the need for belongingness, for self-esteem, for control, and for a meaningful existence. In the second part of the study, therapeutic alliance was measured on three dimensions, the therapists, the fellow patients and the group as a whole, using the Group-Questionnaire (GQ-D). BPD patients scored higher in their level of threat according to the NTS in both, the inclusion and the exclusion condition. The level of threat after exclusion predicted impairments of the therapeutic alliance in MBT-G. It was associated with more negative relationships, lower positive bonding and a lower positive working alliance with the fellow patients and lower positive bonding to the group as a whole whilst no negative prediction of the alliance to the therapists was found. Consequently, our translational study design has shown that Cyberball is an appropriate tool to use as an approach for clinical

Alliance, Technology, and Outcome in the Treatment of Anxious Youth

ERIC Educational Resources Information Center

Chu, Brian C.; Choudhury, Muniya S.; Shortt, Alison L.; Pincus, Donna B.; Creed, Torrey A.; Kendall, Philip C.

2004-01-01

A strong therapeutic alliance is intuitively important in a cognitive-behavioral treatment of anxious youth where the child must confront feared stimuli in numerous exposure tasks. Research examining alliance-outcome relationships and the specific role of the alliance is currently limited. Is the alliance supportive in nature, does it enhance…

Therapeutic alliance in the personal therapy of graduate clinicians: relationship to the alliance and outcomes of their patients.

PubMed

Gold, Stephanie H; Hilsenroth, Mark J; Kuutmann, Klara; Owen, Jesse J

2015-01-01

This is the first study to explore the relationship between aspects of a therapists' personal therapy and the subsequent psychotherapy process and outcome they perform. The participants were 14 graduate clinicians with various experiences in personal therapy, who treated 54 outpatients engaged in short-term psychodynamic psychotherapy at a university-based community clinic. Results demonstrated non-significant relationships between the duration of personal therapy as well as a graduate clinician's overall alliance in their personal therapy with alliance ratings made by themselves as therapists and their patients, as well as the number of psychotherapy sessions attended by patients. However, the clinician's personal therapy alliance was significant and positively related to their patients' rating of outcome. Additionally, a significant negative correlation was observed between the degree of perceived helpfulness in their personal therapy and how these clinicians rated alliances, as the therapist, with their patients. The current findings suggest a relationship between a clinician's personal therapy alliance and the outcome of treatments they conduct. Implications for clinical training and practice as well as future research are discussed. While graduate clinician's personal therapy alliance was not significantly related to their patients' ratings of alliance, it was related to their patients' ratings of outcome. Trainee satisfaction with or quality of their personal therapy may be a more relevant than the amount or duration of their treatment in regard to the process and outcomes of their patients. The findings from retrospective clinician surveys on the helpfulness of their personal therapy may not be entirely consistent with empirical examination of these issues. The relation of personal therapy and outcome may work through improving the therapist's level of adaptive functioning (i.e., psychological-relational-emotional health) and future research should examine

Negotiating therapeutic alliances with a family at impasse.

PubMed

Friedlander, Myrna L; Lee, Hsin-Hua; Shaffer, Katharine S; Cabrera, Patricia

2014-03-01

To bridge the science-practice gap, the APA Presidential Task Force endorsed the publication of evidence-based case studies, but to date, there have been few such investigations of conjoint family therapy. To fill this gap, we studied a successful case of treatment-as-usual in a community agency. Owing to the complexity of the working alliance in conjoint therapy, we examined how an experienced family therapist managed to develop and sustain multiple alliances over time with an estranged couple in crisis. The outcome data showed clinically meaningful changes as well as high satisfaction levels and notable declines in the target complaint discomfort levels of all family members. Alliance indicators showed that the therapist worked diligently over time to connect emotionally with each family member and to foster and maintain safety. Session impact scores showed consistently deep sessions but more variability in smoothness. By working toward the only shared treatment goal-to repair each parent's individual relationship with their very angry daughter-the therapist was able to reduce the effect of the marital estrangement on the child. At the end of the 10 contracted family sessions, the parents agreed to begin working on their relationship in couples therapy, which led shortly thereafter to a reconciliation. (c) 2014 APA, all rights reserved.

Do treatment manuals undermine youth-therapist alliance in community clinical practice?

PubMed

Langer, David A; McLeod, Bryce D; Weisz, John R

2011-08-01

Some critics of treatment manuals have argued that their use may undermine the quality of the client-therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics. Seventy-six clinically referred youths (57% female, age 8-15 years, 34% Caucasian) were randomly assigned to receive nonmanualized usual care or manual-guided treatment to address anxiety or depressive disorders. Treatment was provided in community clinics by clinic therapists randomly assigned to treatment condition. Youth-therapist alliance was measured with the Therapy Process Observational Coding System--Alliance (TPOCS-A) scale at 4 points throughout treatment and with the youth report Therapeutic Alliance Scale for Children (TASC) at the end of treatment. Youths who received manual-guided treatment had significantly higher observer-rated alliance than usual care youths early in treatment; the 2 groups converged over time, and mean observer-rated alliance did not differ by condition. Similarly, the manual-guided and usual care groups did not differ on youth report of alliance. Our findings did not support the contention that using manuals to guide treatment harms the youth-therapist alliance. In fact, use of manuals was related to a stronger alliance in the early phase of treatment.

Ambivalence and alliance ruptures in cognitive behavioral therapy for generalized anxiety.

PubMed

Hunter, Jennifer A; Button, Melissa L; Westra, Henny A

2014-01-01

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.

The Role of Theory-Specific Techniques and Therapeutic Alliance in Promoting Positive Outcomes: Integrative Psychotherapy for World Trade Center Responders.

PubMed

Haugen, Peter Tejas; Werth, Aditi Sinha; Foster, Alyce Lauren; Owen, Jesse

2016-12-01

World Trade Center responders demonstrate high symptom burden, underscoring the importance of refining treatment approaches for this cohort. One method is examining the impact of therapy techniques on outcomes, and the interactions between technique and alliance on outcomes. This study a) examined the interaction of early treatment techniques on integrative psychotherapy outcomes and b) explored whether associations differed at varying levels of alliance. Twenty-nine adult responders diagnosed with partial or full posttraumatic stress disorder received outpatient psychotherapy and completed weekly measures of alliance, technique, and symptom distress. Analyses indicated significant interactions between 1) alliance and psychodynamic interventions on outcomes and 2) alliance and cognitive behavioral (CB) interventions on outcomes. Clients with high alliance had better outcomes when their therapist used fewer CB techniques. No meaningful differences were found between technique and outcomes for clients with lower alliance. These findings reiterate the critical roles technique and responsiveness to the alliance play in engendering successful outcomes.

An Attempt to Measure the Traffic Impact of Airline Alliances

NASA Technical Reports Server (NTRS)

Iatrou, Kostas; Skourias, Nikolaos

2005-01-01

This paper analyzes the effects of airline alliances on the allied partners output by comparing the traffic change observed between the pre- and the post-alliance period. First, a simple methodology based on traffic passenger modelling is developed, and then an empirical analysis is conducted using time series from four global strategic alliances (Wings, Star Alliance, oneworld and SkyTeam) and 124 alliance routes. The analysis concludes that, all other things being equal, strategic alliances do lead to a 9.4%, on average, improvement in passenger volume.

When do drilling alliances add value? The alliance value model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brett, J.F.; Craig, V.B.; Wadsworth, D.B.

1996-12-31

A recent GRI report details three previously unstudied aspects of alliances: specific measurable factors that improve alliance success, how a successful alliance should be structured, and when an alliance makes economic sense. The most innovative tool to emerge from the report, the Alliance Value Model, addresses the third aspect. The theory behind the Alliance Value Model is that the long-term viability of any drilling relationship hinges on its ability to create real value and achieve stability. Based upon the report`s findings, the most effective way to form such an alliance is through a detailed description and integration of the technicalmore » processes involved. This new type of process-driven alliance is characterized by a value chain which links together a common set of technical processes, mutually defined bottomline goals, and shared benefits. Building a process-driven alliance requires time and people and therefore has an associated cost. The real value generated by an alliance must exceed this start-up cost. The Alliance Value Model computes the net present value (NPV) of the cash flows for four different operating arrangements: (1) Business As Usual (conventional competitive bidding process), (2) Process-Driven Alliance (linking technical processes to accelerate production and reduce expenses), (3) Incentivized Process-Driven Alliance (linked technical processes with performance incentives to promote stability), and (4) No Drill Case (primarily used to gauge the market value of services). These arrangements test different degrees of process integration between an operator and its suppliers. They can also help determine if the alliance can add enough value to exceed startup costs and if the relationship will be stable. Each partner can test the impact of the relational structure on its own profitability. When an alliance is warranted, all participants can benefit from real value generated in a stable relationship.« less

Collaboration in Culturally Responsive Therapy: Establishing A Strong Therapeutic Alliance Across Cultural Lines

PubMed Central

Asnaani, Anu; Hofmann, Stefan G.

2012-01-01

Achieving effectiveness of therapeutic interventions across a diversity of patients continues to be a foremost concern of clinicians and clinical researchers alike. Further, across theoretical orientations and in all treatment modalities, therapy alliance remains a critical component to determine such favorable outcome from therapy. Yet, there remains a scarcity of empirical data testing specific features that most readily facilitate effective collaboration in a multi-cultural therapy relationship. This article reviews the literature on terminology, empirical findings, and features to enhance collaboration in multi-cultural therapy, suggesting guidelines for achieving this goal in therapy with patients (and therapists) of various cultural/racial backgrounds. This is followed by a multi-cultural case study presenting with several co-morbid Axis I disorders, to exemplify the application of these guidelines over the course of therapy. PMID:23616299

Beyond the Therapeutic Hour: An Exploratory Pilot Study of Using Technology to Enhance Alliance and Engagement within Face-to-Face Psychotherapy

ERIC Educational Resources Information Center

Richards, Penelope; Simpson, Susan

2015-01-01

In this paper we introduce and investigate the capacity for a novel, technologically advanced system (goACT) to enhance face-to-face psychotherapy. Specifically, we explore the capacity for goACT to enhance therapeutic alliance (TA) and engagement, and reduce distress. Using a mixed-methods, multiple-baseline design we present the first study to…

The Role of the Working Alliance in Treatment for Alcohol Problems

PubMed Central

2015-01-01

Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study’s objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted posttreatment motivation and then later treatment outcome. Client and therapist perceptions of the working alliance were assessed after the first treatment session using a short form of the Working Alliance Inventory (WAI) among 173 clients taking part in the United Kingdom Alcohol Treatment Trial (UKATT) and randomized to motivational enhancement therapy (MET) or social behavior and network therapy (SBNT) with complete data on all measures of interest. Structural equation models were fitted to identify predictors of WAI scores and investigate the relationships between WAI and measures of drinking during treatment, posttreatment motivation, and successful treatment outcome (abstinent or nonproblem drinker), and measures of drinks per drinking day and nondrinking days, assessed 9 months after the conclusion of treatment. Motivation to change drinking when treatment began was a strong predictor of client—adjusted coefficient = 2.21 (95% confidence interval [CI] [0.36, 4.06]—but not therapist WAI. Client WAI predicted successful treatment outcome—adjusted odds ratios (OR) = 1.09 (95% CI [1.02, 1.17])—and had effects on drinking during treatment, and on posttreatment motivation to change. There was evidence for effect modification by treatment, with strong associations between WAI and posttreatment motivation, and evidence of WAI prediction of treatment outcomes in the MET group, but no evidence of associations for SBNT. Therapist WAI was not strongly associated with treatment outcome (adjusted OR = 1.05; 95% CI [0.99, 1.10]). The working alliance is important to treatment outcomes for alcohol problems, with client evaluation of the alliance strongly related to

Patient-oncologist alliance as protection against suicidal ideation in young adults with advanced cancer.

PubMed

Trevino, Kelly M; Abbott, Caroline H; Fisch, Michael J; Friedlander, Robert J; Duberstein, Paul R; Prigerson, Holly G

2014-08-01

Young adults with cancer are at an increased risk of suicidal ideation. To the authors' knowledge, the impact of the patient-oncologist alliance on suicidal ideation has not been examined to date. The current study examined the relationship between the patient-oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer. A total of 93 young adult patients (aged 20 years-40 years) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality scale, dichotomized into a positive and negative score. Predictors included diagnoses of major depressive disorder and posttraumatic stress disorder, physical quality of life, social support, and use of mental health and supportive care services. The Human Connection Scale, dichotomized into a strong (upper third) and weak (lower two-thirds) therapeutic alliance, assessed the strength of the patients' perceived oncologist alliance. Approximately 22.6% of patients screened positive for suicidal ideation. Patients with a strong therapeutic alliance were found to be at reduced risk of suicidal ideation after controlling for confounding influences of cancer diagnosis, Karnofsky performance status, number of physical symptoms, physical quality of life, major depressive disorder, posttraumatic stress disorder, and social support. A strong therapeutic alliance was also associated with a reduced risk of suicidal ideation after controlling for mental health discussions with health care providers and use of mental health interventions. The patient-oncologist alliance was found to be a robust predictor of suicidal ideation and provided better protection against suicidal ideation than mental health interventions, including psychotropic medications. Oncologists may significantly influence patients' mental health and may benefit from training and guidance in building strong alliances with their young adult patients. �

Adolescent and Parent Alliance and Treatment Outcome in Multidimensional Family Therapy

ERIC Educational Resources Information Center

Shelef, Karni; Diamond, Gary M.; Diamond, Guy S.; Liddle, Howard A.

2005-01-01

In this study, the authors examined the relation between adolescent and parent therapeutic alliances and treatment outcome among 65 substance-abusing adolescents receiving multidimensional family therapy. Observer ratings of parent alliance predicted premature termination from treatment. Observer ratings, but not self-report, of adolescent…

The effect of Tomm's therapeutic questioning styles on therapeutic alliance: a clinical analog study.

PubMed

Dozier, R M; Hicks, M W; Cornille, T A; Peterson, G W

1998-01-01

Tomm (1988) suggests that circular and reflexive questions tend to elicit feelings of freedom/acceptance whereas lineal and strategic questions usually trigger feelings of judgment/constraint. Employing an analog methodology, each of Tomm's four questioning styles was portrayed in the form of a 5-minute videotaped intake scenario. Forty family triads with a mother, father, and adolescent son were randomly assigned to one of four experimental conditions with ten families each. Each condition involved viewing one of four questioning style scenarios. All participants (N = 120 individuals--40 mothers, 40 fathers, and 40 adolescent sons) completed the Family Therapy Alliance Scale (FTAS; Pinsof & Catherall, 1986) and a validity-check instrument. The results indicated that circular and reflexive questioning styles elicited significantly higher (p < 0.001) alliance scores on the FTAS than did either lineal or strategic questions. Implications for the use of different types of questions in family therapy are discussed.

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists' Observable Behaviors.

PubMed

Sotero, Luciana; Cunha, Diana; da Silva, José Tomás; Escudero, Valentín; Relvas, Ana Paula

2017-12-01

This study aimed to compare therapists' observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists' contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients' engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists' alliance-building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research. © 2016 Family Process Institute.

The advising alliance for international and domestic graduate students: Measurement invariance and implications for academic stress.

PubMed

Rice, Kenneth G; Suh, Hanna; Yang, Xiaohui; Choe, Elise; Davis, Don E

2016-04-01

We expanded the focus of a prior study of international graduate student advising relationships (Rice et al., 2009) to examine advising experiences of both international and domestic students. International (n = 434) and domestic (n = 387) students completed the Advisory Working Alliance Inventory (AWAI-S; Schlosser & Gelso, 2001) and measures of advising experiences, perceived academic stress, and desire to change advisor. Measurement invariance analyses suggested that a 23-item AWAI-S showed support for scalar invariance. A bifactor structure showed superior fit to the 3-factor model or a second-order factor model for the AWAI-S. International and domestic graduate students did not differ in ratings of general alliance, academic stress, or desire to change advisors. General alliance was strongly related to less academic stress and less desire to change advisors. International students who felt disrespected by their advisors were more likely to be academically stressed than domestic students. Structured mentoring experiences were associated with lower stress and less desire to change, and this effect was similar in both international and domestic students. Overall, results suggested that the current level of measurement, and possibly theory development, regarding the advisory alliance is good at identifying generic satisfaction but weaker at differentiating components of the alliance. (c) 2016 APA, all rights reserved).

Therapeutic Effects of Brief Hospitalization

PubMed Central

LIEBERMAN, PAUL B.; VON REHN, SUSAN; DICKIE, ELLEN; ELLIOTT, BINETTE; EGERTER, ELISE

1992-01-01

Correlational data in this study suggest that a strong therapeutic alliance is associated with improvement during brief hospitalization. Two measures of alliance were used: patient-staff agreement on treatment goals and patient expectations of benefit from treatment. Greater patient-staff agreement at admission was associated with symptomatic improvement, independent of medication use; less use of immature defense mechanisms at discharge; and reduced risk of precipitous discharge. For a given level of symptoms, greater agreement was associated with lower doses of antipsychotics but higher doses of minor tranquilizers and antidepressants. Perception of the ward was associated with patients’ expectation of benefit. PMID:22700056

Simulation modeling analysis of sequential relations among therapeutic alliance, symptoms, and adherence to child-centered play therapy between a child with autism spectrum disorder and two therapists.

PubMed

Goodman, Geoff; Chung, Hyewon; Fischel, Leah; Athey-Lloyd, Laura

2017-07-01

This study examined the sequential relations among three pertinent variables in child psychotherapy: therapeutic alliance (TA) (including ruptures and repairs), autism symptoms, and adherence to child-centered play therapy (CCPT) process. A 2-year CCPT of a 6-year-old Caucasian boy diagnosed with autism spectrum disorder was conducted weekly with two doctoral-student therapists, working consecutively for 1 year each, in a university-based community mental-health clinic. Sessions were video-recorded and coded using the Child Psychotherapy Process Q-Set (CPQ), a measure of the TA, and an autism symptom measure. Sequential relations among these variables were examined using simulation modeling analysis (SMA). In Therapist 1's treatment, unexpectedly, autism symptoms decreased three sessions after a rupture occurred in the therapeutic dyad. In Therapist 2's treatment, adherence to CCPT process increased 2 weeks after a repair occurred in the therapeutic dyad. The TA decreased 1 week after autism symptoms increased. Finally, adherence to CCPT process decreased 1 week after autism symptoms increased. The authors concluded that (1) sequential relations differ by therapist even though the child remains constant, (2) therapeutic ruptures can have an unexpected effect on autism symptoms, and (3) changes in autism symptoms can precede as well as follow changes in process variables.

Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence.

PubMed

Jordan, Jennifer; McIntosh, Virginia V W; Carter, Frances A; Joyce, Peter R; Frampton, Christopher M A; Luty, Suzanne E; McKenzie, Janice M; Carter, Janet D; Bulik, Cynthia M

2017-08-01

Failure to complete treatment for anorexia nervosa (AN) is- common, clinically concerning but difficult to predict. This study examines whether therapy-related factors (patient-rated pretreatment credibility and early therapeutic alliance) predict subsequent premature termination of treatment (PTT) alongside self-transcendence (a previously identified clinical predictor) in women with AN. 56 women aged 17-40 years participating in a randomized outpatient psychotherapy trial for AN. Treatment completion was defined as attending 15/20 planned sessions. Measures were the Treatment Credibility, Temperament and Character Inventory, Vanderbilt Therapeutic Alliance Scale and the Vanderbilt Psychotherapy Process Scale. Statistics were univariate tests, correlations, and logistic regression. Treatment credibility and certain early patient and therapist alliance/process subscales predicted PTT. Lower self-transcendence and lower early process accounted for 33% of the variance in predicting PTT. Routine assessment of treatment credibility and early process (comprehensively assessed from multiple perspectives) may help clinicians reduce PTT thereby enhancing treatment outcomes. © 2017 Wiley Periodicals, Inc.

Therapeutic friendliness and the development of therapeutic leverage by mental health nurses in community rehabilitation settings.

PubMed

Gardner, Andrew

2010-01-01

In a world dominated by technology and driven by fiscal policy emphasis, the therapeutic relationship as a healing modality is still a central theme to mental health nurses (MHN) in their everyday work. This research, as part of a PhD program, used a constructivist grounded theory approach to explore the process of therapeutic relationships and professional boundaries. The current paper outlines how therapeutic friendliness provides a connection for the therapeutic relationship to develop but in doing so requires a balancing of the therapeutic relationship and constant maintenance of the professional boundary. The authors also discuss how community mental health nurses (CMHN) invest in the therapeutic relationship in order to develop a therapeutic alliance and how the alliance between the CMHN and the client facilitates the use of therapeutic leverage applied by the CMHN as part of the therapeutic process.

Examining the relation between the therapeutic alliance, treatment adherence, and outcome of cognitive behavioral therapy for children with anxiety disorders.

PubMed

Liber, Juliette M; McLeod, Bryce D; Van Widenfelt, Brigit M; Goedhart, Arnold W; van der Leeden, Adelinde J M; Utens, Elisabeth M W J; Treffers, Philip D A

2010-06-01

Little is known about the contribution of technical and relational factors to child outcomes in cognitive behavioral therapy (CBT) for children with anxiety disorders. This study investigated the association between treatment adherence, the child-therapist alliance, and child clinical outcomes in manual-guided individual- and group-based CBT for youths diagnosed with anxiety disorders. Trained observers rated tapes of therapy sessions for treatment adherence and child-therapist alliance in a sample of 52 children (aged 8 to 12) with anxiety disorders. Self-reported child anxiety was assessed at pre-, mid-, and posttreatment; parent-reported child internalizing symptoms was assessed at pre- and posttreatment. The results showed high levels of treatment adherence and child-therapist alliance in both CBT programs. Neither treatment adherence nor child-therapist alliance predicted traditional measurements of child outcomes in the present study, but a relation between alliance and outcome was found using a more precise estimation of the true pre-post differences. Implications of these findings for expanding our understanding of how treatment processes relate to child outcome in CBT for children with anxiety disorders are discussed. 2009. Published by Elsevier Ltd.

Pretreatment Social Relations, Therapeutic Alliance, and Improvements in Parenting Practices in Parent Management Training

ERIC Educational Resources Information Center

Kazdin, Alan E.; Whitley, Moira K.

2006-01-01

The authors examined the parent-therapist alliance in parent management training for children (N = 218; 53 girls and 165 boys, ages 2-14) referred clinically for oppositional, aggressive, and antisocial behavior. The interrelations of pretreatment parent social relationships, the parent-therapist alliance over the course of treatment, and…

Feasibility of Using the Helping Alliance Questionnaire II as a Self-Report Measure for Individuals with a Psychiatric Disorder Receiving Music Therapy.

PubMed

Hannibal, Niels; Domingo, Maria Rodrigo; Valentin, Jan B; Licht, Rasmus W

2017-11-01

No specific instrument has been developed for measuring alliance during music therapy. To evaluate the feasibility of using the Helping Alliance Questionnaire II (HAq-II) as a self-report measure for individuals receiving treatment for a psychiatric disorder. Specifically, we examined the percent of patients who filled out the questionnaire, and when completed, whether there were any missing items. We also examined internal consistency and associations between patient variables and HAq-II scores. Between October 2013 and April 2014, we invited 45 individuals with a psychiatric disorder, who were also receiving music therapy, to fill out the HAq-II. We also collected clinical data from each person's record. Thirty-one (69%) of the 45 invited patients filled out the HAq-II, and of those completed, only three had missing items. Of the 45 invited patients, thirty (67%) had a diagnosis of schizophrenia or other psychotic disorders, and 11 (24%) were diagnosed with other psychiatric disorders. In terms of diagnosis and other clinical variables, no statistically significant differences were found between the 31 patients who filled out the HAq-II and the 14 patients who did not return the questionnaire. The median HAq-II score was 5.11 (range 3.74-6.00), indicating a relatively high alliance. We did not find any statistically significant associations between the HAq-II scores and potential predictors of interest. The Cronbach's alpha was 0.85. Completion of the HAq-II was fairly high in this group of individuals with psychiatric diagnoses who were receiving music therapy. Internal consistency of the HAq-II was acceptable. Relatively high HAq-II scores suggest a high degree of therapeutic alliance, but the external validity of the HAq-II and the relationship between scores and therapy needs further evaluation. © the American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The course of the working alliance during virtual reality and exposure group therapy for social anxiety disorder.

PubMed

Ngai, Irene; Tully, Erin C; Anderson, Page L

2015-03-01

Psychoanalytic theory and some empirical research suggest the working alliance follows a "rupture and repair" pattern over the course of therapy, but given its emphasis on collaboration, cognitive behavioral therapy may yield a different trajectory. The current study compares the trajectory of the working alliance during two types of cognitive behavioral therapy for social anxiety disorder - virtual reality exposure therapy (VRE) and exposure group therapy (EGT), one of which (VRE) has been proposed to show lower levels of working alliance due to the physical barriers posed by the technology (e.g. no eye contact with therapist during exposure). Following randomization, participants (N = 63) diagnosed with social anxiety disorder received eight sessions of manualized EGT or individual VRE and completed a standardized self-report measure of working alliance after each session. Hierarchical linear modeling showed overall high levels of working alliance that changed in rates of growth over time; that is, increases in working alliance scores were steeper at the beginning of therapy and slowed towards the end of therapy. There were no differences in working alliance between the two treatment groups. Results neither support a rupture/repair pattern nor the idea that the working alliance is lower for VRE participants. Findings are consistent with the idea that different therapeutic approaches may yield different working alliance trajectories.

Resolving Alliance Ruptures from an Attachment-Informed Perspective.

PubMed

Miller-Bottome, Madeleine; Talia, Alessandro; Safran, Jeremy D; Muran, J Christopher

2018-04-01

In this article, we examine how the different attachment patterns enable or hinder the resolution of ruptures in the therapeutic alliance. We try to show that secure and insecure patients alike may experience ruptures in the therapeutic alliance, but that their ability to participate in resolving such ruptures differ markedly. Recent findings with the Patient Attachment Coding System (PACS) show that attachment classifications manifest in psychotherapy as distinct ways of communicating about present internal experience. Secure patients disclose their present experience openly and invite attunement from the therapist, while insecure patients either minimize their contributions to the dialogue (avoidant) or the contributions of the therapist (preoccupied). Using examples from session transcripts, we demonstrate how secure patients are particularly responsive to resolution strategies that focus on here-and-now experience, while insecure patients' characteristic ways of communicating pose significant challenges to the resolution process.

Predicting Spouses Perceptions of Their Parenting Alliance

ERIC Educational Resources Information Center

Hughes, Farrah M.; Gordon, Kristina Coop; Gaertner, Lowell

2004-01-01

This study used marital and individual-level variables to predict spouses perceived parenting alliance. One hundred married couples completed measures of parenting alliance, marital consensus, marital power, and depression. Analyses revealed that marital consensus was a significant predictor of parenting alliance for both parents, and that…

Remote “Hovering” with Individuals with Psychotic Disorders and Substance Use: Feasibility, Engagement, and Therapeutic Alliance with a Text-Messaging Mobile Interventionist

PubMed Central

Ben-Zeev, Dror; Kaiser, Susan M.; Krzos, Izabela

2014-01-01

Objective People with serious mental illnesses and substance abuse problems (i.e., dual diagnosis) constitute a particularly challenging and costly clinical group. This study evaluated the feasibility and acceptability of a novel model of care in which a mobile interventionist used mobile phone text messaging to remotely monitor and provide daily support to individuals with psychotic disorders and substance use. Methods Seventeen participants with dual diagnosis were enrolled in a twelve-week single-arm trial. A clinical social worker served as the mobile interventionist and sent daily text-messages to participants’ privately-owned mobile phones to assess their medication adherence and clinical status. The mobile interventionist provided text-message feedback and support, and suggested various coping strategies flexibly, in response to participants’ replies to prompts. At the end of the trial, participants completed a usability and satisfaction measure and two self-rated measures of therapeutic alliance with their clinicians. In one version, participants rated their relationship with their mobile interventionist; in the second version, they rated their relationship with their community-based treatment team. Results Participants received an average of 139 text messages (SD = 37.5) each from the mobile interventionist over the twelve-week trial. On average, participants responded to 87% of the mobile interventionist’s messages that required a reply. Over 90% of participants thought the intervention was useful and rewarding, and that it helped them be more effective and productive in their lives. Participants’ assessments of their relationship with the mobile interventionist were positive. Paired sample t-test found the therapeutic alliance ratings participants provided for their mobile interventionist were significantly higher than those provided for their community-based treatment team clinicians who they met with regularly. Conclusions Our findings suggest

Enlight: A Comprehensive Quality and Therapeutic Potential Evaluation Tool for Mobile and Web-Based eHealth Interventions

PubMed Central

Faber, Keren; Mathur, Nandita; Kane, John M; Muench, Fred

2017-01-01

Background Studies of criteria-based assessment tools have demonstrated the feasibility of objectively evaluating eHealth interventions independent of empirical testing. However, current tools have not included some quality constructs associated with intervention outcome, such as persuasive design, behavior change, or therapeutic alliance. In addition, the generalizability of such tools has not been explicitly examined. Objective The aim is to introduce the development and further analysis of the Enlight suite of measures, developed to incorporate the aforementioned concepts and address generalizability aspects. Methods As a first step, a comprehensive systematic review was performed to identify relevant quality rating criteria in line with the PRISMA statement. These criteria were then categorized to create Enlight. The second step involved testing Enlight on 42 mobile apps and 42 Web-based programs (delivery mediums) targeting modifiable behaviors related to medical illness or mental health (clinical aims). Results A total of 476 criteria from 99 identified sources were used to build Enlight. The rating measures were divided into two sections: quality assessments and checklists. Quality assessments included usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. The checklists included credibility, privacy explanation, basic security, and evidence-based program ranking. The quality constructs exhibited excellent interrater reliability (intraclass correlations=.77-.98, median .91) and internal consistency (Cronbach alphas=.83-.90, median .88), with similar results when separated into delivery mediums or clinical aims. Conditional probability analysis revealed that 100% of the programs that received a score of fair or above (≥3.0) in therapeutic persuasiveness or therapeutic alliance received the same range of scores in user engagement and content—a pattern that did not appear in

Further Validation of the Learning Alliance Inventory: The Roles of Working Alliance, Rapport, and Immediacy in Student Learning

ERIC Educational Resources Information Center

Rogers, Daniel T.

2015-01-01

This study further examined the reliability and validity of the Learning Alliance Inventory (LAI), a self-report measure designed to assess the working alliance between a student and a teacher. The LAI was found to have good internal consistency and test--retest reliability, and it demonstrated the predicted convergence with measures of immediacy…

Advancing the Interdisciplinary Collaborative Health Team Model: Applying Democratic Professionalism, Implementation Science, and Therapeutic Alliance to Enact Social Justice Practice.

PubMed

Murphy, Nancy

2015-01-01

This essay reframes the interdisciplinary collaborative health team model by proposing the application of 3 foundational pillars-democratic professionalism, implementation science, and therapeutic alliance to advance this practice. The aim was to address challenges to the model, enhance their functional capacity, and explicate and enact social justice practices to affect individual health outcomes while simultaneously addressing health inequities. The pillars are described and examples from the author's dissertation research illustrate how the pillars were used to bring about action. Related theories, models, and frameworks that have negotiation, capacity building, collaboration, and knowledge/task/power sharing as central concepts are presented under each of the pillars.

Teaching the Working Alliance: Bridging the Gap between Counseling Microskills and Establishing Meaningful and Productive Relationships

ERIC Educational Resources Information Center

Connor, Annemarie; Leahy, Michael J.

2016-01-01

Purpose: This article conceptualizes teaching alliance as a framework to guide educators in teaching the affective components of working alliance (WA) through enhanced student-teacher relationships and augmented curricular focus on therapeutic bonds. Method: Drawing on the extant literature, and integrating counseling and educational theory, this…

The Role of Leaders’ Working Alliance in Premarital Education

PubMed Central

Owen, Jesse J.; Rhoades, Galena K.; Stanley, Scott M.; Markman, Howard J.

2011-01-01

Premarital (and general relationship) education programs, as a prevention method, have been shown to have a positive effect on marital quality and can prevent divorce. However, it is unclear whether these positive effects are consistent across leaders who conduct premarital education programs. Examining the variability in relationship outcomes attributed to the leaders of premarital education programs, and the role of general therapeutic factors such as working alliance in explaining relationship outcomes, may help increase the effectiveness of these programs. Accordingly, this study examined 31 leaders who trained 118 couples (236 attendees) in a randomized clinical trial of PREP, a research-based and empirically supported premarital education program being compared to a treatment as usual track. The results demonstrated that couples’ relationship outcomes from pre to post training varied based on the leader who provided the premarital education training. Both training in PREP and aggregated leader working alliance quality (as rated by attendees) explained variability between leaders in change in attendees’ observed negative and positive communication. Leaders’ aggregated working alliance quality also explained change in relationship satisfaction. Additionally, attendees’ ratings of their leaders’ working alliance predicted change in their relationship satisfaction and confidence, and attendees had higher positive communication when they reported better working alliance with their leader. PMID:21355646

Resolution of alliance ruptures: The special case of animal-assisted psychotherapy.

PubMed

Zilcha-Mano, Sigal

2017-01-01

Many therapists regard alliance ruptures as one of the greatest challenges therapists face in the therapy room. Alliance ruptures has been previously defined as breakdowns in the process of negotiation of treatment tasks and goals and a deterioration in the affective bond between patient and therapist. Alliance ruptures have been found to predict premature termination of treatment and poor treatment outcomes. But ruptures can also present important opportunities for gaining insight and awareness and for facilitating therapeutic change. A process of rupture resolution may lead to beneficial outcomes and serve as a corrective emotional experience. The article describes unique processes of alliance rupture resolution inherent in animal-assisted psychotherapy (AAP). Building on Safran and Muran's model and on clinical examples, the article describes strategies for identifying ruptures in AAP and techniques for repairing them to facilitate a corrective experience in treatment. Implications for clinical practice and future research are discussed.

The Effects of Counselor Trainee Stress and Coping Resources on the Working Alliance and Supervisory Working Alliance

ERIC Educational Resources Information Center

Gnilka, Philip B.

2010-01-01

Counselor trainees' stress and coping resources have the potential to influence the relationships formed with supervisors and clients. Two hundred thirty two (N = 232) Master-level counselor trainees completed surveys designed to measure perceived stress, coping resources, the working alliance, and the supervisory working alliance. Participants…

Attachment and alliance in the treatment of depressed, sexually abused women.

PubMed

Smith, Phillip N; Gamble, Stephanie A; Cort, Natalie A; Ward, Erin A; He, Hua; Talbot, Nancy L

2012-02-01

Depression among women with sexual abuse histories is less treatment responsive than in general adult samples. One contributor to poorer treatment outcomes may be abused women's difficulties in forming and maintaining secure relationships, as reflected in insecure attachment styles, which could also impede the development of a positive therapeutic alliance. The current study examines how attachment orientation (i.e. anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse. Seventy women seeking treatment in a community mental health center who had Major Depressive Disorder and a childhood sexual abuse history were randomized to Interpersonal Psychotherapy or treatment as usual. Greater attachment avoidance and weaker working alliance were each related to worse depression symptom outcomes; these effects were independent of the presence of comorbid Borderline Personality Disorder and Post-Traumatic Stress Disorder. The effect of avoidant attachment on outcomes was not mediated by the working alliance. Further, working alliance had a stronger effect on depression outcomes in the Interpersonal Psychotherapy group. Understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve the treatments for depressed women with a history of childhood sexual abuse. © 2012 Wiley Periodicals, Inc.

Enlight: A Comprehensive Quality and Therapeutic Potential Evaluation Tool for Mobile and Web-Based eHealth Interventions.

PubMed

Baumel, Amit; Faber, Keren; Mathur, Nandita; Kane, John M; Muench, Fred

2017-03-21

Studies of criteria-based assessment tools have demonstrated the feasibility of objectively evaluating eHealth interventions independent of empirical testing. However, current tools have not included some quality constructs associated with intervention outcome, such as persuasive design, behavior change, or therapeutic alliance. In addition, the generalizability of such tools has not been explicitly examined. The aim is to introduce the development and further analysis of the Enlight suite of measures, developed to incorporate the aforementioned concepts and address generalizability aspects. As a first step, a comprehensive systematic review was performed to identify relevant quality rating criteria in line with the PRISMA statement. These criteria were then categorized to create Enlight. The second step involved testing Enlight on 42 mobile apps and 42 Web-based programs (delivery mediums) targeting modifiable behaviors related to medical illness or mental health (clinical aims). A total of 476 criteria from 99 identified sources were used to build Enlight. The rating measures were divided into two sections: quality assessments and checklists. Quality assessments included usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. The checklists included credibility, privacy explanation, basic security, and evidence-based program ranking. The quality constructs exhibited excellent interrater reliability (intraclass correlations=.77-.98, median .91) and internal consistency (Cronbach alphas=.83-.90, median .88), with similar results when separated into delivery mediums or clinical aims. Conditional probability analysis revealed that 100% of the programs that received a score of fair or above (≥3.0) in therapeutic persuasiveness or therapeutic alliance received the same range of scores in user engagement and content-a pattern that did not appear in the opposite direction. Preliminary

Treatment outcomes of a combined cognitive behavior therapy and pharmacotherapy for a sample of women with and without substance abuse histories on an acute psychiatric unit: do therapeutic alliance and motivation matter?

PubMed

Clarke, Nickeisha; Mun, Eun-Young; Kelly, Shalonda; White, Helene R; Lynch, Katherine

2013-01-01

Women with comorbid psychiatric and substance abuse problems (PwSA) experience more consequences from their use and typically have the poorest prognosis and outcome, compared to those with psychiatric problems but without substance abuse problems (PwoSA). The present study examined outcomes of a combined intensive inpatient cognitive behavior therapy (CBT) and pharmacotherapy program for women with PwSA and PwoSA. Sample consisted of 117 women on a women-only acute inpatient unit (PwSA = 50, PwoSA = 67). Women in both groups made significant improvements in psychological functioning. High motivation at admission and therapeutic alliance at discharge were associated with improved psychological functioning at discharge for both groups. Findings provide preliminary support for the efficacy of a combined CBT and pharmacotherapy program for women with psychiatric diagnoses on a women-only acute inpatient unit, and for pre-treatment motivation and therapeutic alliance as important correlates of better treatment outcomes. Copyright © American Academy of Addiction Psychiatry.

The role of leaders' working alliance in premarital education.

PubMed

Owen, Jesse J; Rhoades, Galena K; Stanley, Scott M; Markman, Howard J

2011-02-01

Premarital (and general relationship) education programs, as a prevention method, have been shown to have a positive effect on marital quality and can prevent divorce. However, it is unclear whether these positive effects are consistent across leaders who conduct premarital education programs. Examining the variability in relationship outcomes attributed to the leaders of premarital education programs, and the role of general therapeutic factors such as working alliance in explaining relationship outcomes, may help increase the effectiveness of these programs. Accordingly, this study examined 31 leaders who trained 118 couples (236 attendees) in a randomized clinical trial of the Prevention and Relationship Enhancement Program (PREP), a research-based and empirically supported premarital education program being compared with a treatment as usual track. The results demonstrated that couples' relationship outcomes from pre- to post-training varied on the basis of the leader who provided the premarital education training. Both training in PREP and aggregated leader working alliance quality (as rated by attendees) explained variability between leaders in change in attendees' observed negative and positive communication. Leaders' aggregated working alliance quality also explained change in relationship satisfaction. In addition, attendees' ratings of their leaders' working alliance predicted change in their relationship satisfaction and confidence, and attendees had higher positive communication when they reported better working alliance with their leader. PsycINFO Database Record (c) 2011 APA, all rights reserved.

Intersect between self-esteem and emotion regulation in narcissistic personality disorder - implications for alliance building and treatment.

PubMed

Ronningstam, Elsa

2017-01-01

Building an alliance with patients with pathological narcissism or narcissistic personality disorder, NPD, can be challenging and include avoidance, negative reactivity and disruptions. A main contributing factor can be the complex interaction between emotion and self-esteem regulation, which affects patients' ability to engage in a therapeutic alliance and treatment. Recent studies, especially in neuroscience have identified functional characteristic and compromises in self-esteem and emotion regulation related to NPD. Self-enhancement, hyper reactivity and need for control, which patients within the range of disordered narcissism often present, can have different roots and underpinnings that require thorough exploration in the process of building the therapeutic alliance and promote change in treatment. Clinical examples with treatment implications and strategies will be discussed to highlight both internal fluctuations and external features and shifts in narcissistic personality functioning.

Behavioral health care for adolescents with poorly controlled diabetes via Skype: does working alliance remain intact?

PubMed

Freeman, Kurt A; Duke, Danny C; Harris, Michael A

2013-05-01

Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient-provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™). Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≥9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked. No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group. Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care. © 2013 Diabetes Technology Society.

Behavioral Health Care for Adolescents with Poorly Controlled Diabetes via Skype: Does Working Alliance Remain Intact?

PubMed Central

Freeman, Kurt A.; Duke, Danny C.; Harris, Michael A.

2013-01-01

Background: Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient–provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™). Methods: Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≥9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked. Results: No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group. Conclusion: Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care. PMID:23759406

Longitudinal results of strengthening the parent-team alliance in child semi-residential psychiatry: does team investment make a difference?

PubMed

Lamers, Audri; van Nieuwenhuizen, Chijs; Twisk, Jos; de Koning, Erica; Vermeiren, Robert

2016-01-01

In a semi-residential setting where children switch daily between treatment and home, establishment of a strong parent-team alliance can be a challenge. The development of alliance with parents and the symptoms of the child might be strengthened by a structured investment of treatment team members. Participants were caregivers and treatment team members of 46 children (6-12 years) who received semi-residential psychiatric treatment. An A-B design was applied, in which the first 22 children were assigned to the comparison group receiving treatment as usual and the next 24 to the experimental group, where treatment team members used additional alliance-building strategies. Alliance and symptom questionnaires were filled out at three-month intervals during both treatment conditions. Parent-treatment team interactions, assessed on DVD, were coded according to members' adherence to these strategies. Multilevel analyses (using MLwiN) showed that based on reports of primary caregivers and a case manager, the alliance-building strategies had a statistically significant effect on the strength of the therapeutic alliance between treatment team members and parents. In addition, primary caregivers in the experimental group reported significant less hyperactivity symptoms of their children. Despite the methodological challenge of examining therapeutic processes in this complex treatment setting, this study supports the benefits of structured investment in the parent-team alliance.

Patients' perspectives on political self-disclosure, the therapeutic alliance, and the infiltration of politics into the therapy room in the Trump era.

PubMed

Solomonov, Nili; Barber, Jacques P

2018-05-01

The primary aim of this study was to investigate the effects of the 2016 United States presidential election and ensuing political climate on patients' experiences in psychotherapy. A sample of 604 self-described Democrat and Republican patients from 50 states participated in the study. Results showed that most therapists disclosed their political stance (explicitly or implicitly) and most patients discussed politics with their therapists. 64% of Clinton supporters and 38% of Trump supporters assumed political similarity with their therapist. Stronger patient-reported alliance levels were found for patients who (a) perceived political similarity; (b) reported implicit therapist political disclosure; and (c) found in-session political discussions helpful. Additionally, Clinton (but not Trump) supporters reported significant pre-post-election decreases in expression of positive emotions and increases in both expression of negative emotions and engagement in discussions about socio-political topics. Our findings suggest that the current political climate infiltrates the therapeutic space and affects therapeutic process and content. © 2018 Wiley Periodicals, Inc.

Predictors of Patient Cognitive Therapy Skills and Symptom Change in Two Randomized Clinical Trials: The Role of Therapist Adherence and the Therapeutic Alliance

PubMed Central

Webb, Christian A.; DeRubeis, Robert J.; Dimidjian, Sona; Hollon, Steven D.; Amsterdam, Jay D.; Shelton, Richard C.

2014-01-01

Objective Previous research has found that therapist adherence to concrete, problem-focused cognitive therapy (CT) techniques predicts depressive symptom change (e.g., Feeley, DeRubeis, & Gelfand, 1999). More recently, Strunk, DeRubeis, Chui, and Alvarez (2007) demonstrated that in-session evidence of patients’ use of CT skills was related to a lower rate of relapse in the year following CT for depression. The current investigation attempts to integrate and extend these findings within 2 separate samples of patients and therapists. Method Drawing from the CT samples (N = 105, mean age = 40 years, female = 62%, White = 82%) of 2 published randomized clinical trials of depression treatment, we conducted analyses to examine whether therapist adherence to concrete CT techniques (Collaborative Study Psychotherapy Rating Scale) and the quality of the therapeutic alliance (Working Alliance Inventory) predict patients’ use of CT skills (Performance of Cognitive Therapy Strategies) and subsequent Beck Depression Inventory symptom change. Results Results indicated a differential pattern of prediction in the 2 samples. In one, CT techniques exhibited a stronger association with patient CT skills and symptom change than did the alliance, whereas the reverse pattern emerged in the second sample. A baseline symptom severity × CT techniques interaction indicated that between-study differences in intake depression severity might in part explain the process– outcome differences. Conclusions The present findings suggest that the nature of the therapy sample examined may moderate process–outcome findings in psychotherapy research. The implications of these results and directions for future research are discussed. PMID:22468907

Understanding the working alliance with clients diagnosed with anorexia nervosa.

PubMed

Oyer, Laura; O'Halloran, Mary Sean; Christoe-Frazier, Liesel

2016-01-01

The therapeutic working alliance is a vital ingredient of psychotherapy, specifically for clients diagnosed with anorexia nervosa, as progress is often slow and treatment difficult. This qualitative phenomenological study investigated the experiences of eight clients with anorexia nervosa and seven therapists who work with this population, regarding which therapist factors aided in and challenged the working alliance formation in individual psychotherapy. Data was gathered through semi-structured interviews. Some helpful therapist factors included collaboration, appropriate self-disclosure, providing a warm and safe environment, and willingness to be contacted outside of a session. Unhelpful factors included lack of attunement and objectivity and failure to individualize treatment.

Recalibrating Alliance Contributions: Changing Policy Environment and Military Alliances

DTIC Science & Technology

2005-06-01

Organization,” International Studies Quarterly, 27, 1983, pp.77-96. 14 effects on peace and war have been studied ..7,8 Alliance adaptation and alliance...high. The private consumption increased because of asset effects reflecting the high stock and land price.7 The increase of private consumption and... effect of some of the environment change on the alliance may need a separate and full study . For example, what is the effect of technological change on

Child and adolescent service experience (ChASE): measuring service quality and therapeutic process.

PubMed

Day, Crispin; Michelson, Daniel; Hassan, Imren

2011-11-01

OBJECTIVES. Dissatisfaction with services has been associated with poorer child mental health outcomes, early treatment termination as well as disagreements over the nature of mental health difficulties, reasons for referral and therapy goals. The development of straightforward, reliable, and accurate methods of eliciting service users' views is essential within child and adolescent mental health care. This paper describes the development of the child and adolescent service experience (ChASE), a tool to measure children and young people's service experience DESIGN. The study comprises a non-experimental, cross-sectional design. METHODS. Participants were 132 mental health service users aged 8-18 years. Participants and their main carer completed the ChASE, Parent Satisfaction Questionnaire (PSQ) (Stallard, 1996) and Strengths and Difficulties (SDQ) Impact Supplement. Clinicians completed the SDQ Impact Supplement and provided clinical activity data. A sub-sample of participants completed the ChASE on a second occasion, 6 weeks after the completion of the first questionnaire. RESULTS. Scrutiny of ChASE data indicated high levels of completion. Principal axis factoring identified three factors within the ChASE: Relationship, Privacy, and Session Activity. The ChASE has good internal consistency and test-retest reliability. Significant correlations were found between the ChASE and carer satisfaction, service use, and youth clinical outcomes. CONCLUSIONS. The ChASE is a short, psychometrically robust tool for routine measurement of children, and young people's experience of mental health services, which users can complete easily. The results underline the importance of alliance factors to children and young people and their association with clinical improvement as well as the potential for the ChASE to be used a measure of children's therapeutic progress and alliance. ©2011 The British Psychological Society.

National Special Education Alliance.

ERIC Educational Resources Information Center

Pressman, Harvey

1987-01-01

The article describes the National Special Education Alliance, a network of parent-led organizations seeking to speed the delivery of computer technology to the disabled. Discussed are program origins, starting a local center, charter members of the alliance, benefits of Alliance membership, and the Alliance's relationship with Apple computer. (DB)

The relationship between agreeableness and the development of the working alliance in patients with borderline personality disorder.

PubMed

Hirsh, Jacob B; Quilty, Lena C; Bagby, R Michael; McMain, Shelley F

2012-08-01

The working alliance between therapist and patient is an important component of effective interventions for borderline personality disorder (BPD). The current study examines whether client personality affects the development of the working alliance during the treatment of BPD, and whether this influences treatment effectiveness. Data was based on 87 patients with BPD who were participants in a randomized controlled trial comparing Dialectical Behavior Therapy (DBT) and general psychiatric management. Higher levels of trait Agreeableness were associated with steeper increases in working alliance throughout treatment, but only in the DBT condition. Increases in working alliance were in turn associated with better clinical outcomes. Mediation models revealed a significant indirect path from Agreeableness to better clinical outcomes, mediated through larger improvements in working alliance over time. These results highlight the role that patient personality can play during the therapeutic process, with a specific focus on the importance of Agreeableness for alliance development.

Use of technology for note taking and therapeutic alliance.

PubMed

Wiarda, Nicholas R; McMinn, Mark R; Peterson, Mary A; Gregor, Joel A

2014-09-01

Is psychotherapeutic alliance helped or harmed by using an iPad or computer during an intake session? Two studies are reported where psychotherapists use one of three different technologies in semistructured initial interviews: paper and pen, iPad, or a computer. The studies were conducted at a Primary Care Clinic and a Community Mental Health Clinic to provide a broader context to account for recent behavioral health integration into medical settings in addition to a traditional psychotherapy setting. The Primary Care Study consisted of 60 participants from a behavioral health service at a primary care clinic. The Community Mental Health Study involved 55 participants from a community mental health clinic in semirural Oregon. No differences were found for the three technologies in either study. Practice and training implications are offered. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Nanotechnology-based cancer therapeutics--promise and challenge--lessons learned through the NCI Alliance for Nanotechnology in Cancer.

PubMed

Farrell, Dorothy; Ptak, Krzysztof; Panaro, Nicholas J; Grodzinski, Piotr

2011-02-01

The new generation of nanotechnology-based drug formulations is challenging the accepted ways of cancer treatment. Multi-functional nanomaterial constructs have the capability to be delivered directly to the tumor site and eradicate cancer cells selectively, while sparing healthy cells. Tailoring of the nano-construct design can result in enhanced drug efficacy at lower doses as compared to free drug treatment, wider therapeutic window, and lower side effects. Nanoparticle carriers can also address several drug delivery problems which could not be effectively solved in the past and include reduction of multi-drug resistance effects, delivery of siRNA, and penetration of the blood-brain-barrier. Although challenges in understanding toxicity, biodistribution, and paving an effective regulatory path must be met, nanoscale devices carry a formidable promise to change ways cancer is diagnosed and treated. This article summarizes current developments in nanotechnology-based drug delivery and discusses path forward in this field. The discussion is done in context of research and development occurring within the NCI Alliance for Nanotechnology in Cancer program.

Helping Alliance, Retention, and Treatment Outcomes: A Secondary Analysis From the NIDA Clinical Trials Network Women and Trauma Study

PubMed Central

Ruglass, Lesia M.; Miele, Gloria M.; Hien, Denise A.; Campbell, Aimee N. C.; Hu, Mei-Chen; Caldeira, Nathilee; Jiang, Huiping; Litt, Lisa; Killeen, Therese; Hatch-Maillette, Mary; Najavits, Lisa; Brown, Chanda; Robinson, James A.; Brigham, Gregory S.; Nunes, Edward V.

2013-01-01

We examined the association between the therapeutic alliance and treatment outcomes among 223 women with posttraumatic stress disorder (PTSD) and substance use disorders who participated in a multisite clinical trial of group treatments for trauma and addictions in the United States throughout 2004 and 2005. General linear models indicated that women who received Seeking Safety, a cognitive-behavioral treatment, had significantly higher alliance ratings than those in Women's Health Education, a control group. Alliance was related to significant decreases in PTSD symptoms and higher attendance in both interventions. Alliance was not related to substance use outcomes. Implications and limitations of the findings are discussed. PMID:22475068

Alliance in Two Telephone-Administered Treatments: Relationship with Depression and Health Outcomes

ERIC Educational Resources Information Center

Beckner, Victoria; Vella, Lea; Howard, Isa; Mohr, David C.

2007-01-01

The present study examined the relationship between therapeutic alliance and both depression and health outcomes in a randomized clinical trial of 2 telephone-administered treatments with 97 clients with multiple sclerosis (MS). The 16-week, manualized treatments compared were telephone-administered cognitive-behavioral therapy (T-CBT) and…

The Alliance Negotiation Scale: A psychometric investigation.

PubMed

Doran, Jennifer M; Safran, Jeremy D; Muran, J Christopher

2016-08-01

This study investigates the utility and psychometric properties of a new measure of psychotherapy process, the Alliance Negotiation Scale (ANS; Doran, Safran, Waizmann, Bolger, & Muran, 2012). The ANS was designed to operationalize the theoretical construct of negotiation (Safran & Muran, 2000), and to extend our current understanding of the working alliance concept (Bordin, 1979). The ANS was also intended to improve upon existing measures such as the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) and its short form (WAI-S; Tracey & Kokotovic, 1989) by expanding the emphasis on negative therapy process. The present study investigates the psychometric validity of the ANS test scores and interpretation-including confirming its original factor structure and evaluating its internal consistency and construct validity. Construct validity was examined through the ANS' convergence and divergence with several existing scales that measure theoretically related constructs. The results bolster and extend previous findings about the psychometric integrity of the ANS, and begin to illuminate the relationship between negotiation and other important variables in psychotherapy research. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The therapeutic relationship in e-therapy for mental health: a systematic review.

PubMed

Sucala, Madalina; Schnur, Julie B; Constantino, Michael J; Miller, Sarah J; Brackman, Emily H; Montgomery, Guy H

2012-08-02

E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Our objective in this study was to systematically review the therapeutic relationship in e-therapy. We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance-a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.

The Relationship between Supervisee Stress, Coping Resources, the Working Alliance, and the Supervisory Working Alliance

ERIC Educational Resources Information Center

Gnilka, Philip B.; Chang, Catherine Y.; Dew, Brian J.

2012-01-01

The authors examined the relationship of perceived stress, specific types of coping resources, the working alliance, and the supervisory working alliance among 232 counselor supervisees. The working alliance and the supervisory working alliance were negatively related to perceived stress and positively related to multiple coping resources. Two…

[Determine the patient's position towards psychiatric care: a simple tool to estimate the alliance and the motivation].

PubMed

Versaevel, C; Samama, D; Jeanson, R; Lajugie, C; Dufeutrel, L; Defromont, L; Lebouteiller, V; Danel, T; Duhamel, A; Genin, M; Salleron, J; Cottencin, O

2013-09-01

For the brief systemic therapy (BST), the evaluation of the patient's position towards the care is a prerequisite to psychotherapy. Three positions of the patient are described. The "tourist's" position: the patient claims to have no problem and doesn't suffer. Someone asks him to make an appointment, sometimes with threats. The "complaint's" position: the patient claims to suffer, but attributes the responsibility of this suffering to others. These two positions are not good for beginning a therapy. The "customer's" position differs from both previous positions. The "customer" considers that he has a psychological problem which depends on him and he is motivated in the resolution of it. In theory, the "customer" is more motivated and the therapeutic alliance is better. It is for this reason that the BST estimates the position of the patient at first, to bring the patient to the "customer's" position. The objective of this study is to assess an interview which identifies the patient's position towards the care, and to validate the theoretical elaborations of the brief systemic therapy. The study concerns the follow-up of outpatients who consult a psychiatrist for the first time. The evaluation of the patients checks their position towards care using the Tourist-Complaint-Customer (TCC) inventory, how they suffer, the therapeutic alliance (scale Haq-2) and the compliance during care. The evaluation by the psychiatrists checks the suffering perceived, the motivation perceived and the diagnoses according to the DSM. The typology of these patients is made up of one half "complaint", a quarter of "tourist" and a quarter of "customer". The "customer's" position is correlated with the therapeutic alliance and the motivation perceived by the psychiatrist. The motivation perceived by the psychiatrist is correlated with the therapeutic alliance. These results correspond to the theoretical elaborations of the BST. the TCC inventory provides information on the motivation and

Alliances in "The Hunger Games"

ERIC Educational Resources Information Center

Painter, Judith

2012-01-01

This lesson plan is based on "The Hunger Games" by Suzanne Collins. Characters in "The Hunger Games" form alliances both inside and outside the arena. Katniss and Gale form alliances within District 12. Katniss, Peeta, and the other tributes form alliances for a variety of reasons during the Games. An alliance means that "someone's got your back"…

The Development of a Measure of the Parenting Alliance.

ERIC Educational Resources Information Center

Abidin, Richard R.; Brunner, John F.

The Parenting Alliance Inventory (PAI) was administered to 186 mothers and 75 fathers with a wide range of socioeconomic backgrounds who had at least one child between 2 and 6 years of age. Subjects were recruited from child care facilities, pediatric practices, and public recreational facilities in central Virginia. Extrafamilial child caregivers…

Strengthening the working alliance through a clinician's familiarity with the 12-step approach.

PubMed

Dennis, Cory B; Roland, Brian D; Loneck, Barry M

2018-01-01

The working alliance plays an important role in the substance use disorder treatment process. Many substance use disorder treatment providers incorporate the 12-Step approach to recovery into treatment. With the 12-Step approach known among many clients and clinicians, it may well factor into the therapeutic relationship. We investigated how, from the perspective of clients, a clinician's level of familiarity with and in-session time spent on the 12-Step approach might affect the working alliance between clients and clinicians, including possible differences based on a clinician's recovery status. We conducted a secondary study using data from 180 clients and 31 clinicians. Approximately 81% of client participants were male, and approximately 65% of clinician participants were female. We analyzed data with Stata using a population-averaged model. From the perspective of clients with a substance use disorder, clinicians' familiarity with the 12-Step approach has a positive relationship with the working alliance. The client-estimated amount of in-session time spent on the 12-Step approach did not have a statistically significant effect on ratings of the working alliance. A clinician's recovery status did not moderate the relationship between 12-Step familiarity and the working alliance. These results suggest that clinicians can influence, in part, how their clients perceive the working alliance by being familiar with the 12-Step approach. This might be particularly salient for clinicians who provide substance use disorder treatment at agencies that incorporate, on some level, the 12-Step approach to recovery.

Lessons Learned: A Strategic Alliance to Improve Elementary Physical Education in an Urban School District.

PubMed

Thompson, Hannah R; Haguewood, Robin; Tantoco, Nicole; Madsen, Kristine A

2015-01-01

Physical education (PE) can help to achieve important public health goals, but is often under-prioritized and lacking in schools. To detail the actions, impact, and successes of a strategic alliance formed by three collaborating organizations to improve PE in a large California school district. Semistructured interviews with alliance members, principals, and teachers in 20 elementary schools, 3 years after the alliance formation. Interviewees reported district-level increases in priority and funding for PE and attributed improvements to the alliance's collection and dissemination of local data on the status of PE. Common goals, trust, and open communication within the alliance were seen as critical to the alliance's success. However, changes in district- or school-level accountability measures for PE were not reported. This strategic alliance succeeded in promoting district-level priority and funding for PE. Ongoing alliance work will focus on increasing accountability measures for PE, which may take longer to implement.

A therapist version of the Alliance Negotiation Scale.

PubMed

Doran, Jennifer M; Gómez-Penedo, Juan Martín; Safran, Jeremy D; Roussos, Andrés

2018-05-02

The aim of the current study was to design and evaluate a therapist version of the Alliance Negotiation Scale (ANS). The ANS was created in order to operationalize the construct of dyadic negotiation in psychotherapy and to augment existing conceptualizations of the working alliance. The ANS has existed only as a client self-report form since its inception and has demonstrated promise as a psychotherapy process measure. This research intended to develop a complementary therapist self-report version of the measure. The scale creation process is discussed in detail, and the results of a preliminary psychometric investigation are reported. The ANS-Therapist version (ANS-T) was developed using a sample of therapists (n = 114) through a principal components analysis procedure. The ANS-T contains 9 unidimensional items and was moderately correlated with therapist-reported working alliance (r = .468). The results of the study support the composition of the ANS-T and provide initial support for the reliability and validity of the measure. Copyright © 2018 John Wiley & Sons, Ltd.

The working alliance and Clinician-assisted Emotional Disclosure for rheumatoid arthritis.

PubMed

Lumley, Mark A; Anderson, Timothy; Ankawi, Brett; Goldman, Gregory; Perri, LisaCaitlin M; Bianco, Joseph A; Keefe, Francis J

2018-01-01

The working alliance predicts improvement following general psychotherapy, but how it operates in brief interventions conducted with medically ill patients is unknown. Also, the role of the working alliance may differ in emotion-focused versus educational interventions. We report secondary analyses of a randomized clinical trial (Keefe et al.) [35], in which patients with rheumatoid arthritis (RA) received four nurse-provided sessions of either a) Clinician-assisted Emotional Disclosure (CAED), which emphasized the disclosure, expression, and processing of emotions related to stressful events; or b) Arthritis Education (AE), which provided basic education about RA. The Working Alliance Inventory was completed by both patient and nurse after each session. Patients were evaluated on multiple health measures at baseline and 1, 3, and 12months post-treatment. Analyses compared the alliance between interventions and related the alliance to outcomes within interventions. Patients in CAED reported a lower alliance than patients in AE. Interestingly, in CAED, lower alliance ratings predicted better outcomes (improved functioning, lower pain behaviors, lower inflammation, lower daily stress), whereas in AE, the working alliance was largely not predictive of outcomes. Having nurses encourage emotional disclosure among patients with RA reduced the patients' working alliance, but a lower alliance nonetheless predicted better patient outcomes, perhaps reflecting successful engagement in an intervention that is emotionally and relationally challenging. The level and predictive validity of the working alliance likely depends on patient, provider, and intervention factors, and further study of the working alliance in psychosocial interventions in the medical context is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of Profiling Microwave Radiometer, Aircraft, and Radiosonde Measurements From the Alliance Icing Research Study (AIRS)

NASA Technical Reports Server (NTRS)

Reehorst, Andrew L.

2001-01-01

Measurements from a profiling microwave radiometer are compared to measurements from a research aircraft and radiosondes. Data compared is temperature, water vapor, and liquid water profiles. Data was gathered at the Alliance Icing Research Study (AIRS) at Mirabel Airport outside Montreal, Canada during December 1999 and January 2000. All radiometer measurements were found to lose accuracy when the radome was wet. When the radome was not wetted, the radiometer was seen to indicate an inverted distribution of liquid water within a cloud. When the radiometer measurements were made at 15 deg. instead of the standard zenith, the measurements were less accurate.

Interpersonal differentiation within depression diagnosis: relating interpersonal subgroups to symptom load and the quality of the early therapeutic alliance.

PubMed

Grosse Holtforth, Martin; Altenstein, David; Krieger, Tobias; Flückiger, Christoph; Wright, Aidan G C; Caspar, Franz

2014-01-01

We examined interpersonal problems in psychotherapy outpatients with a principal diagnosis of a depressive disorder in routine care (n=361). These patients were compared to a normative non-clinical sample and to outpatients with other principal diagnoses (n=959). Furthermore, these patients were statistically assigned to interpersonally defined subgroups that were compared regarding symptoms and the quality of the early alliance. The sample of depressive patients reported higher levels of interpersonal problems than the normative sample and the sample of outpatients without a principal diagnosis of depression. Latent Class Analysis identified eight distinct interpersonal subgroups, which differed regarding self-reported symptom load and the quality of the early alliance. However, therapists' alliance ratings did not differentiate between the groups. This interpersonal differentiation within the group of patients with a principal diagnosis of depression may add to a personalized psychotherapy based on interpersonal profiles.

Alliance through Change

ERIC Educational Resources Information Center

Sebalj, Darlene; Hudson, Susan; Ryan, Jan; Wight-Boycott, Juliet

2007-01-01

Following a landmark organisational change event within the University of Western Sydney, when the university ceased operating as a federation of four distinct, inter-related elements and merged to become a single entity, four foundation College Managers made a strategic decision to form an alliance. This alliance significantly enhanced the…

Dynamics of Alliances.

ERIC Educational Resources Information Center

Hubbard, James; And Others

To encourage the involvement of the community in mathematics, science, and technology education, some states and localities have formed alliances. This book outlines four key components of alliance building: process, environment, structure, and outcomes; and describes how changes in one component affect the others. It is designed to serve as a…

Attachment history as a moderator of the alliance outcome relationship in adolescents.

PubMed

Zack, Sanno E; Castonguay, Louis G; Boswell, James F; McAleavey, Andrew A; Adelman, Robert; Kraus, David R; Pate, George A

2015-06-01

The role of the alliance in predicting treatment outcome is robust and long established. However, much less attention has been paid to mechanisms of change, including moderators, particularly for youth. This study examined the moderating role of pretreatment adolescent-caregiver attachment and its impact on the working alliance-treatment outcome relationship. One hundred adolescents and young adults with primary substance dependence disorders were treated at a residential facility, with a cognitive-behavioral emphasis. The working alliance and clinical symptoms were measured at regular intervals throughout treatment. A moderator hypothesis was tested using a path analytic approach. Findings suggested that attachment to the primary caregiver moderated the impact of the working alliance on treatment outcome, such that for youth with the poorest attachment history, working alliance had a stronger relationship with outcome. Conversely, for those with the strongest attachment histories, alliance was not a significant predictor of symptom reduction. This finding may help elucidate alliance-related mechanisms of change, lending support for theories of corrective emotional experience as one function of the working alliance in youth psychotherapy. (c) 2015 APA, all rights reserved).

Peer Mentoring through eAlliances

NASA Astrophysics Data System (ADS)

Blaha, Cindy; Cunningham, Beth; Cox, Anne; Ramos, Idalia; Whitten, Barbara

2018-06-01

Being a woman in astronomy or physics can be a very isolating experience. Peer mentoring has been shown to help combat this isolation. eAlliance, an NSF ADVANCE PLAN-D program hosted by AAPT, is seeking to establish mutual mentoring networks of women faculty within the physics and astronomy community. The eAlliance program will reduce the isolation of participating faculty members and provide support to help members achieve their personal goals and enhance their career development. Participants register at the eAlliance website (ealliance.aapt.org) and complete a personal profile which is used to match them to other registered women faculty with similar mentoring goals. So far, 95 women have registered in the eAlliance database and 22 of the participants are astronomers. Currently the project has five sponsored eAlliances (with 4-5 members each) and several more in the process of forming. As of March 2018, 4 of the 22 sponsored eAlliance members are astronomers. The mentoring cohorts are holding regular electronic meetings and using project funds to support annual face-to-face meetings at national meetings of their own choosing. The first eAlliance Summit Meeting will be held in July 2018 and will bring all the cohorts together to share their peer mentoring experiences and gather advice for future cohorts just starting out. All women faculty in astronomy and physics are invited to join the eAlliance program.

[Therapeutic touch and anorexia nervosa].

PubMed

Satori, Nadine

2016-01-01

An innovative practice, therapeutic touch has been used for around ten years in the treatment of eating disorders. Delivered by nurse clinicians having received specific training, this approach is based on nursing diagnoses which identify the major symptoms of this pathology. The support is built around the body and its perceptions. Through the helping relationship, it mobilises the patient's resources to favour a relationship of trust, a letting-go, physical, psychological and emotional relaxation, and improves the therapeutic alliance. Copyright © 2016. Published by Elsevier Masson SAS.

[From teaching and care to creativity, a therapeutic stay project].

PubMed

Cherai, M'hand

2011-01-01

A group of young patients led by teachers and caregivers decided to organise a therapeutic stay. The objective of the stay was to visit historical sites to act out scenes from a fictional play written in a workshop. This stay enabled patients to develop their autonomy and strengthened the therapeutic alliance.

Development and Preliminary Examination of the Psychometric Properties of the Psychoeducational Group Alliance Scale for Children (PGA-c) in Two Samples of Children Participating in Groups

ERIC Educational Resources Information Center

Brouzos, Andreas; Vassilopoulos, Stephanos P.; Baourda, Vasiliki C.

2018-01-01

Studies examining processes in youth group psychotherapy are scarce. This article reports on the development and psychometric properties of the Psychoeducational Group Alliance Scale for Children (PGAS-c). This scale was designed to assess the therapeutic alliance that develops between the members and the facilitator in a psychoeducational group…

A model of strategic marketing alliances for hospices: vertical, internal, osmotic alliances and the complete model.

PubMed

Starnes, B J; Self, D R

1999-01-01

This article develops two previous research efforts. William J. Winston (1994, 1995) has proposed a set of strategies by which health care organizations can benefit from forging strategic alliances. Raadt and Self (1997) have proposed a classification model of alliances including horizontal, vertical, internal, and osmotic. In the second of two articles, this paper presents a model of vertical, internal, and osmotic alliances. Advantages and disadvantages of each are discussed. Finally, the complete alliance system model is presented.

Strategic alliances and market risk.

PubMed

Havenaar, Matthias; Hiscocks, Peter

2012-08-01

Strategic alliances in product development and marketing are crucial to the biotechnology industry. Many alliances, however, are terminated before the drug reaches the market. In this article we make the case that strategic alliances can fail because of how they are negotiated. Alliance contracts are often inflexible and do not allow for changes in market conditions. We propose a model for contract valuation that can assist biotech and/or pharma deal makers in negotiating alliances that have a higher chance of survival in uncertain market conditions. The model makes use of variable royalties and milestone payments. Because licensing is key to the biotech and/or pharma business model this article will be of interest not only to professionals in licensing, but to all professionals active in the industry. Copyright © 2012 Elsevier Ltd. All rights reserved.

"What should we talk about?" The association between the information exchanged during the mental health intake and the quality of the working alliance.

PubMed

Nakash, Ora; Nagar, Maayan; Kanat-Maymon, Yaniv

2015-07-01

We investigated the association between the content of the information exchanged between clients and therapists during mental health intake and the quality of the therapeutic alliance. Thirty-eight therapists and 107 clients from four mental health clinics in Israel participated in the study. The content of information discussed was coded directly from the recorded intakes by blinded raters. Clients and therapists completed the Working Alliance Inventory immediately following the intake. Therapists spent the majority of intake time in collecting information about their clients' diagnostic symptoms and personal history and sociocultural background. Due to the high negative correlation between these factors, r(107) = -.68, p < .001, we created a measure of delta score with higher scores reflecting more discussion of personal history and sociocultural background and less discussion of diagnostic symptoms. We computed three-level hierarchical linear model analysis, with intakes nested within therapists and therapists nested within sites, to examine the association between the delta score and the working alliance, while controlling for intake duration. Results showed significant association between the delta score and clients' rating of the working alliance (γ200 = 0.014, p = .02), indicating that discussing more personal history and sociocultural background and less diagnostic symptoms was associated with better clients' rating of the working alliance. Therapists' rating of the working alliance was not significantly associated with the content of the information exchanged. The restricted intake time allocated to therapists dictates use of strategies to deal with time trade-offs to complete a thorough diagnostic assessment while allowing clients to tell their personal story. (c) 2015 APA, all rights reserved).

The quest for connection in interpersonal and therapeutic relationships.

PubMed

Wiseman, Hadas

2017-07-01

This paper focuses on the need for connection as a common core theme at the heart of both close relationships and therapeutic relationships and explores ways to connect these two research domains that have evolved as separate fields of study. Bowlby's attachment theory provides a strong conceptual and empirical base for linking human bonds and bonds in psychotherapy. The growing body of research intersecting attachment and psychotherapy (1980-2014) is documented, and meta-analytic studies on attachment-outcome and attachment-alliance links are highlighted. Five ways of studying attachment as a variable in psychotherapy are underscored: as moderator, as mediator, as outcome, client-therapist attachment match, and as process. By integrating conceptualizations and methods in studying relational narratives of client-therapist dyads (Core Conflictual Relationship Theme), measures of alliance, and client attachment to therapist during psychotherapy, we may discover unique client-therapist relational dances. Future fine-grained studies on how to promote core authentic relational relearning are important to clinicians, supervisors and trainers, who all share the common quest to alleviate interpersonal distress and enhance wellbeing. Directions for advancing research on interpersonal and therapeutic relationships are suggested. Learning from each other, both researchers of close relationships and of psychotherapy relationships can gain a deeper and multidimensional understanding of complex relational processes and outcomes.

Governance processes and change within organizational participants of multi-sectoral community health care alliances: the mediating role of vision, mission, strategy agreement and perceived alliance value.

PubMed

Hearld, Larry R; Alexander, Jeffrey A

2014-03-01

Multi-sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long-term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their 'home' organizations and institutionalize the vision, goals, and programs within participating organizations and the broader community. The purpose of this study was to investigate two mechanisms by which alliance leadership and management processes may promote such changes within organizations participating in alliances. The findings of the study suggest that, despite modest levels of change undertaken by participating organizations, more positive perceptions of alliance leadership, decision making, and conflict management were associated with a greater likelihood of participating organizations making changes as a result of their participation in the alliance, in part by promoting greater vision, mission, and strategy agreement and higher levels of perceived value. Leadership processes had a stronger relationship with change within participating organizations than decision-making style and conflict management processes. Open-ended responses by participants indicated that participating organizations most often incorporated new measures or goals into their existing portfolio of strategic plans and activities in response to alliance participation.

Proceedings of the Inaugural Pediatric Dermatology Research Alliance (PeDRA) Conference

PubMed Central

Siegel, Dawn H.; Choate, Keith; Drolet, Beth A.; Frieden, Ilona J.; Teng, Joyce M.; Tom, Wynnis; Williams, Mary; Eichenfield, Lawrence F.; Paller, Amy S.

2014-01-01

Abstract/Statement of the problem Skin disease research involving children currently faces several major hurdles and as a result, many therapies are only available for off-label use in children and many of the most pressing clinical needs of our pediatric population remain unsolved. A strategic planning committee of the Society for Pediatric Dermatology (SPD) identified the need for an organized, inclusive research alliance to augment the resources of individual practitioners and pre-existing smaller collaborative groups and facilitate robust, multicenter basic, translational, and clinical research and therapeutic trials. A December 2011 National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Roundtable on Pediatric Dermatology further detailed the therapeutic gaps and barriers to translation of scientific advances to clinical practice. Building on these forums, in July 2012, a group of interested investigators met in Monterey, CA to develop the infrastructure for collaborative pediatric skin research, now called the Pediatric Dermatology Research Alliance (PeDRA). The vision of PeDRA is to create sustainable collaborative research networks to better understand, prevent, treat and cure dermatologic diseases in children. From that starting point, subcommittees and expert members were added, stakeholders identified, and seed funding garnered, with the first PeDRA stand-alone research meeting* realized in Chicago, IL in October 2013. PMID:25318428

Development and validation of a 6-item working alliance questionnaire for repeated administrations during psychotherapy.

PubMed

Falkenström, Fredrik; Hatcher, Robert L; Skjulsvik, Tommy; Larsson, Mattias Holmqvist; Holmqvist, Rolf

2015-03-01

Recently, researchers have started to measure the working alliance repeatedly across sessions of psychotherapy, relating the working alliance to symptom change session by session. Responding to questionnaires after each session can become tedious, leading to careless responses and/or increasing levels of missing data. Therefore, assessment with the briefest possible instrument is desirable. Because previous research on the Working Alliance Inventory has found the separation of the Goal and Task factors problematic, the present study examined the psychometric properties of a 2-factor, 6-item working alliance measure, adapted from the Working Alliance Inventory, in 3 patient samples (ns = 1,095, 235, and 234). Results showed that a bifactor model fit the data well across the 3 samples, and the factor structure was stable across 10 sessions of primary care counseling/psychotherapy. Although the bifactor model with 1 general and 2 specific factors outperformed the 1-factor model in terms of model fit, dimensionality analyses based on the bifactor model results indicated that in practice the instrument is best treated as unidimensional. Results support the use of composite scores of all 6 items. The instrument was validated by replicating previous findings of session-by-session prediction of symptom reduction using the Autoregressive Latent Trajectory model. The 6-item working alliance scale, called the Session Alliance Inventory, is a promising alternative for researchers in search for a brief alliance measure to administer after every session. 2015 APA, all rights reserved

The Alliance in a Friendship Coaching Intervention for Parents of Children With ADHD

PubMed Central

Lerner, Matthew D.; Mikami, Amori Yee; McLeod, Bryce D.

2012-01-01

The alliance between parent and therapist was observed in a group-based parent-training intervention to improve social competency among children with attention-deficit/hyperactivity disorder (ADHD). The intervention, called Parental Friendship Coaching (PFC), was delivered to 32 parents in small groups as part of a randomized clinical trial. PFC was delivered in eight, 90-minute sessions to parents; there was no child treatment component. Observed parent–therapist alliance recorded among 27 of the parents was measured using the Therapy Process Observational Coding System—Alliance scale (TPOCS-A; McLeod, 2005). Early alliance and change in alliance over time predicted improvements in several parenting behaviors and child outcomes, including peer sociometrics in a lab-based playgroup. These preliminary findings lend support to the importance of examining the parent–therapist alliance in parent-training groups for youth social and behavioral problems. PMID:21658527

Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome.

PubMed

Anderson, Timothy; Crowley, Mary Ellen J; Himawan, Lina; Holmberg, Jennifer K; Uhlin, Brian D

2016-09-01

Therapist effects, independent of the treatment provided, have emerged as a contributor to psychotherapy outcomes. However, past research largely has not identified which therapist factors might be contributing to these effects, though research on psychotherapy implicates relational characteristics. The present Randomized Clinical Trial tested the efficacy of therapists who were selected by their facilitative interpersonal skills (FIS) and training status. Sixty-five clients were selected from 2713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists met with 2 clients for 7 sessions and 20 participants served in a no-treatment control group. Outcome and alliance differences for Training Status were negligible. High FIS therapists had greater pre-post client outcome, and higher rates of change across sessions, than low FIS therapists. All clients treated by therapists improved more than the silent control, but effects were greater with high FIS than low FIS therapists. From the first session, high FIS therapists also had higher alliances than low FIS therapists as well as significant improvements on client-rated alliance. Results were consistent with the hypothesis that therapists' common relational skills are independent contributors to therapeutic alliance and outcome.

Beef alliances: motivations, extent, and future prospects.

PubMed

Schroeder, Ted C; Kovanda, Joseph

2003-07-01

With their growth, it is important to consider how alliances will impact the beef industry in the future. Alliances have the potential to make sweeping changes to cattle production, live and feeder cattle marketing, food safety protocols, use of government grades and standards, ownership structure, supply chain management, wholesale and retail product marketing, risk management, and many other industry activities. In an effort to address these issues, this article addresses the following questions: What is an alliance? What has motivated their proliferation? What have we learned from alliances? What aspects of alliances affect their likelihood of success or failure? What is the future of alliances? Are they a fad or a long-term evolving industry structural change?

Strategic alliances: an analysis of Catalan hospitals.

PubMed

Bernardo, Merce; Valls, Jaume; Casadesus, Marti

2012-01-01

To analyze the strategic alliances that Catalan hospitals form with other health care entities and other types of institutions to foster technological and organizational innovation. Qualitative case studies were conducted at a sample of 16 public hospitals in Catalonia, Spain. The sample was limited to three (Level 1-3) of Catalonia's four levels of hospitals (classified according to the complexity of the diagnoses and treatments they provide), but Level 4 hospitals were considered as part of the network in the analysis of the alliances. At each hospital, interviews were conducted with the manager, the medical director, and the service director, using a questionnaire that gathered information on strategic alliances with a focus on telemedicine. Qualitative data processing was applied to identify patterns of alliances between hospitals and other institutions. Catalan hospitals interact with other health care agents through three main types of associations: alliances with other hospitals (the most frequent type); alliances with primary care centers (reported mostly by Level 2 hospitals); and alliances with other institutions (e.g., local government, medical companies, and universities). Human resource-sharing (staff mobility) and training were reported most frequently as reasons for creating the alliances. Strategic alliances are formed between hospitals and other health care agents to help improve performance, competitiveness, and services provided to users. These results may help health care system managers promote strategic alliances as a means of optimizing system efficiency without reducing user satisfaction-a key challenge within the context of the current economic situation.

The alliance in a friendship coaching intervention for parents of children with ADHD.

PubMed

Lerner, Matthew D; Mikami, Amori Yee; McLeod, Bryce D

2011-09-01

The alliance between parent and therapist was observed in a group-based parent-training intervention to improve social competency among children with attention-deficit/hyperactivity disorder (ADHD). The intervention, called Parental Friendship Coaching (PFC), was delivered to 32 parents in small groups as part of a randomized clinical trial. PFC was delivered in eight, 90-minute sessions to parents; there was no child treatment component. Observed parent-therapist alliance recorded among 27 of the parents was measured using the Therapy Process Observational Coding System--Alliance scale (TPOCS-A; McLeod, 2005). Early alliance and change in alliance over time predicted improvements in several parenting behaviors and child outcomes, including peer sociometrics in a lab-based playgroup. These preliminary findings lend support to the importance of examining the parent-therapist alliance in parent-training groups for youth social and behavioral problems. Copyright © 2011. Published by Elsevier Ltd.

The working alliance in a randomized controlled trial comparing online with face-to-face cognitive-behavioral therapy for depression

PubMed Central

2011-01-01

Background Although numerous efficacy studies in recent years have found internet-based interventions for depression to be effective, there has been scant consideration of therapeutic process factors in the online setting. In face-to face therapy, the quality of the working alliance explains variance in treatment outcome. However, little is yet known about the impact of the working alliance in internet-based interventions, particularly as compared with face-to-face therapy. Methods This study explored the working alliance between client and therapist in the middle and at the end of a cognitive-behavioral intervention for depression. The participants were randomized to an internet-based treatment group (n = 25) or face-to-face group (n = 28). Both groups received the same cognitive behavioral therapy over an 8-week timeframe. Participants completed the Beck Depression Inventory (BDI) post-treatment and the Working Alliance Inventory at mid- and post- treatment. Therapists completed the therapist version of the Working Alliance Inventory at post-treatment. Results With the exception of therapists' ratings of the tasks subscale, which were significantly higher in the online group, the two groups' ratings of the working alliance did not differ significantly. Further, significant correlations were found between clients' ratings of the working alliance and therapy outcome at post-treatment in the online group and at both mid- and post-treatment in the face-to-face group. Correlation analysis revealed that the working alliance ratings did not significantly predict the BDI residual gain score in either group. Conclusions Contrary to what might have been expected, the working alliance in the online group was comparable to that in the face-to-face group. However, the results showed no significant relations between the BDI residual gain score and the working alliance ratings in either group. Trial registration ACTRN12611000563965 PMID:22145768

Fostering change within organizational participants of multisectoral health care alliances.

PubMed

Hearld, Larry R; Alexander, Jeffrey A; Mittler, Jessica N

2012-01-01

A touted advantage of multisectoral health care alliances is their ability to coordinate diverse constituencies and pursue community health goals in ways that allow them to make greater progress than each constituency could independently. However, participating organizations may have goals that do not entirely overlap or necessarily align with the alliance's goals, which can weaken or undermine an alliance's efforts. Fostering changes within participating organizations in ways that are consistent with the alliance's goals (i.e., alliance-oriented change) may be one mechanism by which alliances can coordinate diverse activities and improve care in their local communities. We examined whether alliance-oriented change within participating organizations is associated with alliance decision-making and conflict management style, level of participation, perceptions of alliance participation benefits and costs, and awareness of alliance activities within participating organizations. The study used two rounds of survey data collected from organizational participants of 14 alliances participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality program. Alliance participants generally reported low levels of alliance-oriented change within their organizations as a result of the alliance and its activities. However, participants reporting higher levels of internal change in response to alliance activities had more positive perceptions of alliance decision-making style, higher levels of participation in alliance activities, more positive perceptions of alliance participation benefits relative to costs, and greater awareness of alliance activities across multiple levels of their respective organizations. Despite relatively low levels of alliance-oriented change within participating organizations, alliances may still have the means to align the goal orientations of a diverse membership and foster change that may extend the reach of the alliance in the community.

Entrepreneurial Alliances: A Study of Entrepreneurship and Strategic Alliances in the Charter School Industry

ERIC Educational Resources Information Center

Washington, Cheryl A.

2012-01-01

This study investigated the practices, processes, and success rates of 15 entrepreneurial alliances in the Texas charter school industry. The research involved interdisciplinary industries (business and education) and focused on how a specific type of alliance structure utilized social innovation to exploit opportunity and impact change in the…

Testing a mediation model of psychotherapy process and outcome in psychodynamic psychotherapy: Previous client distress, psychodynamic techniques, dyadic working alliance, and current client distress.

PubMed

Kivlighan, Dennis M; Hill, Clara E; Ross, Katherine; Kline, Kathryn; Furhmann, Amy; Sauber, Elizabeth

2018-01-05

To test a sequential model of psychotherapy process and outcome, we included previous client distress, therapist psychodynamic techniques, dyadic working alliance, and current client distress. For 114 sets of eight-session segments in 40 cases of psychodynamic psychotherapy, clients completed the Outcome Questionnaire-45 and Inventory of Interpersonal Problems-32 after the first and final session, judges reliably coded one middle sessions on the Psychodynamic subscale of the Multitheoretical List of Therapeutic Interventions, and clients and therapists completed the Working Alliance Inventory after every session. Results indicated that higher use of psychodynamic techniques was associated with higher levels of the working alliance, which in turn was associated decreased client distress; and working alliance was higher later in psychotherapy. There was a significant indirect effect of psychodynamic techniques on decreases in distress mediated by the working alliance. Implications for theory, practice, and research are provided. Clinical or methodological significance of this article: Conducted a longitudinal, latent variable examination of the relationships of psychodynamic techniques and working alliance on client distress. Psychodynamic techniques have an indirect effect on decreases in client distress through the dyadic working alliance.

Space Alliance Technology Outreach Program

NASA Technical Reports Server (NTRS)

2005-01-01

Space Alliance Technology Outreach Program (SATOP), will provide technical assistance to small businesses through the contribution of time and expertise from Space Alliance Partners and support the development and expansion of technology business incubation programs in Florida and New York. A summary of these accomplishments are given.

Strategic Alliance Poker: Demonstrating the Importance of Complementary Resources and Trust in Strategic Alliance Management

ERIC Educational Resources Information Center

Reutzel, Christopher R.; Worthington, William J.; Collins, Jamie D.

2012-01-01

Strategic Alliance Poker (SAP) provides instructors with an opportunity to integrate the resource based view with their discussion of strategic alliances in undergraduate Strategic Management courses. Specifically, SAP provides Strategic Management instructors with an experiential exercise that can be used to illustrate the value creation…

The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review

PubMed Central

Schnur, Julie B; Constantino, Michael J; Miller, Sarah J; Brackman, Emily H; Montgomery, Guy H

2012-01-01

Background E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Objective Our objective in this study was to systematically review the therapeutic relationship in e-therapy. Methods We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. Results From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Conclusions Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments. PMID:22858538

Building Alliances Series: Workforce Development

ERIC Educational Resources Information Center

Brady, Cecilia

2009-01-01

Public-private partnerships done right are a powerful tool for development, providing enduring solutions to some of the greatest challenges. To help familiarize readers with the art of alliance building, the Global Development Alliance (GDA) office has created a series of practical guides that highlight proven practices in partnerships,…

The Slaying of a Beautiful Hypothesis: The Efficacy of Counseling and the Therapeutic Process

ERIC Educational Resources Information Center

Hauser, Mike; Hays, Danica G.

2010-01-01

Although the efficacy of counseling has been empirically linked to the therapeutic process, the emphasis in much of the literature remains on technique use. This article discusses 3 components of therapeutic efficacy (i.e., common factors, working alliance, and counselor attributes) and provides implications for counselors and counselor training.…

Reciprocal empathy and working alliance in terminal oncological illness: the crucial role of patients' attachment style.

PubMed

Calvo, Vincenzo; Palmieri, Arianna; Marinelli, Sara; Bianco, Francesca; Kleinbub, Johann R

2014-01-01

Security of attachment is described as an inner resource that may also facilitate the adaptation of individuals during critical life adversity, even when facing end-stage illness and death. This study assessed the relation between attachment styles, patient-caregiver reciprocal empathy, and patient-physician working alliance, in the terminal phase of an oncological disease. We hypothesized that the attachment security of patients, as measured by the Relationship Questionnaire (RQ), is related to the reciprocal empathy with the caregiver, as measured by the Perception of Partner Empathy (PPE) questionnaire, and to the working alliance with the physician, as measured by the Working Alliance Inventory-Short Form (WAI-S). Thirty-seven end-stage cancer patients, their caregivers, and physicians participated in the study. The PPE and WAI-S were administered twice: immediately after the hospice recovery and a week later. Results showed a significant improvement in patient-caregiver empathy and in patient-physician alliance after a week at the hospice. Findings indicated that the patients' attachment style influenced their perception of reciprocal empathy with the caregiver and the working alliance with the physician. Patients with a secure attachment had a greater capacity to show empathic closeness with their caregivers and enjoyed a better working alliance with their physicians. Caregivers' attachment security, otherwise, did not show the same influence on empathy and alliance. Findings support the hypothesis that patients' attachment security plays a crucial role in the relation with their own caregiver and with the physician, even at the terminal phase. Theoretical and clinical implications of these findings are explored in the discussion.

Traumatic events, posttraumatic stress disorder, attachment style, and working alliance in a sample of people with psychosis.

PubMed

Picken, Alicia L; Berry, Katherine; Tarrier, Nicholas; Barrowclough, Christine

2010-10-01

There is a high incidence of trauma and posttraumatic stress disorder (PTSD) in people with a diagnosis of psychosis. Sequelae of trauma may affect the ability to engage in both attachment and therapeutic relationships. This study investigated associations between trauma histories, PTSD, attachment styles, and working alliance in a sample of 110 individuals with psychosis and substance misuse. Anxious attachment was associated with number of interpersonal traumas and PTSD reported, but there were no associations between trauma and alliance. There were discrepancies in number of traumatic events reported by care coordinators and patients. The findings of this study highlight the potential use of attachment theory in working with trauma and PTSD in psychosis.

Your alliances are too stable.

PubMed

Ernst, David; Bamford, James

2005-06-01

A 2004 McKinsey survey of more than 30 companies reveals that at least 70% of them have major alliances that are underperforming and in need of restructuring. Moreover, JVs that broaden or otherwise adjust their scope have a 79% success rate, versus 33% for ventures that remain essentially unchanged. Yet most firms don't routinely evaluate the need to overhaul their alliances or intervene to correct performance problems. That means corporations are missing huge opportunities: By revamping just one large alliance, a company can generate 100 million dololars to 300 million dollars in extra income a year. Here's how to unlock more value from alliances: (1) Launch the process. Don't wait until your venture is in the middle of a crisis; regularly scan your major alliances to determine which need restructuring. Once you've targeted one, designate a restructuring team and find a senior sponsor to push the process along. Then delineate the scope of the team's work. (2) Diagnose performance. Evaluate the venture on the following performance dimensions: ownership and financials, strategy, operations, governance, and organization and talent. Identify the root causes of the venture's problems, not just the symptoms, and estimate how much each problem is costing the company. (3) Generate restructuring options. Based on the diagnosis, decide whether to fix, grow, or exit the alliance. Assuming the answer is fix or grow, determine whether fundamental or incremental changes are needed, using the five performance dimensions above as a framework. Then assemble three or four packages of restructuring options, test them with shareholders, and gain parents' approval. (4) Execute the changes. Embark on a widespread and consistent communication effort, building support among executives in the JV and the parent companies. So the process stays on track, assign accountability to certain groups or individuals.

[Anorexia nervosa in children and adolescent: new therapeutic approaches].

PubMed

Doyen, C; Le Heuzey, M F; Cook, S; Flého, F; Mouren-Siméoni, M C

1999-11-01

Classical therapeutic recommendations requires that girls with anorexia nervosa be separated from their parents. Refeeding, and later individual psychodynamic approaches were also emphasized. These guidelines are now broadened towards psychotherapeutic approaches (psychodynamic, familial, cognitive-behavioral) associated with psychoeducational and dietetic strategies. In the Child and Adolescent Psychopathology Unit of Robert-Debre Hospital in Paris, individual therapeutic programs are applied to young anorectic girls and their families. These programs are implemented within an inpatient (full-time, part-time) or outpatient (consultations, weekly day-therapeutic program) framework. In order to forge a therapeutic alliance with parents and restore "parental competences" feelings, we do not separate any longer anorectic girls from their parents during hospitalization, and we have developed an alternative therapeutic model to full-time hospitalization.

Patient-Oncologist Alliance, Psychosocial Well-Being, and Treatment Adherence Among Young Adults With Advanced Cancer

PubMed Central

Trevino, Kelly M.; Fasciano, Karen; Prigerson, Holly G.

2013-01-01

Purpose Patients who develop a strong alliance with their health care providers have been shown to have higher levels of psychosocial well-being and rates of treatment adherence. Young adults with cancer have lower levels of psychosocial well-being and treatment adherence relative to patients with cancer in other age groups. This study sought to evaluate the relationships between the patient-oncologist alliance, psychosocial well-being, and treatment adherence in young adults with advanced cancer. Patients and Methods Ninety-five young adults (age 20 to 40 years) with advanced cancer were administered measures of alliance, psychosocial well-being, willingness to adhere to treatment, and treatment adherence. Relationships between alliance and psychosocial well-being were examined bivariately. Multiple linear regression models examined the relationship between alliance and adherence, controlling for confounding influences (eg, psychosocial well-being). Results Alliance was significantly (P ≤ .01) and positively associated with greater perceived social support and less severe illness-related grief. After controlling for significant confounding influences (ie, metastases, appraised support, and grief), alliance remained significantly (P ≤ .01) associated with greater willingness to adhere to treatment and greater adherence to oral medication. Conclusion By developing a strong alliance, oncologists may enhance psychosocial well-being and increase treatment adherence in young adult patients with advanced cancer. PMID:23530105

The Empirical Analysis of Impact of Alliances on Airline Operations

NASA Technical Reports Server (NTRS)

Iatrou, Kostas; Alamdari, Fariba

2003-01-01

Airline alliances are dominating the current air transport industry with the largest carriers of the world belonging to one of the four alliance groupings - "Wings", Star Alliance, one world, SkyTeam - which represent 56% of world Revenue Passenger Kilometers. Although much research has been carried out to evaluate the impact of alliance membership on performance of airlines, it would be of interest to ascertain the degree of impact perceived by participating airlines in alliances. It is the purpose of this paper to gather the opinion of all the airlines, belonging to the four global alliance groupings on the impact alliances have had on their traffic and on their performance in general To achieve this, a comprehensive survey of the alliance management departments of airlines participating in the four global strategic alliances was carried out. With this framework the survey has examined which type of cooperation among carriers (FFP, Code Share, Strategic Alliance without antitrust immunity, Strategic Alliance with antitrust immunity) has produced the most positive impact on traffic and which type of route (short haul, long haul, hub-hub, hub-non hub, non hub-non hub) has been mostly affected. In addition, the respondent airlines quantified the effect alliances have had on specific areas of their operation, such as load factors, traffic, costs, revenue and fares. Their responses have been analysed under each global alliances grouping, under airline and under geographic region to establish which group, type of carrier and geographic region has benefited most. The results show that each of the four global alliances groupings has experienced different results according to the type of collaboration agreed amongst their member airlines.

How collaboration in therapy becomes therapeutic: the therapeutic collaboration coding system.

PubMed

Ribeiro, Eugénia; Ribeiro, António P; Gonçalves, Miguel M; Horvath, Adam O; Stiles, William B

2013-09-01

The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy. We propose a conceptual account of how collaboration in therapy becomes therapeutic. In addition, we report on the construction of a coding system - the therapeutic collaboration coding system (TCCS) - designed to analyse and track on a moment-by-moment basis the interaction between therapist and client. Preliminary evidence is presented regarding the coding system's psychometric properties. The TCCS evaluates each speaking turn and assesses whether and how therapists are working within the client's therapeutic zone of proximal development, defined as the space between the client's actual therapeutic developmental level and their potential developmental level that can be reached in collaboration with the therapist. We applied the TCCS to five cases: a good and a poor outcome case of narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and a dropout case of narrative therapy. The TCCS offers markers that may help researchers better understand the therapeutic collaboration on a moment-to-moment basis and may help therapists better regulate the relationship. © 2012 The British Psychological Society.

Developing consensus measures for global programs: lessons from the Global Alliance for Chronic Diseases Hypertension research program.

PubMed

Riddell, Michaela A; Edwards, Nancy; Thompson, Simon R; Bernabe-Ortiz, Antonio; Praveen, Devarsetty; Johnson, Claire; Kengne, Andre P; Liu, Peter; McCready, Tara; Ng, Eleanor; Nieuwlaat, Robby; Ovbiagele, Bruce; Owolabi, Mayowa; Peiris, David; Thrift, Amanda G; Tobe, Sheldon; Yusoff, Khalid

2017-03-15

The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams' data collection plans. One year later all teams were asked which consensus measures had been implemented. Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. Deriving consensus measures across diverse research projects and contexts was challenging

Alliances and Legitimacy: Walking the Operational Tightrope

DTIC Science & Technology

2013-05-23

powers. In effect , this describes a dynamic whereby alliances serve the interests of both strong 111Brett Ashley Leeds, “Alliance Reliability in...comply with a collection of information if it does not display a currently valid OMB control number . PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS...ALLIANCES AND LEGITIMACY: WALKING THE OPERATIONAL TIGHTROPE 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S

Working alliance, interpersonal trust and perceived coercion in mental health review hearings

PubMed Central

2011-01-01

Background There is some evidence that when mental health commitment hearings are held in accordance with therapeutic jurisprudence principles they are perceived as less coercive, and more just in their procedures leading to improved treatment adherence and fewer hospital readmissions. This suggests an effect of the hearing on therapeutic relationships. We compared working alliance and interpersonal trust in clinicians and forensic patients, whose continued detentions were reviewed by two different legal review bodies according to their legal category. Methods The hearings were rated as positive or negative by patients and treating psychiatrists using the MacArthur scales for perceived coercion, perceived procedural justice (legal and medical) and for the impact of the hearing. We rated Global assessment of Function (GAF), Positive and Negative Symptom Scale (PANSS), Working Alliance Inventory (WAI) and Interpersonal Trust in Physician (ITP) scales six months before the hearing and repeated the WAI and ITP two weeks before and two weeks after the hearing, for 75 of 83 patients in a forensic medium and high secure hospital. Results Psychiatrists agreed with patients regarding the rating of hearings. Patients rated civil hearings (MHTs) more negatively than hearings under insanity legislation (MHRBs). Those reviewed by MHTs had lower scores for WAI and ITP. However, post-hearing WAI and ITP scores were not different from baseline and pre-hearing scores. Using the receiver operating characteristic, baseline WAI and ITP scores predicted how patients would rate the hearings, as did baseline GAF and PANSS scores. Conclusions There was no evidence that positively perceived hearings improved WAI or ITP, but some evidence showed that negatively perceived hearings worsened them. Concentrating on functional recovery and symptom remission remains the best strategy for improved therapeutic relationships. PMID:22074788

Storytelling Project. Southeast Asian Women's Alliance.

ERIC Educational Resources Information Center

de Barros, Judy; And Others

Geared to refugee women, the storytelling project developed by the Refugee Women's Alliance (formerly the South East Asian Women's Alliance) in Seattle, Washington, combines language, cross-cultural, and family skills. The project included development of the storytelling curriculum for English-as-a-Second-Language students, training instructors,…

Therapeutic bond judgments: Congruence and incongruence.

PubMed

Atzil-Slonim, Dana; Bar-Kalifa, Eran; Rafaeli, Eshkol; Lutz, Wolfgang; Rubel, Julian; Schiefele, Ann-Kathrin; Peri, Tuvia

2015-08-01

The present study had 2 aims: (a) to implement West and Kenny's (2011) Truth-and-Bias model to simultaneously assess the temporal congruence and directional discrepancy between clients' and therapists' ratings of the bond facet of the therapeutic alliance, as they cofluctuate from session to session; and (b) to examine whether symptom severity and a personality disorder (PD) diagnosis moderate congruence and/or discrepancy. Participants included 213 clients treated by 49 therapists. At pretreatment, clients were assessed for a PD diagnosis and completed symptom measures. Symptom severity was also assessed at the beginning of each session, using client self-reports. Both clients and therapists rated the therapeutic bond at the end of each session. Therapists and clients exhibited substantial temporal congruence in their session-by-session bond ratings, but therapists' ratings tended to be lower than their clients' across sessions. Additionally, therapeutic dyads whose session-by-session ratings were more congruent also tended to have a larger directional discrepancy (clients' ratings being higher). Pretreatment symptom severity and PD diagnosis did not moderate either temporal congruence or discrepancy at the dyad level; however, during sessions when clients were more symptomatic, therapist and client ratings were both farther apart and tracked each other less closely. Our findings are consistent with a "better safe than sorry" pattern, which suggests that therapists are motivated to take a vigilant approach that may lead both to underestimation and to attunement to fluctuations in the therapeutic bond. (c) 2015 APA, all rights reserved).

Mental health recovery, goal setting and working alliance in an Australian community-managed organisation

PubMed Central

Rose, Grenville; Smith, Lorraine

2018-01-01

This article examines the relationships between goal setting and achievement, working alliance and recovery in an Australian mental health community-managed organisation. The study gathered data over a 14-month period after the introduction of routine outcome measures. Both goal achievement and the strength of the working alliance were shown to have a positive effect on the personal recovery of the clients in the study. Both working alliance and goal achievement are robustly supportive at whatever point a person is on in the recovery journey. The brief goals card used is a useful adjunct to other tools. PMID:29785279

Mental health recovery, goal setting and working alliance in an Australian community-managed organisation.

PubMed

Rose, Grenville; Smith, Lorraine

2018-01-01

This article examines the relationships between goal setting and achievement, working alliance and recovery in an Australian mental health community-managed organisation. The study gathered data over a 14-month period after the introduction of routine outcome measures. Both goal achievement and the strength of the working alliance were shown to have a positive effect on the personal recovery of the clients in the study. Both working alliance and goal achievement are robustly supportive at whatever point a person is on in the recovery journey. The brief goals card used is a useful adjunct to other tools.

Academic Alliances: School/College Faculty Collaboratives.

ERIC Educational Resources Information Center

Silber, Ellen; Moore, Terre

1989-01-01

Reports the results of a survey of high school and college foreign language teachers participating in 24 collaboratives around the country. Information about the effects of the alliances on the teachers' attitudes and instructional effectiveness are reported, and an update about current programs in academic alliances in foreign languages is…

The Effects of Trust in Virtual Strategic-Alliance Performance Outcomes

ERIC Educational Resources Information Center

Preston-Ortiz, Dina

2010-01-01

Outsourcing increases supported by technology have led to the formation of virtual strategic partnerships. Historically, 70% to 75% of alliance partnerships fail because members are often competitors outside the alliance network. To address alliance failure, a Delphi Study was conducted to identify the role of trust and alliance performance…

The Therapeutic Relationship in the Brief Treatment of Depression: Contributions to Clinical Improvement and Enhanced Adaptive Capacities

ERIC Educational Resources Information Center

Zuroff, David C.; Blatt, Sidney J.

2006-01-01

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed…

The building and sustaining of a health care partnership: the Meharry-Vanderbilt Alliance.

PubMed

Chatman, Vera Stevens; Buford, Juanita F; Plant, Brynne

2003-11-01

The ability of academic health centers (AHCs) to maintain their financial viability and mission in the face of revolutionary changes was broadly discussed during the last decade. Among the suggestions for protecting the future of AHCs was to form strategic alliances to further the missions of education, research, and service. Although the evidence indicates that 55% of strategic alliances fall apart after three years, the Meharry-Vanderbilt Alliance is now beginning its fifth year, and it appears to be growing stronger. This article presents a brief overview of the evolving historical relationship between Meharry Medical College and Vanderbilt University Medical Center-two institutions that share the same fundamental missions but have very different traditions, cultures, resources, and emphases for medical training-and their relationship with Metropolitan General Hospital at Meharry, a public hospital. The characteristics that have distinguished this strategic alliance are its organizational structure, clearly articulated and measurable objectives, an independent central office, and a shared responsibility for the management and provision of clinical services at Nashville General Hospital. The belief that the Meharry-Vanderbilt Alliance is the "right thing to do" has provided a foundation for cooperation at all levels of both AHCs.

Marriage and the parenting alliance: longitudinal prediction of change in parenting perceptions and behaviors.

PubMed

Floyd, F J; Gilliom, L A; Costigan, C L

1998-10-01

The study evaluates how marriage and the parenting alliance affect parenting experiences over time. Couples (N = 79) with school-age children who have mental retardation completed self-report and observational measures of marriage, the parenting alliance, and parenting attitudes and behaviors at 2 periods, 18-24 months apart. Longitudinal structural equation modeling demonstrated significant effects of marital quality on changes over time in self-reports of perceived parenting competence for both the mothers and the fathers, and in observed negative mother-child interactions. Also, in all cases, the parenting alliance mediated the effects of marriage on parenting experiences. There was little evidence of reciprocal causation in which parenting variables predicted change in the quality of marriage and the parenting alliance. Interactions involving child age suggested that teenagers as opposed to younger children were more reactive to negative features of their parents' marital functioning and parenting alliance. Implications are discussed regarding stable but negative marital functioning and regarding possible differences in mothers' and fathers' parenting in the context of marital distress.

Preliminary Evaluation of the Validity and Reliability of the Spanish Version of the Therapeutic Alliance with Clinician (TAC) Questionnaire

ERIC Educational Resources Information Center

Bedregal, Luis E.; Paris, Manuel Jr.; Anez, Luis M.; Shahar, Golan; Davidson, Larry

2006-01-01

As part of a broader study aimed at evaluating perceived alliance with service providers and level of satisfaction with services received, 103 monolingual Spanish speaking Hispanic women were interviewed. Participants were receiving ongoing behavioral health treatment at three different community service provider sites located in the greater New…

Working Alliance, Interpersonal Problems, and Depressive Symptoms in Tele-Interpersonal Psychotherapy for HIV-infected Rural Persons: Evidence for Indirect Effects.

PubMed

Anderson, Timothy; McClintock, Andrew S; McCarrick, Shannon S; Heckman, Timothy G; Heckman, Bernadette D; Markowitz, John C; Sutton, Mark

2018-03-01

Interpersonal psychotherapy (IPT) has demonstrated efficacy for the treatment of depression, yet little is known about its therapeutic mechanisms. As a specific treatment, IPT has been shown to directly reduce depressive symptoms, although it is unclear whether these reductions occur via interpersonal changes. Within IPT, the potential role of the working alliance, a common factor, as a predictor of depression and interpersonal changes is also unclear. Participants were 147 depressed persons living with HIV in rural communities of 28 U.S. states enrolled in a randomized clinical trial. Seventy-five patients received up to 9 sessions of telephone-administered IPT (tele-IPT) plus standard care and 72 patients received standard care only. Two models were tested; one included treatment condition (tele-IPT vs. control) and another included the working alliance as independent variables. The first model found an indirect effect whereby tele-IPT reduced depression via decreased social avoidance. There was a direct effect between tele-IPT and reduced depression. In the second model, the working alliance influenced depressive symptom relief via reductions in social avoidance. Both goal and task working alliance subscales were indirectly associated with reductions in depressive symptoms, also through reductions in social avoidance. There were no direct effects involving the working alliance. Tele-IPT's influence on depressive symptom reduction was primarily through a direct effect, whereas the influence of working alliance depression was almost entirely via an indirect effect through interpersonal problems. Study findings have implications for IPT when intervening with depressed rural people living with HIV/AIDS over the telephone. © 2017 Wiley Periodicals, Inc.

78 FR 5710 - Airworthiness Directives; Engine Alliance Turbofan Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

... Airworthiness Directives; Engine Alliance Turbofan Engines AGENCY: Federal Aviation Administration (FAA), DOT... all Engine Alliance GP7270 and GP7277 turbofan engines. This AD requires initial and repetitive...) Applicability This AD applies to all Engine Alliance GP7270 and GP7277 turbofan engines with a high-pressure...

The importance of therapeutic processes in school-based psychosocial treatment of homework problems in adolescents with ADHD.

PubMed

Breaux, Rosanna P; Langberg, Joshua M; McLeod, Bryce D; Molitor, Stephen J; Smith, Zoe R; Bourchtein, Elizaveta; Green, Cathrin D

2018-05-01

To evaluate the importance of therapeutic processes in two brief school-based psychosocial treatments targeting homework problems in adolescents with attention-deficit/hyperactivity disorder (ADHD) as delivered by school mental health professionals. A sample of 222 middle school students (72% male; M age = 12.00 years, SD = 1.02) diagnosed with ADHD was randomized to receive either a contingency-management or a skills-based treatment for homework problems. Both treatments included 16 individual sessions (20-min each) and 2 parent/family meetings. Adolescents and school mental health professionals reported on the working alliance in the middle of the treatment; professionals rated adolescent involvement at each of the 16 sessions, parent involvement during both parent meetings, and parent commitment to carry out the established homework plan. Attendance at parent meetings was also recorded. Therapeutic processes predicted objective, parent-reported, and teacher-reported academic outcomes. Parent engagement was particularly important for the contingency-based treatment, whereas working alliance and adolescent involvement were most important for the skills-based treatment. Therapeutic processes such as developing a strong working alliance and engaging parents and students are key elements of treatment delivery and receipt in school-based mental health programming and should be explicitly trained and monitored. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

2013 NCI Alliance for Nanotechnology in Cancer Annual Bulletin

Cancer.gov

The NCI Alliance for Nanotechnology in Cancer Bulletin is a resource that serves to connect Alliance participants, partners, and affiliates by highlighting the innovative work of the Alliance members in their efforts to harness the power of nanotechnology to radically change the way we diagnose, treat, and prevent cancer.

The way to win in cross-border alliances.

PubMed

Bleeke, J; Ernst, D

1991-01-01

Global competition has paved the way to new corporate combinations--and opened up new pitfalls along the way. In "The Way to Win in Cross-Border Alliances," Joel Bleeke and David Ernst offer the unconventional lessons of their study of 49 cross-border alliances. For example, alliances between a weak and a strong company usually don't work; but fifty-fifty ownership of joint ventures actually improves decision making.

Global Equity Gauge Alliance: reflections on early experiences.

PubMed

McCoy, David; Bambas, Lexi; Acurio, David; Baya, Banza; Bhuiya, Abbas; Chowdhury, A Mushtaque R; Grisurapong, Siriwan; Liu, Yuanli; Ngom, Pierre; Ngulube, Thabale J; Ntuli, Antoinette; Sanders, David; Vega, Jeanette; Shukla, Abhay; Braveman, Paula A

2003-09-01

The paper traces the evolution and working of the Global Equity Gauge Alliance (GEGA) and its efforts to promote health equity. GEGA places health equity squarely within a larger framework of social justice, linking findings on socioeconomic and health inequalities with differentials in power, wealth, and prestige in society. The Alliance's 11 country-level partners, called Equity Gauges, share a common action-based vision and framework called the Equity Gauge Strategy. An Equity Gauge seeks to reduce health inequities through three broad spheres of action, referred to as the 'pillars' of the Equity Gauge Strategy, which define a set of interconnected and overlapping actions. Measuring and tracking the inequalities and interpreting their ethical import are pursued through the Assessment and Monitoring pillar. This information provides an evidence base that can be used in strategic ways for influencing policy-makers through actions in the Advocacy pillar and for supporting grassroots groups and civil society through actions in the Community Empowerment pillar. The paper provides examples of strategies for promoting pro-equity policy and social change and reviews experiences and lessons, both in terms of technical success of interventions and in relation to the conceptual development and refinement of the Equity Gauge Strategy and overall direction of the Alliance. To become most effective in furthering health equity at both national and global levels, the Alliance must now reach out to and involve a wider range of organizations, groups, and actors at both national and international levels. Sustainability of this promising experiment depends, in part, on adequate resources but also on the ability to attract and develop talented leadership.

78 FR 35747 - Airworthiness Directives; Engine Alliance Turbofan Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-14

... Airworthiness Directives; Engine Alliance Turbofan Engines AGENCY: Federal Aviation Administration (FAA), DOT... Alliance GP7270 and GP7277 turbofan engines. This AD was prompted by damage to the high-pressure compressor... Alliance GP7270 and GP7277 turbofan engines with a high-pressure compressor (HPC) stage 6 disk, part number...

Challenges of Capacity Building in Multisector Community Health Alliances

ERIC Educational Resources Information Center

Alexander, Jeffrey A.; Christianson, Jon B.; Hearld, Larry R.; Hurley, Robert; Scanlon, Dennis P.

2010-01-01

Capacity building is often described as fundamental to the success of health alliances, yet there are few evaluations that provide alliances with clear guidance on the challenges related to capacity building. This article attempts to identify potential challenges of capacity building in multistakeholder health alliances. The study uses a multiple…

Alliance and group cohesion in relationship education.

PubMed

Owen, Jesse; Antle, Becky; Barbee, Anita

2013-09-01

Relationship education programs have been shown as an effective way to increase relationship functioning. There is less known about how process factors, such as alliance with the leader or group dynamics, affect outcomes in these interventions. We examined group cohesion and alliance with the leader in a relationship education program tailored for individuals. Specifically, we examined whether participants' ratings (n = 126) of the group cohesion and alliance with the leader were associated with changes in relationship adjustment, relationship confidence, and communication quality from pre- to postintervention. The results demonstrated that participants' perceptions of the cohesion among the members in their relationship education group, but not the leader-participant alliance, made a significant contribution to the changes in participants' relationship functioning. These results suggest that the group dynamics among the members in the group are important ingredients in relationship education. Implications for relationship programs are provided. © FPI, Inc.

An Investigation of the Relationship Between the Alliance Negotiation Scale and Psychotherapy Process and Outcome.

PubMed

Doran, Jennifer M; Safran, Jeremy D; Muran, J Christopher

2017-04-01

This study examines the validity of the Alliance Negotiation Scale (ANS) in a psychotherapy research program. Analyses were designed to evaluate the relationship between the ANS and psychotherapy process and outcome variables. Data were collected in a metropolitan psychotherapy research program. Participants completed 30 sessions of therapy, postsession assessments, and a battery of measures at intake and termination. Relationships were found between the ANS and session outcome, working alliance, and the presence of ruptures and their resolution. Relationships emerged between the ANS and treatment outcome on measures of psychiatric distress and interpersonal problems. The ANS demonstrated relationships with several psychotherapy process and outcome variables. The ANS was the most differentiated from the working alliance on measures of interpersonal functioning and in discriminating personality disorder pathology. These results extend previous findings on the ANS' psychometric integrity, and offer new data on the relationship between negotiation and treatment outcome. © 2016 Wiley Periodicals, Inc.

Global University Alliances and the Creation of Collaborative Advantage

ERIC Educational Resources Information Center

Gunn, Andrew; Mintrom, Michael

2013-01-01

The past two decades have seen the development of many global university alliances. Some alliances have taken a bilateral form, others are multilateral. In a period of increasing competition among universities, such alliances represent a curious form of cooperation. They have become more common just as global competition for academic talent has…

An Overview of Strategic Alliances between Universities and Corporations

ERIC Educational Resources Information Center

Elmuti, Dean; Abebe, Michael; Nicolosi, Marco

2005-01-01

Purpose: Strategic alliances generally represent inter-firm cooperative agreements aimed at achieving competitive advantage for the partners. In recent years, there has been a dramatic increase in strategic alliances by multinational firms. This paper aims to explore the essence of these alliances and why they have become such a growing area of…

Factor Structure and Validity of the Therapy Process Observational Coding System for Child Psychotherapy--Alliance Scale

ERIC Educational Resources Information Center

Fjermestad, Krister W.; McLeod, Bryce D.; Heiervang, Einar R.; Havik, Odd E.; Ost, Lars-Goran; Haugland, Bente S. M.

2012-01-01

The aim of this study was to examine the factor structure and psychometric properties of an observer-rated youth alliance measure, the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale (TPOCS-A). The sample was 52 youth diagnosed with anxiety disorders ("M" age = 12.43, "SD" = 2.23, range = 15;…

A three-degree horizon of peace in the military alliance network

PubMed Central

Li, Weihua; Bradshaw, Aisha E.; Clary, Caitlin B.; Cranmer, Skyler J.

2017-01-01

States form defensive military alliances to enhance their security in the face of potential or realized interstate conflict. The network of these international alliances is increasingly interconnected, now linking most of the states in a complex web of ties. These alliances can be used both as a tool for securing cooperation and to foster peace between direct partners. However, do indirect connections—such as the ally of an ally or even further out in the alliance network—result in lower probabilities of conflict? We investigate the extent to which military alliances produce peace between states that are not directly allied. We find that the peacemaking horizon of indirect alliances extends through the network up to three degrees of separation. Within this horizon of influence, a lack of decay in the effect of degrees of distance indicates that alliances do not diminish with respect to their ability to affect peace regardless of whether or not the states in question are directly allied. Beyond the three-degree horizon of influence, we observe a sharp decline in the effect of indirect alliances on bilateral peace. Further investigation reveals that the community structure of the alliance network plays a role in establishing this horizon, but the effects of indirect alliances are not spurious to the community structure. PMID:28275732

NASA Museum Alliance

NASA Astrophysics Data System (ADS)

Sohus, Anita

2006-12-01

NASA’s Museum Alliance is a nationwide network of informal educators at museums, science centers, and planetariums that present NASA information to their local audiences. Begun in 2002 as the Mars Museum Visualization Alliance with advisors from a dozen museums, the network has grown to over 300 people from 200 organizations, including a dozen or so international partners. The network has become a community of practice among these informal educators who work with students, educators, and the general public on a daily basis, presenting information and fielding questions about space exploration. Communications are primarily through an active listserve, regular telecons, and a password-protected website. Professional development is delivered via telecons and downloadable presentations. Current content offerings include Mars exploration, Cassini, Stardust, Genesis, Deep Impact, Earth observations, STEREO, and missions to explore beyond our solar system.

Item response theory analysis of Working Alliance Inventory, revised response format, and new Brief Alliance Inventory.

PubMed

Mallinckrodt, Brent; Tekie, Yacob T

2016-11-01

The Working Alliance Inventory (WAI) has made great contributions to psychotherapy research. However, studies suggest the 7-point response format and 3-factor structure of the client version may have psychometric problems. This study used Rasch item response theory (IRT) to (a) improve WAI response format, (b) compare two brief 12-item versions (WAI-sr; WAI-s), and (c) develop a new 16-item Brief Alliance Inventory (BAI). Archival data from 1786 counseling center and community clients were analyzed. IRT findings suggested problems with crossed category thresholds. A rescoring scheme that combines neighboring responses to create 5- and 4-point scales sharply reduced these problems. Although subscale variance was reduced by 11-26%, rescoring yielded improved reliability and generally higher correlations with therapy process (session depth and smoothness) and outcome measures (residual gain symptom improvement). The 16-item BAI was designed to maximize "bandwidth" of item difficulty and preserve a broader range of WAI sensitivity than WAI-s or WAI-sr. Comparisons suggest the BAI performed better in several respects than the WAI-s or WAI-sr and equivalent to the full WAI on several performance indicators.

77 FR 73637 - Alliance Pipeline L.P.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-11

... Pipeline L.P.; Notice of Application Take notice that on November 26, 2012, Alliance Pipeline L.P..., Manager, Regulatory Affairs, Alliance Pipeline Ltd. on behalf of Alliance Pipeline L.P., 800, 605-5 Ave...] BILLING CODE 6717-01-P ...

Commentary: University-Industry Alliances.

ERIC Educational Resources Information Center

Nelkin, Dorothy; And Others

1987-01-01

Addresses issues and assesses developments in research and development collaborative efforts between universities and industry. Provides an historical context and explores current industry-university alliances. (ML)

The global alliance for transplantation.

PubMed

Groth, C G; Chapman, J R

2006-03-01

In 2002, The Transplantation Society proposed the creation of a Global Alliance for Transplantation, with the purpose of reducing the existing disparity regarding transplantation activities across the globe. This alliance should include major international scientific societies, international governmental organizations, and pharmaceutical companies. Consultations with each of these parties have taken place during the past 18 months and three Strategic Programs have been initiated: (1) the collection of information on transplantation; (2) the expansion of education in transplantation; and (3) the development of professional guidelines for organ donation and transplantation.

From rhetoric to reality: consumer engagement in 16 multi-stakeholder alliances.

PubMed

Greene, Jessica; Farley, Diane C; Christianson, Jon B; Scanlon, Dennis P; Shi, Yunfeng

2016-08-01

A key component of the Aligning Forces for Quality (AF4Q) program was engaging consumers in their health and healthcare. We examined the extent to which the alliances embraced 4 areas of consumer engagement: self-management, consumer friendliness of reports of healthcare provider quality, involvement of consumers in alliance governance, and the integration of consumers into quality improvement teams. We used a largely qualitative approach. The evaluation team conducted 1100 in-depth interviews with alliance stakeholders. Two authors reviewed the consumer engagement data for each alliance to assess its level of embrace in the 4 consumer engagement areas. For consumer friendliness of public reporting websites, we also assessed alliance public reports for reading level, technical language, and evaluable displays. Population-level effects were also examined for self-management and public reporting. Consumer engagement was new to most alliances, and few had staff with consumer engagement expertise or existing consumer constituencies. For each area of consumer engagement, some alliances enthusiastically embraced the work, other alliances made a concerted but limited effort to develop programs, and a third group of alliances did the minimum work required. Integrating consumers into governance was the area most often embraced, followed by making public reports consumer friendly. Two alliances strongly embraced both self-management and integrating patients into quality improvement efforts. The AF4Q program did not have greater population level effects from self-management or public reporting than were those observed in a national comparison sample. The AF4Q program sparked a few alliances to develop robust consumer engagement programming, while most alliances tried consumer engagement efforts for the first time and developed an appreciation for integrating consumer perspectives into their work.

Strategic Classification and Examination of the Development of Current Airline Alliance Activities

NASA Technical Reports Server (NTRS)

Wang, Zhi H.; Evans, Michael

2002-01-01

Previous research argues that despite the fact that strategic alliances have become an important feature of the world airline industry, little rigorous analysis has been done on the effects of these alliances. This is partially because there is a lack of precise definitions to specify different types of airline alliances in the literature. This research identifies several categories of airline alliances through a strategic classification of the current alliance activities involving the major airlines for the period 1989 to 1999. The classification enables this research to examine how strategic alliance activities are evolving, particularly to compare how airlines in North America, the European Union and the Asia Pacific region have committed to different alliances. Findings show that there is a significant difference between the number and scope of alliances adopted in the three aviation markets. These findings facilitate research to further analyse the impact of market liberalization on various formations of strategic airline alliances.

77 FR 7572 - Alliance Pipeline L.P.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

...] Alliance Pipeline L.P.; Notice of Application Take notice that on January 25, 2012, Alliance Pipeline L.P... Pipeline Inc., Managing General Partner of Alliance Pipeline L.P., 800, 605--5 Ave. SW., Calgary, Alberta...; 8:45 am] BILLING CODE 6717-01-P ...

The Physician-Patient Working Alliance in Hemodialysis Treatment.

PubMed

Fuertes, Jairo N; Rubinstein, Sofia; Reyes, Mariela; Iampornpipopchai, Pichet; Mujeeb, Shanza; Smith, Carroll R; Toporovsky, Arielle

2017-01-01

Over the past 20 years, the role of psychological and social factors, including the physician-patient working alliance, have emerged as integral components of medical care for patients with a myriad of health conditions. The current study examines a model comprised of psychological-interpersonal factors and the extent to which it explains patient satisfaction with and adherence to hemodialysis treatment. One hundred and seven adults with end-stage renal disease who were receiving regular outpatient hemodialysis participated in the study. Path analyses show that the physician-patient working alliance indirectly predicts patient adherence through patient satisfaction and patients' outcome expectations. The working alliance directly predicts patients' quality of life. It is concluded that consistent with previous research, the physician-patient working alliance is a significant factor in predicting key patient behaviors in medical care.

Examining the Relation between the Therapeutic Alliance, Treatment Adherence, and Outcome of Cognitive Behavioral Therapy for Children with Anxiety Disorders

ERIC Educational Resources Information Center

Liber, Juliette M.; McLeod, Bryce D.; Van Widenfelt, Brigit M.; Goedhart, Arnold W.; van der Leeden, Adelinde J. M.; Utens, Elisabeth M. W. J.; Treffers, Philip D. A.

2010-01-01

Little is known about the contribution of technical and relational factors to child outcomes in cognitive behavioral therapy (CBT) for children with anxiety disorders. This study investigated the association between treatment adherence, the child-therapist alliance, and child clinical outcomes in manual-guided individual- and group-based CBT for…

How Do Airlines Perceive That Strategic Alliances Affect Their Individual Branding?

NASA Technical Reports Server (NTRS)

Kalligiannis, Konstantinos; Iatrou, Kostas; Mason, Keith

2006-01-01

Much research has been carried out to evaluate the impact of strategic alliance membership on the performance of airlines. However it would be of interest to identify how airlines perceive this impact in terms of branding by each of the three global alliance groupings. It is the purpose of this paper to gather the opinion of airlines, belonging to the three strategic alliance groups, on the impact that the strategic alliance brands have had on their individual brands and how do they perceive that this impact will change in the future. To achieve this, a comprehensive survey of the alliance management and marketing departments of airlines participating in the three global strategic alliances was required. The results from this survey give an indication whether the strategic airline alliances, which are often referred to as marketing agreements, enhance, damage or have no impact on the individual airline brands.

Impact of HMO market structure on physician-hospital strategic alliances.

PubMed

Burns, L R; Bazzoli, G J; Dynan, L; Wholey, D R

2000-04-01

To assess the impact of HMO market structure on the formation of physician-hospital strategic alliances from 1993 through 1995. The two trends, managed care and physician-hospital integration have been prominent in reshaping insurance and provider markets over the past decade. Pooled cross-sectional data from the InterStudy HMO Census and the Annual Survey conducted by the American Hospital Association (AHA) between 1993 and the end of 1995 to examine the effects of HMO penetration and HMO numbers in a market on the formation of hospital-sponsored alliances with physicians. Because prior research has found nonlinear effects of HMOs on a variety of dependent variables, we operationalized HMO market structure two ways: using a Taylor series expansion and cross-classifying quartile distributions of HMO penetration and numbers into 16 dummy indicators. Alliance formation was operationalized using the presence of any alliance model (IPA, PHO, MSO, and foundation) and the sum of the four models present in the hospital. Because managed care and physician-hospital integration are endogenous (e.g., some hospitals also sponsor HMOs), we used an instrumental variables approach to model the determinants of HMO penetration and HMO numbers. These instruments were then used with other predictors of alliance formation: physician supply characteristics, the extent of hospital competition, hospital-level descriptors, population size and demographic characteristics, and indicators for each year. All equations were estimated at the MSA level using mixed linear models and first-difference models. Contrary to conventional wisdom, alliance formation is shaped by the number of HMOs in the market rather than by HMO penetration. This confirms a growing perception that hospital-sponsored alliances with physicians are contracting vehicles for managed care: the greater the number of HMOs to contract with, the greater the development of alliances. The models also show that alliance formation is

Impact of HMO market structure on physician-hospital strategic alliances.

PubMed Central

Burns, L R; Bazzoli, G J; Dynan, L; Wholey, D R

2000-01-01

OBJECTIVE: To assess the impact of HMO market structure on the formation of physician-hospital strategic alliances from 1993 through 1995. The two trends, managed care and physician-hospital integration have been prominent in reshaping insurance and provider markets over the past decade. STUDY DESIGN: Pooled cross-sectional data from the InterStudy HMO Census and the Annual Survey conducted by the American Hospital Association (AHA) between 1993 and the end of 1995 to examine the effects of HMO penetration and HMO numbers in a market on the formation of hospital-sponsored alliances with physicians. Because prior research has found nonlinear effects of HMOs on a variety of dependent variables, we operationalized HMO market structure two ways: using a Taylor series expansion and cross-classifying quartile distributions of HMO penetration and numbers into 16 dummy indicators. Alliance formation was operationalized using the presence of any alliance model (IPA, PHO, MSO, and foundation) and the sum of the four models present in the hospital. Because managed care and physician-hospital integration are endogenous (e.g., some hospitals also sponsor HMOs), we used an instrumental variables approach to model the determinants of HMO penetration and HMO numbers. These instruments were then used with other predictors of alliance formation: physician supply characteristics, the extent of hospital competition, hospital-level descriptors, population size and demographic characteristics, and indicators for each year. All equations were estimated at the MSA level using mixed linear models and first-difference models. PRINCIPAL FINDINGS: Contrary to conventional wisdom, alliance formation is shaped by the number of HMOs in the market rather than by HMO penetration. This confirms a growing perception that hospital-sponsored alliances with physicians are contracting vehicles for managed care: the greater the number of HMOs to contract with, the greater the development of alliances

Investigating an approach to the alliance based on interpersonal defense theory.

PubMed

Westerman, Michael A; Muran, J Christopher

2017-09-01

Notwithstanding consistent findings of significant relationships between the alliance and outcome, questions remain to be answered about the relatively small magnitude of those correlations, the mechanisms underlying the association, and how to conceptualize the alliance construct. We conducted a preliminary study of an approach to the alliance based on interpersonal defense theory, which is an interpersonal reconceptualization of defense processes, to investigate the promise of this alternative approach as a way to address the outstanding issues. We employed qualitative, theory-building case study methodology, closely examining alliance processes at four time points in the treatment of a case in terms of a case formulation based on interpersonal defense theory. The results suggested that our approach made it possible to recognize key processes in the alliance and that it helps explain how the alliance influences outcome. Our analyses also provided a rich set of concrete illustrations of the alliance phenomena identified by the theory. The findings suggest that an approach to the alliance based on interpersonal defense theory holds promise. However, although the qualitative method we employed has advantages, it also has limitations. We offer suggestions about how future qualitative and quantitative investigations could build on this study.

Intrinsic Subtype and Therapeutic Response Among HER2-Positive Breast Tumors from the NCCTG (Alliance) N9831 Trial

PubMed Central

Perez, Edith A.; Ballman, Karla V.; Mashadi-Hossein, Afshin; Tenner, Kathleen S.; Kachergus, Jennifer M.; Norton, Nadine; Necela, Brian M.; Carr, Jennifer M.; Ferree, Sean; Perou, Charles M.; Baehner, Frederick; Cheang, Maggie Chon U.

2017-01-01

Background: Genomic data from human epidermal growth factor receptor 2–positive (HER2+) tumors were analyzed to assess the association between intrinsic subtype and clinical outcome in a large, well-annotated patient cohort. Methods: Samples from the NCCTG (Alliance) N9831 trial were analyzed using the Prosigna algorithm on the NanoString platform to define intrinsic subtype, risk of recurrence scores, and risk categories for 1392 HER2+ tumors. Subtypes were evaluated for recurrence-free survival (RFS) using Kaplan-Meier and Cox model analysis following adjuvant chemotherapy (n = 484) or chemotherapy plus trastuzumab (n = 908). All statistical tests were two-sided. Results: Patients with HER2+ tumors from N9831 were primarily scored as HER2-enriched (72.1%). These individuals received statistically significant benefit from trastuzumab (hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.52 to 0.89, P = .005), as did the patients (291 of 1392) with luminal-type tumors (HR = 0.52, 95% CI = 0.32 to 0.85, P = .01). Patients with basal-like tumors (97 of 1392) did not have statistically significantly better RFS when treated with trastuzumab and chemotherapy compared with chemotherapy alone (HR = 1.06, 95% CI = 0.53 to 2.13, P = .87). Conclusions: The majority of clinically defined HER2-positive tumors were classified as HER2-enriched or luminal using the Prosigna algorithm. Intrinsic subtype alone cannot replace conventional histopathological evaluation of HER2 status because many tumors that are classified as luminal A or luminal B will benefit from adjuvant trastuzumab if that subtype is accompanied by HER2 overexpression. However, among tumors that overexpress HER2, we speculate that assessment of intrinsic subtype may influence treatment, particularly with respect to evaluating alternative therapeutic approaches for that subset of HER2-positive tumors of the basal-like subtype. PMID:27794124

California Bioresources Alliance Symposia

EPA Pesticide Factsheets

Past and upcoming events and infromation from the California Bioresources Alliance Symposium, focusing on management of organic residuals in California including manure, biosolids, food waste, agricultural wastes, green waste and wood waste.

NREL Incubator Alliance Helps Entrepreneurs Build Clean Energy Solutions

Science.gov Websites

Incubator Alliance Helps Entrepreneurs Build Clean Energy Solutions For more information contact alliance. "We can do that by helping companies succeed." The incubators' objective is to build

Regional Smart Growth Alliances

EPA Pesticide Factsheets

This page describes the Urban Land Institute regional smart growth alliances that received funding from EPA to help support economic development, accommodate growth, enhance quality of, and protect the environment in regions across the country.

The clinical partnership as strategic alliance.

PubMed

Novotny, Jeanne M; Donahue, Moreen; Bhalla, Bharat B

2004-01-01

The purpose of this article is to describe a renewed partnership between a collegiate school of nursing and a community hospital. Universities and hospitals are searching for creative solutions to increase the number of registered nurses available to meet the demand for nursing care. An affiliation agreement had been in existence for many years, but health care system imperatives made it necessary to redesign the partnership between nursing education and nursing service. The model used to develop this new partnership is based on the work done in the field of management and is in the form of a strategic alliance. The success of a strategic alliance depends on two key factors: the relationship between partners and partnership performance. Identified outcomes show that this partnership is helping to meet the increasing demand for nursing care by building student capacity, satisfying mutual needs of faculty and clinical staff, and removing economic barriers. This article describes the development of the strategic alliance, its current status, and strategies for the future.

Networks of military alliances, wars, and international trade

PubMed Central

Jackson, Matthew O.; Nei, Stephen

2015-01-01

We investigate the role of networks of alliances in preventing (multilateral) interstate wars. We first show that, in the absence of international trade, no network of alliances is peaceful and stable. We then show that international trade induces peaceful and stable networks: Trade increases the density of alliances so that countries are less vulnerable to attack and also reduces countries’ incentives to attack an ally. We present historical data on wars and trade showing that the dramatic drop in interstate wars since 1950 is paralleled by a densification and stabilization of trading relationships and alliances. Based on the model we also examine some specific relationships, finding that countries with high levels of trade with their allies are less likely to be involved in wars with any other countries (including allies and nonallies), and that an increase in trade between two countries correlates with a lower chance that they will go to war with each other. PMID:26668370

Networks of military alliances, wars, and international trade.

PubMed

Jackson, Matthew O; Nei, Stephen

2015-12-15

We investigate the role of networks of alliances in preventing (multilateral) interstate wars. We first show that, in the absence of international trade, no network of alliances is peaceful and stable. We then show that international trade induces peaceful and stable networks: Trade increases the density of alliances so that countries are less vulnerable to attack and also reduces countries' incentives to attack an ally. We present historical data on wars and trade showing that the dramatic drop in interstate wars since 1950 is paralleled by a densification and stabilization of trading relationships and alliances. Based on the model we also examine some specific relationships, finding that countries with high levels of trade with their allies are less likely to be involved in wars with any other countries (including allies and nonallies), and that an increase in trade between two countries correlates with a lower chance that they will go to war with each other.

The alliance relationship analysis of international terrorist organizations with link prediction

NASA Astrophysics Data System (ADS)

Fang, Ling; Fang, Haiyang; Tian, Yanfang; Yang, Tinghong; Zhao, Jing

2017-09-01

Terrorism is a huge public hazard of the international community. Alliances of terrorist organizations may cause more serious threat to national security and world peace. Understanding alliances between global terrorist organizations will facilitate more effective anti-terrorism collaboration between governments. Based on publicly available data, this study constructed a alliance network between terrorist organizations and analyzed the alliance relationships with link prediction. We proposed a novel index based on optimal weighted fusion of six similarity indices, in which the optimal weight is calculated by genetic algorithm. Our experimental results showed that this algorithm could achieve better results on the networks than other algorithms. Using this method, we successfully digged out 21 real terrorist organizations alliance from current data. Our experiment shows that this approach used for terrorist organizations alliance mining is effective and this study is expected to benefit the form of a more powerful anti-terrorism strategy.

Robotics Collaborative Technology Alliance (RCTA): Technical Exchange Meeting (TEM) 2015

DTIC Science & Technology

2017-05-01

ARL-CR-0814 ● MAY 2017 US Army Research Laboratory Robotics Collaborative Technology Alliance (RCTA): Technical Exchange Meeting...0814 ● MAY 2017 US Army Research Laboratory Robotics Collaborative Technology Alliance (RCTA): Technical Exchange Meeting (TEM) 2015 by...SUBTITLE Robotics Collaborative Technology Alliance (RCTA): Technical Exchange Meeting (TEM) 2015 5a. CONTRACT NUMBER W911NF-10-2-0016 5b. GRANT

Child involvement, alliance, and therapist flexibility: process variables in cognitive-behavioural therapy for anxiety disorders in childhood.

PubMed

Hudson, Jennifer L; Kendall, Philip C; Chu, Brian C; Gosch, Elizabeth; Martin, Erin; Taylor, Alan; Knight, Ashleigh

2014-01-01

This study examined the relations between treatment process variables and child anxiety outcomes. Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6-14 yr-old; M = 10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up. Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome. Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters. Copyright © 2013 Elsevier Ltd. All rights reserved.

Highlights of recent developments and trends in cancer nanotechnology research--view from NCI Alliance for Nanotechnology in Cancer.

PubMed

Hull, L C; Farrell, D; Grodzinski, P

2014-01-01

Although the incidence of cancer and cancer related deaths in the United States has decreased over the past two decades due to improvements in early detection and treatment, cancer still is responsible for a quarter of the deaths in this country. There is much room for improvement on the standard treatments currently available and the National Cancer Institute (NCI) has recognized the potential for nanotechnology and nanomaterials in this area. The NCI Alliance for Nanotechnology in Cancer was formed in 2004 to support multidisciplinary researchers in the application of nanotechnology to cancer diagnosis and treatment. The researchers in the Alliance have been productive in generating innovative solutions to some of the central issues of cancer treatment including how to detect tumors earlier, how to target cancer cells specifically, and how to improve the therapeutic index of existing chemotherapies and radiotherapy treatments. Highly creative ideas are being pursued where novelty in nanomaterial development enables new modalities of detection or therapy. This review highlights some of the innovative materials approaches being pursued by researchers funded by the NCI Alliance. Their discoveries to improve the functionality of nanoparticles for medical applications includes the generation of new platforms, improvements in the manufacturing of nanoparticles and determining the underlying reasons for the movement of nanoparticles in the blood. © 2013.

Mobilizing Public Opinion for the Tobacco Industry: The Consumer Tax Alliance and Excise Taxes

PubMed Central

Campbell, Richard; Balbach, Edith D.

2009-01-01

Background Tobacco industry funding was instrumental in creating and financing the Consumer Tax Alliance in 1989 as an ostensibly organization that relied upon extensive media outreach to build opposition to excise taxes as a regressive form of taxation. By obscuring its own role in this effort, the tobacco industry undermined the public’s reasonable expectations for transparency in the policy making process. Aim To examine the formation and activities of the Consumer Tax Alliance as a “hybrid” form of interest group in order to provide tobacco control and public health advocates with a better understanding of unanticipated tobacco industry coalitions and facilitate appropriate counter measures. Methods Document searches through the Legacy Tobacco Documents Library and through Tobacco Documents Online and review of background literature. Results The Tobacco Institute actively sought liberal allies beginning in the mid-1980s in seeking to build public opposition to cigarette excise tax increases by promoting them as a regressive form of taxation. The creation of the Consumer Tax Alliance in 1989 was expressly intended to turn labor and middle class opinion against prospective excise tax increases in federal budget deficit negotiations, without divulging the tobacco industry’s role in its formation. Conclusion It is important to understand the dynamic by which trusted organizations can be induced to alter their agendas in response to funding sources. Advocates need to understand this form of interest group behavior so that they are better able to negotiate the policy arena by diagnosing and exposing this influence where it occurs and, by doing so, be better prepared to take appropriate counter measures. What this paper adds The tobacco industry’s political strategies for utilizing third party efforts to contest cigarette excise tax increases have not been extensively studied. While there has been some attention to industry sponsorship of third parties, the

An Exploration of the Working Alliance in Mental Health Case Management

ERIC Educational Resources Information Center

Kondrat, David C.; Early, Theresa J.

2010-01-01

The working alliance between clients and helpers has been identified as a common factor of treatment effectiveness, yet very little research has explored variables associated with working alliance between mental health case managers and their consumers. This study explored the potential covariates of working alliance within community mental health…

Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system.

PubMed

Halverson, P K; Kaluzny, A D; Young, G J

1997-01-01

Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

Financial analysis for the infusion alliance.

PubMed

Perucca, Roxanne

2010-01-01

Providing high-quality, cost-efficient care is a major strategic initiative of every health care organization. Today's health care environment is transparent; very competitive; and focused upon providing exceptional service, safety, and quality. Establishing an infusion alliance facilitates the achievement of organizational strategic initiatives, that is, increases patient throughput, decreases length of stay, prevents the occurrence of infusion-related complications, enhances customer satisfaction, and provides greater cost-efficiency. This article will discuss how to develop a financial analysis that promotes value and enhances the financial outcomes of an infusion alliance.

The School and Business Alliance Blooms in Yonkers.

ERIC Educational Resources Information Center

Enterprise and Education, 1987

1987-01-01

Participants in the New York State School and Business Alliance program, which is designed to strengthen the partnership among public schools, the private sector, communities, and government are working to improve secondary education as well as the quality of the youth labor force. The Alliance Development Committee (ADC) of Yonkers, New York…

FROM ME TO US: THE CONSTRUCTION OF FAMILY ALLIANCE.

PubMed

Galdiolo, Sarah; Roskam, Isabelle

2016-01-01

This longitudinal prospective and multi-informant study based on a three-wave research program (pregnancy, 12 months' postpartum, and 16 months' postpartum) aimed to determine the process of construction of family alliance, as assessed by the Lausanne Trilogue Play (Fivaz-Depeursinge & Corboz-Warnery, 1999). A model using parents' individual characteristics (i.e., personality traits and attachment orientations) as distal variables, coparenting as a mediator, child's temperament as a moderator, and family alliance as outcome was tested using structural equation modeling on 62 nonreferred families. Results showed that both parents' conscientiousness was positively and mothers' avoidant attachment and fathers' anxious attachment were negatively and indirectly (via coparenting) associated with the family alliance. The discussion underlines mothers' and fathers' different roles and the importance of coparenting as a core mechanism in the development of family alliance. © 2015 Michigan Association for Infant Mental Health.

Australian Brain Alliance.

PubMed

2016-11-02

A proposal for an Australian Brain Initiative (ABI) is under development by members of the Australian Brain Alliance. Here we discuss the goals of the ABI, its areas of research focus, its context in the Australian research setting, and its necessity for ensuring continued success for Australian brain research. Copyright © 2016 Elsevier Inc. All rights reserved.

Science alliance: A vital ORNL-UT partnership

DOE Office of Scientific and Technical Information (OSTI.GOV)

Richmond, C.R.; Riedinger, L.; Garritano, T.

1991-01-01

Partnerships between Department of Energy national laboratories and universities have long been keys to advancing scientific research and education in the United States. Perhaps the most enduring and closely knit of these relationships is the one between Oak Ridge National Laboratory and the University of Tennessee at Knoxville. Since its birth in the 1940's, ORNL has had a very special relationship with UT, and today the two institutions have closer ties than virtually any other university and national laboratory. Seven years ago, ORNL and UT began a new era of cooperation by creating the Science Alliance, a Center of Excellencemore » at UT sponsored by the Tennessee Higher Education Commission. As the oldest and largest of these centers, the Science Alliance is the primary vehicle through which Tennessee promotes research and educational collaboration between UT and ORNL. By letting the two institutions pool their intellectual and financial resources, the alliance creates a more fertile scientific environment than either could achieve on its own. Part of the UT College of Liberal Arts, the Science Alliance is composed of four divisions (Biological Sciences, Chemical Sciences, Physical Sciences, and Mathematics and Computer Science) that team 100 of the university's top faculty with their outstanding colleagues from ORNL.« less

Strategic Alliances in Education: The Knowledge Engineering Web

ERIC Educational Resources Information Center

Westera, Wim; van den Herik, Jaap; van de Vrie, Evert

2004-01-01

The field of higher education shows a jumble of alliances between fellow institutes. The alliances are strategic in kind and serve an economy-of-scales concept. A large scale is a prerequisite for allocating the budgets for new educational methods and technologies in order to keep the educational services up-to-date. All too often, however,…

Dynamics of Alliance Formation and the Egalitarian Revolution

PubMed Central

Gavrilets, Sergey; Duenez-Guzman, Edgar A.; Vose, Michael D.

2008-01-01

Background Arguably the most influential force in human history is the formation of social coalitions and alliances (i.e., long-lasting coalitions) and their impact on individual power. Understanding the dynamics of alliance formation and its consequences for biological, social, and cultural evolution is a formidable theoretical challenge. In most great ape species, coalitions occur at individual and group levels and among both kin and non-kin. Nonetheless, ape societies remain essentially hierarchical, and coalitions rarely weaken social inequality. In contrast, human hunter-gatherers show a remarkable tendency to egalitarianism, and human coalitions and alliances occur not only among individuals and groups, but also among groups of groups. These observations suggest that the evolutionary dynamics of human coalitions can only be understood in the context of social networks and cognitive evolution. Methodology/Principal Findings Here, we develop a stochastic model describing the emergence of networks of allies resulting from within-group competition for status or mates between individuals utilizing dyadic information. The model shows that alliances often emerge in a phase transition-like fashion if the group size, awareness, aggressiveness, and persuasiveness of individuals are large and the decay rate of individual affinities is small. With cultural inheritance of social networks, a single leveling alliance including all group members can emerge in several generations. Conclusions/Significance We propose a simple and flexible theoretical approach for studying the dynamics of alliance emergence applicable where game-theoretic methods are not practical. Our approach is both scalable and expandable. It is scalable in that it can be generalized to larger groups, or groups of groups. It is expandable in that it allows for inclusion of additional factors such as behavioral, genetic, social, and cultural features. Our results suggest that a rapid transition from a

The role of co-parenting alliance as a mediator between trait anxiety, family system maladjustment, and parenting stress in a sample of non-clinical Italian parents.

PubMed

Delvecchio, Elisa; Sciandra, Andrea; Finos, Livio; Mazzeschi, Claudia; Riso, Daniela Di

2015-01-01

This study investigated the role of co-parenting alliance in mediating the influence of parents' trait anxiety on family system maladjustment and parenting stress. A sample of 1606 Italian parents (803 mothers and 803 fathers) of children aged one to 13 years completed measures of trait anxiety (State Trait Anxiety Inventory-Y), co-parenting alliance (Parenting Alliance Measure), family system maladjustment (Family Assessment Measure-III), and parenting stress (Parenting Stress Inventory-Short Form). These variables were investigated together comparing two structural equations model-fitting including both partners. A model for both mothers and fathers was empirically devised as a series of associations between parent trait anxiety (independent variable), family system maladjustment and parenting stress (dependent variables), mediated by co-parenting alliance, with the insertion of cross predictions between mothers and fathers and correlations between dependent variables for both parents. Results indicated that the relation between mothers and fathers' trait anxiety, family system maladjustment and parenting stress was mediated by the level of co-parenting alliance. Understanding the role of couples' co-parenting alliance could be useful during the family assessment and/or treatment, since it is an efficient and effective tool to improve the family system maladjustment and stress.

The effect of congruence in patient and therapist alliance on patient's symptomatic levels.

PubMed

Zilcha-Mano, Sigal; Snyder, John; Silberschatz, George

2017-05-01

The ability of alliance to predict outcome has been widely demonstrated, but less is known about the effect of the level of congruence between patient and therapist alliance ratings on outcome. In the current study we examined whether the degree of congruence between patient and therapist alliance ratings can predict symptomatic levels 1 month later in treatment. The sample consisted of 127 patient-therapist dyads. Patients and therapists reported on their alliance levels, and patients reported their symptomatic levels 1 month later. Polynomial regression and response surface analysis were used to examine congruence. Findings suggest that when the congruence level of patient and therapist alliance ratings was not taken into account, only the therapist's alliance served as a significant predictor of symptomatic levels. But when the degree of congruence between patient and therapist alliance ratings was considered, the degree of congruence was a significant predictor of symptomatic levels 1 month later in treatment. Findings support the importance of the level of congruence between patient and therapist alliance ratings in predicting patient's symptomatic levels.

A Socio-technical Approach for Transient SME Alliances

NASA Astrophysics Data System (ADS)

Rezgui, Yacine

The paper discusses technical requirements to promote the adoption of alliance modes of operation by SMEs in the construction sector. These requirements have provided a basis for specifying a set of functionality to support the collaboration and cooperation needs of SMEs. While service-oriented architectures and semantic web services provide the middleware technology to implement the identified functionality, a number of key technical limitations have been identified, including lack of support for the dynamic and non-functional characteristics of SME alliances distributed business processes, lack of execution monitoring functionality to manage running business processes, and lack of support for semantic reasoning to enable SME business process service composition. The paper examines these issues and provides key directions for supporting SME alliances effectively.

The History and Accomplishments of the LIVESTRONG Young Adult Alliance.

PubMed

Mathews-Bradshaw, Beth; Johnson, Rebecca; Kaplan, Stuart; Craddock, Kelli; Hayes-Lattin, Brandon

2011-03-01

This article outlines the history, background, and accomplishments of the LIVESTRONG Young Adult Alliance. The LIVESTRONG Young Adult Alliance, a program of the Lance Armstrong Foundation, was developed as a vehicle for a strategic plan designed to implement the Adolescent and Young Adult Oncology Progress Review Group (AYAO PRG) recommendations. The AYAO PRG was co-sponsored by Lance Armstrong Foundation and the National Cancer Institute (NCI); both LIVESTRONG and NCI provide strategic oversight and guidance to the Alliance. Highlights and accomplishments: The Alliance accomplishments include the publication of disease-specific retrospective analyses, funding of an AYA cohort study and biorepository proposal, publication of two position statements on guidelines for care of AYAs with cancer and training for AYA oncology health professionals, promotion of an international charter of rights for AYA cancer patients, creation and distribution of a survey to college health professionals, creation and implementation of a Cancer Centers Working Group and Institutional Review Board Toolkit, and continued growth and collaboration through an annual meeting. The growth and success of the Alliance has coincided with the growth of AYA oncology as a field. The collaborative environment of the Alliance draws together a diverse group of individuals united in the effort to increase survival rates and improve the quality of life for adolescents and young adults diagnosed with cancer.

Person-centered Therapeutics

PubMed Central

Cloninger, C. Robert; Cloninger, Kevin M.

2015-01-01

A clinician’s effectiveness in treatment depends substantially on his or her attitude toward -- and understanding of -- the patient as a person endowed with self-awareness and the will to direct his or her own future. The assessment of personality in the therapeutic encounter is a crucial foundation for forming an effective working alliance with shared goals. Helping a person to reflect on their personality provides a mirror image of their strengths and weaknesses in adapting to life’s many challenges. The Temperament and Character Inventory (TCI) provides an effective way to describe personality thoroughly and to predict both the positive and negative aspects of health. Strengths and weaknesses in TCI personality traits allow strong predictions of individual differences of all aspects of well-being. Diverse therapeutic techniques, such as diet, exercise, mood self-regulation, meditation, or acts of kindness, influence health and personality development in ways that are largely indistinguishable from one another or from effective allopathic treatments. Hence the development of well-being appears to be the result of activating a synergistic set of mechanisms of well-being, which are expressed as fuller functioning, plasticity, and virtue in adapting to life’s challenges PMID:26052429

The Document Management Alliance.

ERIC Educational Resources Information Center

Fay, Chuck

1998-01-01

Describes the Document Management Alliance, a standards effort for document management systems that manages and tracks changes to electronic documents created and used by collaborative teams, provides secure access, and facilitates online information retrieval via the Internet and World Wide Web. Future directions are also discussed. (LRW)

Establishing strategic alliance among hospitals through SAIS: a case study in Taiwan.

PubMed

Hung, Won-Fu; Hwang, Hsin-Ginn; Liao, Chechen

2005-01-01

Due to a reformed healthcare insurance system and a gradually decreasing public affairs' budget by the government year by year, Central Taiwan Office (CTO), the Department of Health (DOH) in Taiwan, initiated a strategic alliance project of the hospitals subordinated to the DOH in November, 2001. This project was a five-year plan with an attempt to expand and develop three more strategic alliances covering the northern, southern and eastern regions of Taiwan respectively. Through a cooperative system, such an alliance allows the following: resource sharing, technique collaboration, marketing affiliations and so on. In order to decrease operation management costs and improve the quality of service at hospitals, the strategic alliance practice is supported by IS. We call this alignment the IS-enabled strategic alliance. All the IS-enabled functions are supported by the Strategic Alliance Information System (SAIS). In this article, the SAIS developed by the CTO of the DOH is introduced.

Alliances for Undergraduate Research in the Geosciences Through Collaborative Recruitment

NASA Astrophysics Data System (ADS)

Pandya, R.; Eriksson, S.; Haacker-Santos, R.; Calhoun, A.

2006-12-01

Undergraduate research is a key strategy for encouraging students to pursue graduate school and careers in science end engineering. In the geosciences, where participation by members of underrepresented groups is among the lowest of any science field, these programs must continue and strengthen their efforts to engage students from historically underrepresented groups. A significant limitation on our ability to engage students from historically underrepresented groups comes from the expense, in terms of time and resources, of promoting these career options to talented undergraduates considering a host of STEM careers. Another hurdle is our ability to match students with research projects tailored to their interests. Further complicating this is the challenge of matching students who have culturally motivated geographic constraints—for example, Native students who seek to serve their local community—to relevant opportunities. As a result, we believe that a number of highly qualified students never fully consider careers in the geosciences. To address these obstacles, we propose an alliance of undergraduate research programs in the geosciences. In this model, all members of the alliance would share recruiting, and students would submit a single application forwarded to all alliance members. The Alliance could offer applicants multiple research opportunities, from across the alliance, tailored to fit the applicant's needs and interests. This strategy has proven very effective in other fields; for example, the Leadership Alliance allows 32 member institutions to offer internships and fellowships through one central application process. SOARS and RESESS, programs in atmospheric science and geophysics, respectively, have done this co-recruiting for two years. There are many benefits to this type of alliance. First, it would allow programs to leverage and coordinate their recruiting investments. From our experience with SOARS and RESESS, much of the effort in

Representations of Parent-Child Alliances in Children's Family Drawings

ERIC Educational Resources Information Center

Leon, Kim; Wallace, Tamar; Rudy, Duane

2007-01-01

The purpose of this study was to investigate relationships between children's representations of parent-child alliances (PCA) and their peer relationship quality, using a new scale that was developed to rate representations of PCA in children's family drawings. The parent-child alliance pattern is characterized by a relationship between parent and…

The development of family alliance from pregnancy to toddlerhood and child outcomes at 5 years.

PubMed

Favez, Nicolas; Lopes, Francesco; Bernard, Mathieu; Frascarolo, France; Lavanchy Scaiola, Chloe; Corboz-Warnery, Antoinette; Fivaz-Depeursinge, Elisabeth

2012-12-01

This article presents a longitudinal study of the development of "family alliance" from pregnancy to toddlerhood in a community sample, as well as its links with the emotional and cognitive development of the child at age 5 years. Family alliance is defined as the quality of the interactive coordination between family members. We consider that the alliance constitutes a context for the child to learn emotion regulation and to develop an understanding of inner states. Family interactions (N = 38) were observed at the 5th month of pregnancy and at 3, 9, and 18 months after birth in a standardized situation of observation (Lausanne Trilogue Play). Marital satisfaction and child temperament were assessed through self-reported questionnaires. Several outcomes of the child at age 5 years were measured: theory of mind performances, predominant emotional themes in pretend play, internalized and externalized symptoms. Results show that (a) three patterns of evolution of family alliance occur: "high stable" (n = 19), "high to low" (n = 10), and "low stable" (n = 9); (b) a high stable alliance is predictive of better outcomes in children at age 5 years, especially regarding theory of mind; (c) the temperament of the child is predictive of child outcomes; and (d) an interaction effect occurs between family alliance and temperament. These results highlight the importance of both family-level and individual-level variables for understanding individual differences in the social and cognitive development of children. © FPI, Inc.

Behavioral Indices in Medical Care Outcome: The Working Alliance, Adherence, and Related Factors

PubMed Central

Boylan, Laura S.; Fontanella, Jessie A.

2008-01-01

Background The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome. Objective Cognitive and emotional dimensions of the physician–patient relationship were examined in relation to patients’ ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients’ adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment. Design The study was based on an ex-post facto field correlation design. Participants One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study. Interventions Surveys given to participants. Measurements We used the following measurements: Physician–Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire. Main Results The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to >0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49). Conclusions Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes. PMID:18972089

How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study.

PubMed

Holter, Marianne T S; Johansen, Ayna; Brendryen, Håvar

2016-06-28

eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist's support of a working alliance, internalization of motivation, and managing lapses. We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several "counseling sessions" about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. The program supports the user's working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective.

How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study

PubMed Central

Johansen, Ayna; Brendryen, Håvar

2016-01-01

Background eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective. PMID:27354373

Sustaining alliances for integrity.

PubMed

Werhane, P H

2000-01-01

Research in business ethics has shown that value-grounded organizations outperform their counterparts in business terms and that industries can successfully regulate themselves. The market in health care, systems theory, and stakeholder analysis are used to generate a set of five potential core values to sustain an Ethics Alliance of Oral Health Organizations.

Architecture for the Interdisciplinary Earth Data Alliance

NASA Astrophysics Data System (ADS)

Richard, S. M.

2016-12-01

The Interdisciplinary Earth Data Alliance (IEDA) is leading an EarthCube (EC) Integrative Activity to develop a governance structure and technology framework that enables partner data systems to share technology, infrastructure, and practice for documenting, curating, and accessing heterogeneous geoscience data. The IEDA data facility provides capabilities in an extensible framework that enables domain-specific requirements for each partner system in the Alliance to be integrated into standardized cross-domain workflows. The shared technology infrastructure includes a data submission hub, a domain-agnostic file-based repository, an integrated Alliance catalog and a Data Browser for data discovery across all partner holdings, as well as services for registering identifiers for datasets (DOI) and samples (IGSN). The submission hub will be a platform that facilitates acquisition of cross-domain resource documentation and channels users into domain and resource-specific workflows tailored for each partner community. We are exploring an event-based message bus architecture with a standardized plug-in interface for adding capabilities. This architecture builds on the EC CINERGI metadata pipeline as well as the message-based architecture of the SEAD project. Plug-in components for file introspection to match entities to a data type registry (extending EC Digital Crust and Research Data Alliance work), extract standardized keywords (using CINERGI components), location, cruise, personnel and other metadata linkage information (building on GeoLink and existing IEDA partner components). The submission hub will feed submissions to appropriate partner repositories and service endpoints targeted by domain and resource type for distribution. The Alliance governance will adopt patterns (vocabularies, operations, resource types) for self-describing data services using standard HTTP protocol for simplified data access (building on EC GeoWS and other `RESTful' approaches). Exposure

Strategic alliance: adapting to the business environment in long-term care.

PubMed

Mara, Cynthia Massie; Ziegenfuss, James T

2002-01-01

This article is addressed to long-term-care administrators and planners as well as purchasers of long-term care. Believing the current and future business environment will force continued adaptation in long-term-care organizations, the authors utilize nine categories to map pressures for change: cultural, technological, educational, political, legal, natural resource, demographic, sociologic, and economic. Long-term-care organizations, especially those that are not-for-profit, are becoming members of alliances as one way of addressing these pressures. This article describes and presents a case example of a composite alliance to demonstrate the advantages of membership in a strategic alliance. We also present examples of ways in which alliance members use strategic partnerships to improve their ability to manage these forces.

The supervisory alliance: a half century of theory, practice, and research in critical perspective.

PubMed

Watkins, C Edward

2014-01-01

Over the course of psychotherapy supervision history, the supervisor-supervisee alliance has increasingly emerged as a variable of preeminent importance in the conceptualization and conduct of the supervision experience: It has come to be embraced as the very heart and soul of supervision. But after a half century, what evidence do we actually have to justify that highly favorable outlook afforded to the alliance? What do we really know about the supervisory alliance? What do we need to know about it? As we mark the first 50 years of supervisory alliance and look toward its future, I thought it might be useful to examine those questions and provide a current status report about the construct itself In what follows, I (a) describe the two supervisory alliance visions that have been (and remain) dominant in the supervision literature and (b) provide a review of 20 plus years of supervision alliance research. While the supervisory alliance has accumulated solid clinical support, its empirical support appears to be more tentative and less robust. I consider why that is so, identify some missing elements in the alliance research conducted thus far and propose possible remedies to move inquiry in this area forward.

The private partners of public health: public-private alliances for public good.

PubMed

McDonnell, Sharon; Bryant, Carol; Harris, Jeff; Campbell, Marci Kramish; Lobb, Ano; Hannon, Peggy A; Cross, Jeffrey L; Gray, Barbara

2009-04-01

We sought to convey lessons learned by the Centers for Disease Control and Prevention's (CDC's) Prevention Research Centers (PRCs) about the value and challenges of private-sector alliances resulting in innovative health promotion strategies. Several PRCs based in a variety of workplace and community settings contributed. We conducted interviews with principal investigators, a literature review, and a review of case studies of private-sector alliances in a microbusiness model, a macrobusiness model, and as multiparty partnerships supporting public health research, implementation, and human resource services. Private-sector alliances provide many advantages, particularly access to specialized skills generally beyond the expertise of public health entities. These skills include manufacturing, distribution, marketing, business planning, and development. Alliances also allow ready access to employee populations. Public health entities can offer private-sector partners funding opportunities through special grants, data gathering and analysis skills, and enhanced project credibility and trust. Challenges to successful partnerships include time and resource availability and negotiating the cultural divide between public health and the private sector. Critical to success are knowledge of organizational culture, values, mission, currency, and methods of operation; an understanding of and ability to articulate the benefits of the alliance for each partner; and the ability and time to respond to unexpected changes and opportunities. Private-public health alliances are challenging, and developing them takes time and resources, but aspects of these alliances can capitalize on partners' strengths, counteract weaknesses, and build collaborations that produce better outcomes than otherwise possible. Private partners may be necessary for program initiation or success. CDC guidelines and support materials may help nurture these alliances.

Motivation and treatment credibility predict alliance in cognitive behavioral treatment for youth with anxiety disorders in community clinics.

PubMed

Fjermestad, K W; Lerner, M D; McLeod, B D; Wergeland, G J H; Haugland, B S M; Havik, O E; Öst, L-G; Silverman, W K

2017-11-16

We examined whether motivation and treatment credibility predicted alliance in a 10-session cognitive behavioral treatment delivered in community clinics for youth anxiety disorders. Ninety-one clinic-referred youths (mean age  = 11.4 years, standard deviation = 2.1, range 8-15 years, 49.5% boys) with anxiety disorders-rated treatment motivation at pretreatment and perceived treatment credibility after session 1. Youths and therapists (YT) rated alliance after session 3 (early) and session 7 (late). Hierarchical linear models were applied to examine whether motivation and treatment credibility predicted YT early alliance, YT alliance change, and YT alliance agreement. Motivation predicted high early YT alliance, but not YT alliance change or alliance agreement. Youth-rated treatment credibility predicted high early youth alliance and high YT positive alliance change, but not early therapist alliance or alliance agreement. Conclusion Efforts to enhance youth motivation and treatment credibility early in treatment could facilitate the formation of a strong YT alliance. © 2017 Wiley Periodicals, Inc.

The German Navy: From World Power to Alliance Power

DTIC Science & Technology

2013-12-01

NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited THE GERMAN NAVY...FROM WORLD POWER TO ALLIANCE POWER by Benjamin I. McCarty December 2013 Thesis Advisor: Donald Abenheim Second Reader: Hans Woehlermann...COVERED Master’s Thesis 4. TITLE AND SUBTITLE THE GERMAN NAVY: FROM WORLD POWER TO ALLIANCE POWER 5. FUNDING NUMBERS 6. AUTHOR(S) Benjamin I

Constituents of political cognition: Race, party politics, and the alliance detection system.

PubMed

Pietraszewski, David; Curry, Oliver Scott; Petersen, Michael Bang; Cosmides, Leda; Tooby, John

2015-07-01

Research suggests that the mind contains a set of adaptations for detecting alliances: an alliance detection system, which monitors for, encodes, and stores alliance information and then modifies the activation of stored alliance categories according to how likely they will predict behavior within a particular social interaction. Previous studies have established the activation of this system when exposed to explicit competition or cooperation between individuals. In the current studies we examine if shared political opinions produce these same effects. In particular, (1) if participants will spontaneously categorize individuals according to the parties they support, even when explicit cooperation and antagonism are absent, and (2) if party support is sufficiently powerful to decrease participants' categorization by an orthogonal but typically-diagnostic alliance cue (in this case the target's race). Evidence was found for both: Participants spontaneously and implicitly kept track of who supported which party, and when party cross-cut race-such that the race of targets was not predictive of party support-categorization by race was dramatically reduced. To verify that these results reflected the operation of a cognitive system for modifying the activation of alliance categories, and not just socially-relevant categories in general, an identical set of studies was also conducted with in which party was either crossed with sex or age (neither of which is predicted to be primarily an alliance category). As predicted, categorization by party occurred to the same degree, and there was no reduction in either categorization by sex or by age. All effects were replicated across two sets of between-subjects conditions. These studies provide the first direct empirical evidence that party politics engages the mind's systems for detecting alliances and establish two important social categorization phenomena: (1) that categorization by age is, like sex, not affected by alliance

Intrinsic Subtype and Therapeutic Response Among HER2-Positive Breaty st Tumors from the NCCTG (Alliance) N9831 Trial.

PubMed

Perez, Edith A; Ballman, Karla V; Mashadi-Hossein, Afshin; Tenner, Kathleen S; Kachergus, Jennifer M; Norton, Nadine; Necela, Brian M; Carr, Jennifer M; Ferree, Sean; Perou, Charles M; Baehner, Frederick; Cheang, Maggie Chon U; Thompson, E Aubrey

2017-02-01

Genomic data from human epidermal growth factor receptor 2-positive (HER2+) tumors were analyzed to assess the association between intrinsic subtype and clinical outcome in a large, well-annotated patient cohort. Samples from the NCCTG (Alliance) N9831 trial were analyzed using the Prosigna algorithm on the NanoString platform to define intrinsic subtype, risk of recurrence scores, and risk categories for 1392 HER2+ tumors. Subtypes were evaluated for recurrence-free survival (RFS) using Kaplan-Meier and Cox model analysis following adjuvant chemotherapy (n = 484) or chemotherapy plus trastuzumab (n = 908). All statistical tests were two-sided. Patients with HER2+ tumors from N9831 were primarily scored as HER2-enriched (72.1%). These individuals received statistically significant benefit from trastuzumab (hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.52 to 0.89, P = .005), as did the patients (291 of 1392) with luminal-type tumors (HR = 0.52, 95% CI = 0.32 to 0.85, P = .01). Patients with basal-like tumors (97 of 1392) did not have statistically significantly better RFS when treated with trastuzumab and chemotherapy compared with chemotherapy alone (HR = 1.06, 95% CI = 0.53 to 2.13, P = .87). The majority of clinically defined HER2-positive tumors were classified as HER2-enriched or luminal using the Prosigna algorithm. Intrinsic subtype alone cannot replace conventional histopathological evaluation of HER2 status because many tumors that are classified as luminal A or luminal B will benefit from adjuvant trastuzumab if that subtype is accompanied by HER2 overexpression. However, among tumors that overexpress HER2, we speculate that assessment of intrinsic subtype may influence treatment, particularly with respect to evaluating alternative therapeutic approaches for that subset of HER2-positive tumors of the basal-like subtype. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions

Homeopathy as Boundary Object and Distributed Therapeutic Agency. A Discussion on the Homeopathic Placebo Response.

PubMed

Rughiniş, Cosima; Ciocănel, Alexandra; Vasile, Sorina

2017-09-27

We discuss homeopathy's placebo effect as the result of a distributed therapeutic agency involving humans, objects, and texts. Homeopathy has been involved in controversies for centuries, and the dispute whether it is therapy or quackery is as lively as ever. Still, homeopathy has retained significant popularity and acceptance within the medical establishment. We bracket the issue of biochemical effectiveness of homeopathic remedies as we only discuss homeopathy's potential to elicit a placebo response within its therapeutic alliance, in virtue of its social, symbolic, and material features. The review is based on literature discussing homeopathic effectiveness, including historical, biographical, sociological, and epistemological perspectives. We build upon research that clarifies the therapeutic relationship, examining its activities and meanings for practitioners and patients. Previous analyses discussing homeopathy's placebo effect stress the importance of the individualized consultation that functions as psychotherapy and generates empathy and hope. We enlarge the discussion, highlighting homeopathy's distributed therapeutic agency across humans, texts, and materials. The historical evolution of homeopathy in relation to biomedicine and science is important to understand its institutional integration into mainstream medicine and its appeal to scientifically minded doctors. Anecdotes of healing and the message of no-harm encourage patients to try homeopathy and hope for the best. The esthetics and ritual of remedies, coupled with computers' scientific legitimacy and time-saving power constitute a material infrastructure of therapeutic persuasion. Through its relation with biomedicine, its doctrine, consultation design, and treatment rituals, homeopathy offers a powerful medium to elicit a placebo response in a therapeutic alliance. By virtue of its proximity and radical difference from the scientific and biomedical enterprises, its material and textual

Therapeutic magnetic microcarriers characterization by measuring magnetophoretic attributes

NASA Astrophysics Data System (ADS)

Vidal Ibacache, Guillermo

Micro/nano robots are considered a promising approach to conduct minimally invasive interventions. We have proposed to embed magnetic nanoparticles in therapeutic or diagnostic agents in order to magnetically control them. A modified clinical Magnetic Resonance Imaging (MRI) scanner is used to provide the driving force that allows these magnetically embedded microcarriers to navigate the vascular human network. By using specific Magnetic Resonance (MR) gradient sequences this method has been validated in previous research works. Magnetophoresis is the term used to describe the fact that a magnetic particle changes its trajectory under the influence of a magnetic force while being carried by a fluid flow. This movement depends on the particle's magnetic characteristics, the particle's geometric shape, the fluid flow's attributes and other factors. In our proposed method, magnetic microcarriers can be produced in several different ways, and so their response will differ to the same magnetic force and fluid flow conditions. The outcome of the therapeutic treatment using our method depends on the adequate selection of the therapeutic and/or diagnosis agents to be used. The selected therapeutic and/or diagnosis magnetic microcarrier also influences the selection of the MR gradient sequence that best fit for a given treatment. This master's thesis presents the design of a device intended to assess the magnetophoretic properties of magnetic therapeutic microcarriers and/or diagnostic agents. Such characterization is essential for determining the optimal sequences of magnetic gradients to deflect their trajectory through relatively complex vascular networks in order to reach a pre-defined target. A microfluidic device was fabricated to validate the design. Magnetophoretic velocities are measured and a simple tracking method is proposed. The preliminary experimental results indicate that, despite some limitations, the proposed technique has the potential to be appropriate

Financial Stress, Parenting Quality, and the Moderating Effect of Co-Parenting Alliance within the Marital Dissolution Population

ERIC Educational Resources Information Center

Mao, Dung Minh

2017-01-01

In this study, the relationship between the perception of financial stress (measured by income inadequacy), parenting quality (measured by positive parenting, consistent discipline, and good supervision), and the moderating effect that cooperative co-parenting (measured by co-parenting alliance) were investigated within a sample of parents who…

Exploration of a Contextual Management Framework for Strategic Learning Alliances

ERIC Educational Resources Information Center

Dealtry, Richard

2008-01-01

Purpose: This article aims to take a further step forward in examining those important business factors that will shape the future of best practice in the quality management of internal and external strategic alliances. Design/methodology/approach: The article presents a speculative scenario on the future of strategic alliances in education,…

Aligning Forces for Quality multi-stakeholder healthcare alliances: do they have a sustainable future?

PubMed

Alexander, Jeffrey A; Hearld, Larry R; Wolf, Laura J; Vanderbrink, Jocelyn M

2016-08-01

Multi-stakeholder healthcare alliances in the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program brought together diverse stakeholders to work collaboratively to improve healthcare in their local communities. This article evaluates how well the AF4Q alliances were collectively positioned to sustain themselves as AF4Q program support ended. This analysis relied on a mixed-methods design using data from a survey of more than 700 participants in 15 of the 16 AF4Q alliances (1 alliance was unable to participate because it was in the process of closing down operations at the time of survey implementation), qualitative interviews with leaders in all 16 of the alliances, and secondary sources. Qualitative analysis of interview data and secondary sources were used to develop a classification of alliance strategic directions after the AF4Q program relative to their strategies during the AF4Q initiative. Descriptive analyses of survey data were conducted in the following areas: (1) alliance priorities for sustainability, (2) alliance positioning for sustainability, and (3) alliance challenges to sustainability. The likelihood of sustainability and the strategic direction of the former AF4Q alliances are both decidedly mixed. A substantial number of alliances are at risk because of an unclear strategic direction following the AF4Q program, poor financial support, and a lack of relevant community leadership. Some have a clear plan to continue on the path they set during the program. Others appear likely to continue to operate, but they plan to do so in a form that differs from the neutral convener multi-stakeholder model emphasized during the AF4Q program as they specialize, make a major shift in focus, develop fee-for-service products, or focus on particular stakeholder groups (ie, employers and providers). In most cases, preserving the organization itself, rather than its programmatic activities from the AF4Q program era, appeared to receive the

78 FR 63559 - Order of Suspension of Trading; In The Matter of Crown Alliance Capital Limited

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-24

... Alliance Capital Limited (``Crown Alliance''), quoted under the ticker symbol CACL, because of questions regarding the accuracy of assertions in Crown Alliance's public filings concerning the company's assets and... of Crown Alliance Capital Limited October 22, 2013. It appears to the Securities and Exchange...

Military Alliances and Coalitions: Going to War without France

DTIC Science & Technology

2008-03-26

to drive Saddam Hussein’s army from Kuwait, the formal alliance language simply did not exist. The 9/11 attacks highlighted the limitations of static... language does not exist. They have been credited with quickly building purposeful and capable military forces beyond traditional structured alliance... labeled unilateralist for the mostly-American strike against the Taliban in Afghanistan in 2001 and the 2003 regime change in Iraq. 10 The United

The stigma of having psychological problems: relations with engagement, working alliance, and depression in psychotherapy.

PubMed

Kendra, Matthew S; Mohr, Jonathan J; Pollard, Jeffrey W

2014-12-01

The stigma of having psychological problems is a barrier to seeking mental health treatment, but little research has examined whether this stigma influences the experiences of those in treatment. In a sample of 42 psychotherapy clients, we explored links over the first few sessions between 2 facets of stigma (self-stigma and perceived public stigma) and 3 variables germane to the therapeutic process (depression, working alliance, and engagement). Initial self-stigma (SS) level was positively associated with initial depression, negatively associated with initial working alliance, and unrelated to initial engagement. Initial perceived public stigma (PPS) level was unrelated to initial levels in the 3 outcome variables. Initial SS and PPS levels were both generally unrelated to linear changes in the outcomes over the initial phase of counseling. Relations between stigma and outcome variables often differed within- and between-persons. For example, the association between PPS and engagement was negative at the between-person level but positive at the within-person level. Finally, on average, PPS decreased over the first few sessions but SS remained constant. Such findings may help therapists better understand the role of stigma in their clinical work, and stimulate research examining how to address stigmatization in psychotherapy.

[Alliance against MDRO: safeguarding antibiotics].

PubMed

Carlet, J; Rambaud, C; Pulcini, C

2012-09-01

Resistance to antibiotics has increased recently to a dramatic extend, and the pipeline of new antibiotics is almost dry for the 5 next years. Failures happen already for trivial community acquired infections, like pyelonephritis, or peritonitis, and this is likely to increase. Difficult surgical procedures, transplants, and other immunosuppressive therapies will become far more risky. Resistance is mainly due to an excessive usage of antibiotics, in all sectors, including the animal one. Action is urgently needed. Therefore, an alliance against MDRO has been recently created, which includes health care professionals, consumers, health managers, and politicians. The document highlights the different proposed measures, and represents a strong consensus between the different professionals, including general practitioners, and veterinarians. Copyright © 2012 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

The role of co-parenting alliance as a mediator between trait anxiety, family system maladjustment, and parenting stress in a sample of non-clinical Italian parents

PubMed Central

Delvecchio, Elisa; Sciandra, Andrea; Finos, Livio; Mazzeschi, Claudia; Riso, Daniela Di

2015-01-01

This study investigated the role of co-parenting alliance in mediating the influence of parents’ trait anxiety on family system maladjustment and parenting stress. A sample of 1606 Italian parents (803 mothers and 803 fathers) of children aged one to 13 years completed measures of trait anxiety (State Trait Anxiety Inventory—Y), co-parenting alliance (Parenting Alliance Measure), family system maladjustment (Family Assessment Measure—III), and parenting stress (Parenting Stress Inventory—Short Form). These variables were investigated together comparing two structural equations model-fitting including both partners. A model for both mothers and fathers was empirically devised as a series of associations between parent trait anxiety (independent variable), family system maladjustment and parenting stress (dependent variables), mediated by co-parenting alliance, with the insertion of cross predictions between mothers and fathers and correlations between dependent variables for both parents. Results indicated that the relation between mothers and fathers’ trait anxiety, family system maladjustment and parenting stress was mediated by the level of co-parenting alliance. Understanding the role of couples’ co-parenting alliance could be useful during the family assessment and/or treatment, since it is an efficient and effective tool to improve the family system maladjustment and stress. PMID:26347674

Alliance between tobacco and alcohol industries to shape public policy

PubMed Central

Jiang, Nan

2013-01-01

Aims The tobacco and alcohol industries share common policy goals when facing regulation, opposing policies such as tax increases and advertising restrictions. The collaboration between these two industries in the tobacco policy arena is unknown. This study explored if tobacco and alcohol companies built alliances to influence tobacco legislation, and if so, how those alliances worked. Methods Analysis of previously secret tobacco industry documents. Findings In the early 1980s, tobacco companies started efforts to build coalitions with alcohol and other industries to oppose cigarette excise taxes, clean indoor air policies, and tobacco advertising and promotion constraints. Alcohol companies were often identified as a key partner and source of financial support for the coalitions. These coalitions had variable success interfering with tobacco control policymaking. Conclusions The combined resources of tobacco and alcohol companies may have affected tobacco control legislation. These alliances helped to create the perception that there is a broader base of opposition to tobacco control. Advocates should be aware of the covert alliances between tobacco, alcohol, and other industries and expose them to correct this misperception. PMID:23587076

Combining service marketing and strategic alliances in health care.

PubMed

Lazarus, I R

1993-11-01

With or without federal health care reform to impact the delivery of health care services in the U.S., hospitals must commit to service marketing and strategic alliances as a fundamental business strategy. Service marketing not only differentiates the provider, but with the proper programs in place, it may actually facilitate the formation of strategic alliances. The combination of these strategies will be particularly effective in preparing for any health care policy change.

Impact of exchanges and client-therapist alliance in online-text psychotherapy.

PubMed

Reynolds, D'Arcy J; Stiles, William B; Bailer, A John; Hughes, Michael R

2013-05-01

The impact of exchanges and client-therapist alliance of online therapy text exchanges were compared to previously published results in face-to-face therapy, and the moderating effects of four participant factors found significant in previously published face-to-face studies were investigated using statistical mixed-effect modeling analytic techniques. Therapists (N=30) and clients (N=30) engaged in online therapy were recruited from private practitioner sites, e-clinics, online counseling centers, and mental-health-related discussion boards. In a naturalistic design, they each visited an online site weekly and completed the standard impact and alliance questionnaires for at least 6 weeks. Results indicated that the impact of exchanges and client-therapist alliance in text therapy was similar to, but in some respects more positive than, previous evaluations of face-to-face therapy. The significance of participant factors previously found to influence impact and alliance in face-to-face therapy (client symptom severity, social support, therapist theoretical orientation, and therapist experience) was not replicated, except that therapists with the more symptomatic clients rated their text exchanges as less smooth and comfortable. Although its small size and naturalistic design impose limitations on sensitivity and generalizability, this study provides some insights into treatment impact and the alliance in online therapy.

Alliance for Health Policy and Systems Research: aims, achievements and ambitions.

PubMed

Ghaffar, Abdul; Tran, Nhan; Langlois, Etienne; Shroff, Zubin; Javadi, Dena

2017-02-15

The Alliance for Health Policy and Systems Research was established in 1999 and is hosted as an international partnership by the World Health Organization (WHO). The Alliance emerged from recommendations of the 1996 WHO Ad Hoc Committee on Health Research, which recognised the role of research in strengthening health policies and the overall development of health systems. Work towards the Alliance's mission - to promote the generation and use of health policy and systems research (HPSR) as a means to strengthen health systems in low- and middle-income countries - historically focused on three areas: generation of policy and systems knowledge, promotion of its use in decision making to improve the performance of health systems, and strengthening researchers' and decision makers' capacity to engage in these efforts. Now, after nearly 20 years of learning and accomplishments, the Alliance is launching new strategic objectives to reflect a changed context, and new challenges and opportunities. Over the coming years, the Alliance plans to provide a unique forum for the HPSR community; support institutional capacity to conduct and use HPSR; stimulate the generation of knowledge and innovations to nurture learning and resilience in health systems; and increase demand for, and use of, knowledge for strengthening health systems.

Counselor Training Level and the Formation of the Psychotherapeutic Working Alliance.

ERIC Educational Resources Information Center

Mallinckrodt, Brent; Nelson, Mary Lee

1991-01-01

Investigated relation of training level to working alliance in 50 counselor-client dyads. Counselors were novices, advanced trainees, or experienced counselors. After three sessions, counselors and clients completed Working Alliance Inventory. Results revealed significant main effects for training level of counselor. Found no difference for bond…

Using multi-stakeholder alliances to accelerate the adoption of health information technology by physician practices.

PubMed

McHugh, Megan; Shi, Yunfeng; McClellan, Sean R; Shortell, Stephen M; Fareed, Naleef; Harvey, Jillian; Ramsay, Patricia; Casalino, Lawrence P

2016-06-01

Multi-stakeholder alliances - groups of payers, purchasers, providers, and consumers that work together to address local health goals - are frequently used to improve health care quality within communities. Under the Aligning Forces for Quality (AF4Q) initiative, multi-stakeholder alliances were given funding and technical assistance to encourage the use of health information technology (HIT) to improve quality. We investigated whether HIT adoption was greater in AF4Q communities than in other communities. Drawing upon survey data from 782 small and medium-sized physician practices collected as part of the National Study of Physician Organizations during July 2007 - March 2009 and January 2012-November 2013, we used weighted fixed effects models to detect relative changes in four measures representing three domains: use of electronic health records (EHRs), receipt of electronic information from hospitals, and patients' online access to their medical records. Improvement on a composite EHR adoption measure was 7.6 percentage points greater in AF4Q communities than in non-AF4Q communities, and the increase in the probability of adopting all five EHR capabilities was 23.9 percentage points greater in AF4Q communities. There was no significant difference in improvement in receipt of electronic information from hospitals or patients' online access to medical records between AF4Q and non-AF4Q communities. By linking HIT to quality improvement efforts, AF4Q alliances may have facilitated greater adoption of EHRs in small and medium-sized physician practices, but not receipt of electronic information from hospitals or patients' online access to medical records. Multi-stakeholder alliances charged with promoting HIT to advance quality improvement may accelerate adoption of EHRs. Copyright © 2016 Elsevier Inc. All rights reserved.

Results and current status of the NPARC alliance validation effort

NASA Technical Reports Server (NTRS)

Towne, Charles E.; Jones, Ralph R.

1996-01-01

The NPARC Alliance is a partnership between the NASA Lewis Research Center (LeRC) and the USAF Arnold Engineering Development Center (AEDC) dedicated to the establishment of a national CFD capability, centered on the NPARC Navier-Stokes computer program. The three main tasks of the Alliance are user support, code development, and validation. The present paper is a status report on the validation effort. It describes the validation approach being taken by the Alliance. Representative results are presented for laminar and turbulent flat plate boundary layers, a supersonic axisymmetric jet, and a glancing shock/turbulent boundary layer interaction. Cases scheduled to be run in the future are also listed. The archive of validation cases is described, including information on how to access it via the Internet.

Creating a NASA-Wide Museum Alliance

NASA Technical Reports Server (NTRS)

Sohus, Anita M.

2006-01-01

NASA's Museum Alliance is a nationwide network of informal educators at museums, science centers, and planetariums that present NASA information to their local audiences. Begun in 2002 as the Mars Museum Visualization Alliance with advisors from a dozen museums, the network has grown to over 300 people from 200 organizations, including a dozen or so international partners. The network has become a community of practice among these informal educators who work with students, educators, and the general public on a daily basis, presenting information and fielding questions about space exploration. Communications are primarily through an active listserve, regular telecons, and a pass word protected website. Professional development is delivered via telecons and downloadable presentations. Current content offerings include Mars exploration, Cassini, Stardust, Genesis, Deep Impact, Earth observations, STEREO, and missions to explore beyond our solar system.

Overview of the oral HIV/AIDS Research Alliance Program.

PubMed

Shiboski, C H; Webster-Cyriaque, J Y; Ghannoum, M; Greenspan, J S; Dittmer, D

2011-04-01

The Oral HIV/AIDS Research Alliance is part of the AIDS Clinical Trials Group, the largest HIV clinical trial organization in the world, and it is funded by the National Institute of Dental and Craniofacial Research, in collaboration with the National Institute of Allergy and Infectious Diseases. The alliance's main objective is to investigate the oral complications associated with HIV/AIDS as the epidemic is evolving-in particular, the effects of potent antiretrovirals on the development of oral mucosal lesions and associated fungal and viral pathogens. Furthermore, oral fluids are being explored for their potential monitoring and diagnostic role with respect to HIV disease and coinfections. This article presents an overview of the alliance, its scientific agenda, and an outline of the novel interventional and noninterventional clinical studies ongoing and developing within the AIDS Clinical Trials Group infrastructure in the United States and internationally.

Effects of Live and Educational Music Therapy on Working Alliance and Trust With Patients on Detoxification Unit: A Four-Group Cluster-Randomized Trial.

PubMed

Silverman, Michael J

2016-11-09

Lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation wherein participants interpret song lyrics related to their clinical objectives. For these patients, working alliance and trust in the therapist represent consequential factors that may influence outcomes. However, there is a lack of randomized controlled music therapy studies investigating working alliance and trust in the therapist within lyric analysis interventions for patients with addictions. The purpose of this study was to quantitatively differentiate live versus recorded and educational versus recreational music therapy interventions via measures of working alliance and trust with patients on a detoxification unit. Participants (N = 130) were cluster randomized in a single-session posttest-only design to one of four conditions: Live educational music therapy, recorded educational music therapy, education without music, or recreational music therapy. Dependent measures included working alliance and trust in the therapist. Educational music therapy interventions were scripted lyric analyses. There was no statistically significant between-group difference in any of the measures. Although not significant, a greater number of patients and research participants attended live educational music therapy sessions. Between-group descriptive data were consistently similar but attendance trends may have implications for engaging patients and billing. Implications for clinical practice, limitations of the study, and suggestions for future research are provided.

Working Alliances in College Classrooms

ERIC Educational Resources Information Center

Meyers, Steven A.

2008-01-01

I explain how professors can establish working alliances with students to cultivate a climate conducive to learning. This process involves (a) attending to the emotional bonds that exist in the college classroom, (b) developing shared educational goals and tasks to promote a common sense of purpose, and (c) addressing classroom conflict to repair…

Understanding Alliance Formation Patterns

DTIC Science & Technology

2015-12-01

military, transportation, and communications technologies, which caused every place in the world to be politically significant. Second, “divisions of power...test a similar claim about the association between distance and dyadic alliance formation. In their first model, in which they use the complete data...1885 to 1990] are positively related to dyadic trade levels, and that their non- defense-pact counterparts are not significantly related to trade in

Behavioral indices in medical care outcome: the working alliance, adherence, and related factors.

PubMed

Fuertes, Jairo N; Boylan, Laura S; Fontanella, Jessie A

2009-01-01

The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome. Cognitive and emotional dimensions of the physician-patient relationship were examined in relation to patients' ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients' adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment. The study was based on an ex-post facto field correlation design. One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study. Surveys given to participants. We used the following measurements: Physician-Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire. The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to >0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49). Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes.

The Climate Change Education Partnership Alliance: Building a Network for Effective Collaboration and Impact (Invited)

NASA Astrophysics Data System (ADS)

Scowcroft, G.

2013-12-01

The mission of the Climate Change Education Partnership Alliance (The Alliance), funded by the National Science Foundation (NSF), is to advance exemplary climate change education through research and innovative partnerships. Through six unique regional projects, The Alliance is reaching wide and diverse audiences across the U.S., while linking groups and institutions that might not otherwise be connected by a common focus on climate change education. The goals for The Alliance include building collaborations between projects and institutions, sharing effective practices, and leveraging resources to create a community in which the whole is greater than the sum of its parts. To foster these goals, NSF has funded a central hub, the Alliance Office. Currently, the Alliance Office is building the infrastructure necessary to support activities and communication between the projects. Successful networks need objectives for their interactions and a common vision held by the partners. In the first national meeting of The Alliance members, held in June 2013, the foundation was laid to begin this work. The Alliance now has a common mission and vision to guide the next four years of activities. An initial 'mapping' of the network has identified the scope and diversity of the network, how members are connected, current boundaries of the network, network strengths and weaknesses, and network needs. This information will serve as a baseline as the network develops. The Alliance has also identified the need for key 'working groups' which provide an opportunity for members to work across the projects on common goals. As The Alliance evolves, building blocks identified by the field of network science will be used to forge a strong and successful collaborative enterprise. Infrastructure is being established to support widespread engagement; social ties are being fostered through face-to-face meetings and monthly teleconferences; time is provided to build and share knowledge; the

NCI Alliance for Nanotechnology in Cancer

Cancer.gov

The NCI Alliance for Nanotechnology in Cancer funds the Cancer Nanotechnology Training Centers collectively with the NCI Cancer Training Center. Find out about the funded Centers, to date, that train our next generation of scientists in the field of Canc

The insecure psychotherapy base: Using client and therapist attachment styles to understand the early alliance.

PubMed

Marmarosh, Cheri L; Kivlighan, Dennis M; Bieri, Kathryn; LaFauci Schutt, Jean M; Barone, Carrie; Choi, Jaehwa

2014-09-01

The purpose of this study was to test the notion that complementary attachments are best for achieving a secure base in psychotherapy. Specifically, we predicted third to fifth session alliance from client- and therapist-rated attachment style interactions. Using a combined sample of 46 therapy dyads from a community mental health clinic and university counseling center, the client- and therapist-perceived therapy alliance, attachment anxiety, and attachment avoidance were examined at the beginning of therapy. The results of an Actor-Partner Interdependence Model (APIM; Kenny & Cook, 1999, Partner effects in relationship research: Conceptual issues, analytic difficulties, and illustrations. Personal Relationships, 6, 433-448.) indicated that there was no direct effect of either client or therapist attachment style on therapist or client early ratings of the alliance. One significant interaction emerged and indicated that client-perceived alliance was influenced by therapist and client attachment anxiety. The client-perceived early alliance was higher when more anxious therapists worked with clients with decreasing anxiety. The client early alliance was higher when less anxious therapists worked with clients with increasing anxiety. The findings partially support the notion that different attachment configurations between the therapist and client facilitate greater alliance, but this was the case only when assessing client-perceived early alliance and only with regards to the dimension of attachment anxiety. There were no significant main effects or interactions when exploring therapist-perceived alliance. Implications of the findings are discussed along with recommendations for future study and clinical training. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Antioxidant Micronutrients: Therapeutic Counter Measures for Chemical Agents

DTIC Science & Technology

2011-03-01

ANSI Std. Z39.18 W81XWH-08-2-0007 1 Mar 2010 - 28 Feb 2011Annual01-03-2011 Antioxidant Micronutrients : Therapeutic Counter Measures for Chemical...Agents Kedar Prasad, Ph.D. Premier Micronutrient Corporation Novato, CA 94949 The results of the first phase of HD study suggested that exposure to...Hypothesis of HD study: For the first phase of the study, our hypothesis is that oral supplementation with a mixture of dietary and endogenous

Strategic hospital alliances: do the type and market structure of strategic hospital alliances matter?

PubMed

McCue, M J; Clement, J P; Luke, R D

1999-10-01

Throughout the 1990s, hospitals formed local alliances to defend against increasingly powerful hospital rivals and to improve their market positions relative to aggressive and consolidating managed-care organizations. An important consequence of hospitals combining or aligning horizontally at the local level is a significant consolidation of hospital markets. The aim of this study was to examine the relationship between the type of the local strategic hospital alliances (SHAs), market, environment, and operational factors with financial performance. The study is a cross-sectional analysis of the financial performance across SHAs in all metropolitan statistical areas in 1995. SHAs with dominant or dominant for-profit (FP) hospitals are not more financially successful than other SHAs. SHAs in markets with high health maintenance organization (HMO) or SHA penetration have lower revenues per case-mix adjusted discharge. The operational characteristics, proportion of teaching members in the SHA, and SHA bed size, result in higher revenues and expenses, whereas greater SHA technical efficiency results in lower costs. Health care organizations are centralizing their operations and governance. This study shows that this trend has not added financial value to hospital collectives, at least at this point in their development.

The Carnegie Mellon/Sirsi Corporation Alliance.

ERIC Educational Resources Information Center

Troll, Denise A.; Depellegrin, Tracey A.; Myers, Melanie D.

1999-01-01

Describes the relationship between Carnegie Mellon University libraries and Sirsi Corporation, their integrated library-management system vendor. Topics include Carnegie Mellon's expertise in library automation research and development; and three primary elements of the alliance: research, including user protocols, surveys, and focus groups;…

Adolescent and parent alliances with therapists in Brief Strategic Family Therapy with drug-using Hispanic adolescents.

PubMed

Robbins, Michael S; Mayorga, Carla C; Mitrani, Victoria B; Szapocznik, José; Turner, Charles W; Alexander, James F

2008-07-01

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.

AORN and University of Michigan School of nursing research alliance.

PubMed

Talsma, Akkeneel; Chard, Robin; Kleiner, Catherine; Anderson, Christine; Geun, Hyogeun

2011-06-01

Research related to perioperative care requires advanced training and is well suited to take place at a research-intensive university. A recent research alliance established between AORN and the University of Michigan School of Nursing, Ann Arbor, uses the strengths of both a robust perioperative professional organization and a research-intensive university to make progress toward improving patient safety and transforming the perioperative work environment. Research activities undertaken by this alliance include investigating nurse staffing characteristics and patient outcomes, as well as evaluating the congruence and definitions of data elements contained in AORN's SYNTEGRITY™ Standardized Perioperative Framework. Disseminating the findings of the alliance is expected to facilitate the communication and application of new knowledge to nursing practice and help advance the perioperative nursing profession. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Autonomous and controlled motivation and interpersonal therapy for depression: moderating role of recurrent depression.

PubMed

McBride, Carolina; Zuroff, David C; Ravitz, Paula; Koestner, Richard; Moskowitz, Debbie S; Quilty, Lena; Bagby, R Michael

2010-11-01

We examined the moderating role of depression recurrence on the relation between autonomous and controlled motivation and interpersonal therapy (IPT) treatment outcome. The investigation was conducted in an out-patient mood disorders clinic of a large university-affiliated psychiatric hospital. The sample represents a subset of a larger naturalistic database of patients seen in the clinic. We examined 74 depressed out-patients who received 16 sessions of IPT. The Beck Depression Inventory-II, administered at pre-treatment and post-treatment, served as a measure of depressive severity. Measures of motivation and therapeutic alliance were collected at the third session. In the entire sample, both the therapeutic alliance and autonomous motivation predicted higher probability of achieving remission; however, the relation differed for those with highly recurrent depression compared to those with less recurrent depression. For those with highly recurrent depression, the therapeutic alliance predicted remission whereas autonomous motivation had no effect on remission. For those with less recurrent depression, both autonomous motivation and the therapeutic alliance predicted better achieving remission. Controlled motivation emerged as a significant negative predictor of remission across both groups. Taken together, these results highlight the possible use of motivation theory to inform and enrich therapeutic conceptualizations and interventions in clinical practice, but also point to the importance of modifying interventions based on the chronicity of a client's depression.

[Online Counselling: The prospect of a therapeutic connection].

PubMed

Giotakos, O; Papadomarkaki, E

2016-01-01

Over the last few years, Internet has become an integral part of daily life. An abundant source of information and a principal gateway of communication between individuals, Internet has been continuously gaining considerable ground as a tool of awareness and intervention in the area of public health. With regard to the field of mental health, Internet exhibits a credible potential in facilitating dialogue not only between experts and their beneficiaries but also between stakeholders. Moreover and with regard to various aspects of public concern, it can serve as a circulation portal of educational material between students and teachers. The advent of remote support services dates back in the decade of 1970-1980. In the present time, they consist of informative guides and self-help groups or online counselling. The latter is defined as the process in which both parties, namely the therapist and the client, are involved in an oral or written conciliation through means of an internet connection, videoconferencing, live chat or e-mail exchange. The benefits of this practice - accessibility, relocation, convenience, anonymity, facilitation of face-to-face psychotherapy and low cost - could make online counseling, in specific cases, the treatment of choice. While the usage of the World Wide Web seems promising for the rectification of mental health disorders, there is some debate among experts regarding the ethical aspect of practicing psychotherapy in an interactive digital environment. Issues such as technical expertise and the tackling of related problems, difficulties in the diagnostic process, interchange of verbal and nonverbal cues, crisis management, safeguarding the therapeutic alliance, protection of personal data, age restriction, keeping boundaries in relation to the setting, the time and the dynamics of the therapeutic relationship and, finally, training and supervisory process of online therapist, are some subjects of disagreement. Relevant research reveals

Self-help books for people with depression: the role of the therapeutic relationship.

PubMed

Richardson, Rachel; Richards, David A; Barkham, Michael

2010-01-01

In the UK, bibliotherapy schemes have become a widespread source of support for people with common mental health disorders such as depression. However, the current evidence suggests that bibliotherapy schemes that are offered without guidance are not effective. It may be possible to improve the effectiveness of self-help books by incorporating into them some of the "common factors" that operate in personal therapeutic encounters, for example therapist responsiveness. The aim was to test whether and to what extent authors have incorporated common factors into self-help books. A model of how common factors might be incorporated into CBT-based self-help books was developed and a sample of three books were examined against the model criteria. The sampled self-help books were found to have common factors to a greater or lesser extent, but some types of common factors were more prevalent than others. Factors addressing the development and maintenance of the therapeutic alliance were less often apparent. Self-help books have the potential to provide a valuable service to people with depression, but further work is necessary to develop them. It is suggested that future generations of self-help books should pay explicit attention to the use of common factors, in particular developing and investigating how factors such as flexibility, responsiveness and alliance-rupture repair can be woven into the text.

Creating value for participants in multistakeholder alliances: The shifting importance of leadership and collaborative decision-making over time.

PubMed

D'Aunno, Thomas; Alexander, Jeffrey A; Jiang, Lan

Multistakeholder alliances that bring together diverse organizations to work on health-related issues are playing an increasingly prominent role in the U.S. health care system. Prior research shows that collaborative decision-making and effective leadership are related to members' perceptions of value for their participation in alliances. Yet, we know little about how collaborative decision-making and leadership might matter over time in multistakeholder alliances. The aim of this study was to advance understanding of the role of collaborative decision-making and leadership in individuals' assessments of the benefits and costs of their participation in multistakeholder alliances over time. We draw on data collected from three rounds of surveys of alliance members (2007-2012) who participated in the Robert Wood Johnson Foundation's Aligning Forces for Quality program. Results from regression analyses indicate that individuals' perceptions of value for their participation in alliances shift over time: Perceived value is higher with collaborative decision-making when alliances are first formed and higher with more effective leadership as time passes after alliance formation. Leaders of multistakeholder alliances may need to vary their behavior over time, shifting their emphasis from inclusive decision-making to task achievement.

Facilitating Economic Development through Strategic Alliances.

ERIC Educational Resources Information Center

Noftsinger, John B., Jr.

2002-01-01

Discusses how colleges and universities are becoming increasingly involved in economic development, with the formation of strategic alliances that have led to programs that benefit business and higher education. Discusses example programs from the Valley of Virginia Partnership for Education, and the outreach program of James Madison University.…

The relevance of the alliance for CME competencies for planning, organizing, and sustaining an interorganizational educational collaborative.

PubMed

Balmer, Jann T; Bellande, Bruce J; Addleton, Robert L; Havens, Carol S

2011-01-01

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these new expectations. In addition to administrative and meeting-planning activities, new competencies associated with educational consultation and performance coaching are needed. This article utilizes the Alliance competencies as the framework for discussion of the competencies of CE professionals and applies it to the unique setting of a collaborative. The CS2day initiative serves as an example of the application of these competencies in this environment. The framework of the Alliance competencies can serve as a guide and a tool for self-assessment, work design, and professional development at individual, organization, and systems levels. Continual reassessment of the Alliance competencies for CE in the health professions will be critical to the continued effectiveness of CE that is linked to performance improvement and outcomes for the CE professional and the health care professionals we serve. A collaborative can provide one option for meeting these new expectations for professional development for CE professionals and the creation of effective educational initiatives. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Chinese Cultural Values and Their Applicability of Successful Sino-Foreign Educational Alliances

ERIC Educational Resources Information Center

Willis, Mike

2006-01-01

Alliances between Chinese and foreign usually western universities continue to attract considerable attention and one of the issues which remains of particular interest is the cross cultural dimension of such alliances and, in particular, the importance of understanding various strands and aspects of Chinese culture when negotiating and managing a…

Working Alliance in Online Cognitive Behavior Therapy for Anxiety Disorders in Youth: Comparison With Clinic Delivery and its Role in Predicting Outcome

PubMed Central

Anderson, Renee E E; Donovan, Caroline L; March, Sonja; Prosser, Samantha; Kenardy, Justin

2012-01-01

Background Substantial evidence exists that positive therapy outcomes are related to the therapist–client working alliance. Objectives To report two studies that examined (1) the quality of the working alliance in online cognitive behavior therapy (CBT), with minimal therapist contact, for anxiety disorders in youth, and (2) the role of working alliance and compliance in predicting treatment outcome. Methods Study 1 participants were 73 adolescents aged 12 to 18 years who met diagnostic criteria for an anxiety disorder, plus one or more of their parents. Participants were randomly assigned to clinic or online delivery of CBT, with working alliance being assessed for youth and parents after session 3. Study 2 participants were 132 children and adolescents aged 7 to 18 years who met diagnostic criteria for an anxiety disorder, plus one or more of their parents. Youths and parents participated in a minimally therapist-assisted online CBT program supported by brief, weekly emails and a single, short phone call. Results Study 1 revealed a strong working alliance for both online and clinic CBT, with no significant difference in working alliance between conditions for adolescents (F 1,73 = 0.44, P = .51, ηp 2 = 0.006, Cohen d = 0.15). Parents also reported high working alliance in both conditions, although a slight but significantly higher working alliance in clinic-based therapy (F 1,70 = 6.76, P = .01, ηp 2 = 0.09, Cohen d = 0.64). Study 2 showed a significant and substantial decrease in anxiety symptoms following online therapy (P < .001 for all outcome measures). Adolescents improved significantly more in overall functioning when working alliance (beta = .22, t 79 = 2.21, P = .03) and therapy compliance (beta = .22, t 84 = 2.22, P = .03) were higher, with working alliance also predicting compliance (beta = .38, F 1,80 = 13.10, P = .01). No such relationships were evident among younger children. Conclusions Working alliance is important in determining clinical

Therapist effects and the outcome-alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia.

PubMed

Huppert, Jonathan D; Kivity, Yogev; Barlow, David H; Gorman, Jack M; Shear, M Katherine; Woods, Scott W

2014-01-01

Although the alliance-outcome correlation is well established, no published studies to date have separated between therapists' and patients' contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists' and patients' contribution to the alliance on outcome and attrition in one trial. Alliance ratings were obtained from patients and therapists early and late in treatment (n = 133). Data were analyzed using multi-level modeling controlling for early symptom change. No therapist effects were found. The patients' contribution to the alliance predicted outcome (in both panic severity and anxiety sensitivity) and attrition. The therapists' contribution to the alliance predicted attrition but not outcome. Results suggest that the patient's contribution to the alliance plays an important role in CBT for PDA and that including common factors into research on CBT may help elucidate treatment processes. Copyright © 2013 Elsevier Ltd. All rights reserved.

An International Framework for Data Sharing: Moving Forward with the Global Alliance for Genomics and Health.

PubMed

Rahimzadeh, Vasiliki; Dyke, Stephanie O M; Knoppers, Bartha M

2016-06-01

The Global Alliance for Genomics and Health is marshaling expertise in biomedical research and data sharing policy to propel bench-to-bedside translation of genomics in parallel with many of the BioSHaRE-EU initiatives described at length in this Issue. Worldwide representation of institutions, funders, researchers, and patient advocacy groups at the Global Alliance is testament to a shared ideal that sees maximizing the public good as a chief priority of genomic innovation in health. The Global Alliance has made a critical stride in this regard with the development of its Framework for Responsible Sharing of Genomic and Health-related Data.(1) This article first discusses the human rights pillars that underlie the Framework and mission of the Global Alliance. Second, it outlines the Global Alliance's use of data governance policies through a number of demonstration projects. Finally, the authors describe how the Global Alliance envisions international data sharing moving forward in the postgenomic era.

Building A Middle Eastern Alliance

DTIC Science & Technology

2015-02-12

with new centers of influence. Taken together, these approaches will allow us to foster more effective global cooperation to confront challenges that...know no borders and affect every nation.”15 Moreover, “regional organizations can be particularly effective at mobilizing and legitimating... effective alliance. Economically, President Obama has emphasized the importance of a strong US economy in many occasions calling it “the foundation of our

Heartland Alliance for Regional Transmission

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jackson, Nancy

2017-03-15

The Heartland Alliance for Regional Transmission (HART) will foster a candid, productive conversation among stakeholders that identifies challenges to and benefits from a massive build out of wind generation and transmission across the Southwest Power Pool. Based on the outcomes of those deliberations, HART will develop and deliver an ambitious, coordinated, peer-to-peer outreach effort that spans the SPP to improve market acceptance for wind.

77 FR 75200 - AllianceBernstein Active ETFs, Inc., et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-19

... SECURITIES AND EXCHANGE COMMISSION [Investment Company Act Release No. 30305; 812-13797] AllianceBernstein Active ETFs, Inc., et al.; Notice of Application December 13, 2012. AGENCY: Securities and...Bernstein Active ETFs, Inc. (``Corporation''), AllianceBernstein L.P. (``Adviser''), and ALPS Distributors...

Developing Strategic Alliances in Management Learning

ERIC Educational Resources Information Center

Thorne, E. Ann; Wright, Gill

2005-01-01

Purpose: The notion of effective strategic alliances provides the basis on which this paper proposes a framework to manage the application and outcomes of management learning. The management of key partner collaboration emerges in this paper as a major success factor in determining effective management learning. A proactive structured approach to…

Movement to Create 'Academic Alliances' of Teachers of Same Subjects at All Education Levels Is Growing.

ERIC Educational Resources Information Center

Watkins, Beverly T.

1988-01-01

The movement to create "academic alliances" of high-school and college teachers is discussed. The alliances owe much of their strength to the increased sense of self-esteem and the pleasure that members find in the company of disciplinary colleagues. A directory of some alliances is included. (MLW)

WAAR (World Alliance against Antibiotic Resistance): Safeguarding antibiotics.

PubMed

Carlet, Jean; Rambaud, Claude; Pulcini, Céline

2012-07-09

Resistance to antibiotics has increased recently to a dramatic extend, and the pipeline of new antibiotics is almost dry for the five next years. Failures happen already for trivial community acquired infections, like pyelonephritis, or peritonitis, and this is likely to increase. Difficult surgical procedures, transplants, and other immunosuppressive therapies will become far more risky. Resistance is mainly due to an excessive usage of antibiotics, in all sectors, including the animal one. Action is urgently needed. Therefore, an alliance against MDRO has been recently created, which includes health care professionals, consumers, health managers, and politicians. The document highlights the different proposed measures, and represents a strong consensus between the different professionals, including general practicionners, and veterinarians.

Black-Brown Relations: Are Alliances Possible?

ERIC Educational Resources Information Center

Klor de Alva, J. Jorge; West, Cornel

1997-01-01

Dialogue between Cornel West and Jorge Klor de Alva explores the question of black-brown alliances, those between African Americans and Hispanic Americans. If minority groups can put aside the difference of skin color and join to combat economic and social racism, they can have far-reaching and meaningful impacts on society. (SLD)

Korean Unification and the Future of the U.S.-ROK Alliance

DTIC Science & Technology

2016-02-01

institutionalized or largely unstruc-tured. Regardless of form, security alliances as instruments of statecraft, at their most fundamental level , reflect a...a unified Korea would, at a macro level , reinforce the inter- national liberal democratic order. At a micro level , it could help ensure security on...Minister of Defense, which has since become an annual platform for strategic- level consultations on the alliance. Similar- ly, the Military Committee was

Assessing relationship quality in mandated community treatment: blending care with control.

PubMed

Skeem, Jennifer L; Louden, Jennifer Eno; Polaschek, Devon; Camp, Jacqueline

2007-12-01

Traditional measures of the therapeutic alliance do not capture the dual roles inherent in relationships with involuntary clients. Providers not only care for, but also have control over, involuntary clients. In 2 studies of probationers mandated to psychiatric treatment (n=90; n=322), the authors developed and validated the revised Dual-Role Relationships Inventory (DRI-R). The authors found that (a) relationship quality in mandated treatment involves caring and fairness, trust, and an authoritative (not authoritarian) style, (b) the DRI-R assesses these domains of relationship quality, is internally consistent, and relates in a theoretically coherent pattern with ratings of within-session behavior and with measures of the therapeutic alliance, relationship satisfaction, symptoms, and treatment motivation, and (c) the quality of dual-role relationships predicts future compliance with the rules, as assessed by probation violations and revocation. The DRI-R covaries with multiple domains more strongly than a leading measure of the therapeutic alliance, suggesting that it better captures the nature and effect of relationship quality in mandated treatment.

US Army Research Laboratory (ARL) Robotics Collaborative Technology Alliance 2014 Capstone Experiment

DTIC Science & Technology

2016-07-01

ARL-TR-7729 ● JULY 2016 US Army Research Laboratory US Army Research Laboratory (ARL) Robotics Collaborative Technology Alliance...TR-7729 ● JULY 2016 US Army Research Laboratory US Army Research Laboratory (ARL) Robotics Collaborative Technology Alliance 2014 Capstone...National Robotics Engineering Center, Pittsburgh, PA Robert Dean, Terence Keegan, and Chip Diberardino General Dynamics Land Systems, Westminster

Fracturing alliance improves profitability of Lost Hills field

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stewart, M.; Stewart, D.; Gaona, M.

1994-11-21

About 2 billion bbl of oil-in-place are present in the massive diatomite deposits of California's Lost Hills field, about 45 miles north-west of Bakersfield, Calif. Massive hydraulic fracturing treatments, 2,500-3,000 lb of proppant/net perforated ft, are an integral part of developing these reserves. An exclusive fracturing alliance initiated in 1990 between Chevron U.S.A. and Schlumberger Dowell has improved profitability of the Los Hills field. the paper describes the geology, the field before 1987, the 1987--90 period when hydraulic fracturing stimulation was found to be very costly, and after 1990 when the alliance was formed. The paper also describes the fracturingmore » fluid, proppants, engineering evaluation, and execution of the job.« less

Best Friends: Alliances, Friend Ranking, and the MySpace Social Network.

PubMed

DeScioli, Peter; Kurzban, Robert; Koch, Elizabeth N; Liben-Nowell, David

2011-01-01

Like many topics of psychological research, the explanation for friendship is at once intuitive and difficult to address empirically. These difficulties worsen when one seeks, as we do, to go beyond "obvious" explanations ("humans are social creatures") to ask deeper questions, such as "What is the evolved function of human friendship?" In recent years, however, a new window into human behavior has opened as a growing fraction of people's social activity has moved online, leaving a wealth of digital traces behind. One example is a feature of the MySpace social network that allows millions of users to rank their "Top Friends." In this study, we collected over 10 million people's friendship decisions from MySpace to test predictions made by hypotheses about human friendship. We found particular support for the alliance hypothesis, which holds that human friendship is caused by cognitive systems that function to create alliances for potential disputes. Because an ally's support can be undermined by a stronger outside relationship, the alliance model predicts that people will prefer partners who rank them above other friends. Consistent with the alliance model, we found that an individual's choice of best friend in MySpace is strongly predicted by how partners rank that individual. © The Author(s) 2011.

Global alliances effect in coalition forming

NASA Astrophysics Data System (ADS)

Vinogradova, Galina; Galam, Serge

2014-11-01

Coalition forming is investigated among countries, which are coupled with short range interactions, under the influence of externally-set opposing global alliances. The model extends a recent Natural Model of coalition forming inspired from Statistical Physics, where instabilities are a consequence of decentralized maximization of the individual benefits of actors. In contrast to physics where spins can only evaluate the immediate cost/benefit of a flip of orientation, countries have a long horizon of rationality, which associates with the ability to envision a way up to a better configuration even at the cost of passing through intermediate loosing states. The stabilizing effect is produced through polarization by the global alliances of either a particular unique global interest factor or multiple simultaneous ones. This model provides a versatile theoretical tool for the analysis of real cases and design of novel strategies. Such analysis is provided for several real cases including the Eurozone. The results shed a new light on the understanding of the complex phenomena of planned stabilization in the coalition forming.

76 FR 75922 - AllianceBernstein Cap Fund, Inc., et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-05

... SECURITIES AND EXCHANGE COMMISSION [Investment Company Act Release No. 29876; File No. 812-13939] AllianceBernstein Cap Fund, Inc., et al.; Notice of Application November 29, 2011. AGENCY: Securities and... 12d1-2 under the Act to invest in certain financial instruments. APPLICANTS: AllianceBernstein Cap Fund...

Trainee Therapists' Views on the Alliance in Psychotherapy and Supervision: A Longitudinal Study

ERIC Educational Resources Information Center

Ybrandt, H.; Sundin, E. C.; Capone, G.

2016-01-01

The shape of alliance in psychotherapy and supervision using growth curve modeling was examined for clinically inexperienced trainee therapists, who were engaged in long-term cognitive behavioral--or psychodynamic individual psychotherapy at a Psychology Clinic in Sweden. Trainee therapists rated their view of the alliance with their clients and…

Alliances That Work. A Report from a Conference (Louisville, Kentucky, May 23, 2000).

ERIC Educational Resources Information Center

Regional Technology Strategies, Inc., Carrboro, NC.

This monograph summarizes presentations and discussions that took place at a symposium organized in conjunction with the spring meeting of the Trans-Atlantic Technology and Training Alliance (TA3). TA3 is an international alliance dedicated to sharing practices that prepare workers for technical careers, providing opportunities for faculty…

Report on the Black Hills Alliance.

ERIC Educational Resources Information Center

Ryan, Joe

1979-01-01

A rally to save the Black Hills from coal- and uranium-greedy energy companies was held on July 6 and over 2,000 joined in a 15-mile walk on July 7 in Rapid City, South Dakota. The Black Hills Alliance, an Indian coalition concerned about energy development proposals in the Great Plains, sponsored the gathering. (NQ)

Leadership transitions in multisectoral health care alliances: Implications for member perceptions of participation value.

PubMed

Hearld, Larry R; Alexander, Jeffrey A; Shi, Yunfeng

2015-01-01

Collaborative forms of organizations such as multisectoral health care alliances play an increasingly prominent role in the U.S. health care system. A key feature of these organizations highlighted in previous research is leadership, yet little research has examined what happens when there is a change in leadership. The aim of this study was to examine the relationship between leadership transitions in an alliance and member assessments of the benefits and costs of participation, indicators of the value that members derive from their involvement in the alliance. The study used quantitative data collected from three rounds of surveys of alliance members participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality Program. Qualitative interview data supplemented this analysis by providing examples of why leadership transitions may affect participation benefits and costs. Quantitative analysis indicated that alliance members who experienced a change in leadership reported both higher and lower levels of participation benefits and costs, depending on the type of leadership change (i.e., alliance leader vs. programmatic leader). Qualitative analysis suggested that the scope of responsibilities of different types of leaders plays an important role in how members perceive changes. Likewise, interviews indicated that timing influences how disruptive a leadership transition is and whether it is perceived positively or negatively. Leadership transitions present both challenges and opportunities; whether the effects are felt positively or negatively depends on when a transition occurs and how it is handled by incoming leaders and remaining members. Furthermore, different types of members report higher levels of participation benefits and lower levels of participation costs, suggesting that efforts to maintain a sense of alliance value during times of transitions may be able to target certain types of individuals.

Acronyms and Agencies. Alliance Action Information Sheets

ERIC Educational Resources Information Center

Technical Assistance ALLIANCE for Parent Centers, 2007

2007-01-01

This paper presents acronyms related to early intervention, education, special education, and other laws important to individuals with disabilities and their families. For related information, also read Acronyms and the Law. [For related report, "Acronyms and the Law. Alliance Action Information Sheets," see ED534052.

Fracturing alliance allows economical production of massive diatomite oil reserves: A case study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klins, M.A.; Stewart, D.W.; Pferdehirt, D.J.

1996-01-01

As North American oilfield operations mature, there is a perceptible loosening of the autocratic ties between oil companies and contractors. They are being replaced by alliances or partnerships designed to minimize cost while improving profitability of the companies involved. This paper evaluates a mature alliance, its implementation, structure, and results.

Comparison of Hyperspectral and Multispectral Satellites for Forest Alliance Classification in the San Francisco Bay Area

NASA Astrophysics Data System (ADS)

Clark, M. L.

2016-12-01

The goal of this study was to assess multi-temporal, Hyperspectral Infrared Imager (HyspIRI) satellite imagery for improved forest class mapping relative to multispectral satellites. The study area was the western San Francisco Bay Area, California and forest alliances (e.g., forest communities defined by dominant or co-dominant trees) were defined using the U.S. National Vegetation Classification System. Simulated 30-m HyspIRI, Landsat 8 and Sentinel-2 imagery were processed from image data acquired by NASA's AVIRIS airborne sensor in year 2015, with summer and multi-temporal (spring, summer, fall) data analyzed separately. HyspIRI reflectance was used to generate a suite of hyperspectral metrics that targeted key spectral features related to chemical and structural properties. The Random Forests classifier was applied to the simulated images and overall accuracies (OA) were compared to those from real Landsat 8 images. For each image group, broad land cover (e.g., Needle-leaf Trees, Broad-leaf Trees, Annual agriculture, Herbaceous, Built-up) was classified first, followed by a finer-detail forest alliance classification for pixels mapped as closed-canopy forest. There were 5 needle-leaf tree alliances and 16 broad-leaf tree alliances, including 7 Quercus (oak) alliance types. No forest alliance classification exceeded 50% OA, indicating that there was broad spectral similarity among alliances, most of which were not spectrally pure but rather a mix of tree species. In general, needle-leaf (Pine, Redwood, Douglas Fir) alliances had better class accuracies than broad-leaf alliances (Oaks, Madrone, Bay Laurel, Buckeye, etc). Multi-temporal data classifications all had 5-6% greater OA than with comparable summer data. For simulated data, HyspIRI metrics had 4-5% greater OA than Landsat 8 and Sentinel-2 multispectral imagery and 3-4% greater OA than HyspIRI reflectance. Finally, HyspIRI metrics had 8% greater OA than real Landsat 8 imagery. In conclusion, forest

Adolescent and parent motivation for change affects psychotherapy outcomes among youth with poorly controlled diabetes.

PubMed

Ellis, Deborah A; Berio, Heidi; Carcone, April Idalski; Naar-King, Sylvie

2012-01-01

Investigate effect of baseline motivation for change on treatment fidelity, therapeutic alliance, treatment dose, and treatment outcome in a randomized controlled trial of family therapy for youth with poorly controlled diabetes. Seventy-four adolescents and caregivers completed measures of motivation for change. Measures of fidelity, alliance, dose, and youth health status were collected. Structural equation modeling was used to test the direct and indirect effects of motivation on treatment outcomes. Parent motivation was significantly related to alliance and fidelity. Only alliance was significantly related to posttreatment metabolic control. In adolescent models, only motivation was significantly related to alliance. In both models, motivation had a significant indirect effect on metabolic control through alliance. Findings demonstrate the importance of parent and youth initial motivational status and treatment alliance to treatment outcome among youth with poorly controlled diabetes. Additional research on treatment techniques that promote motivation for change is needed.

The role of collegial alliance in family-based treatment of adolescent anorexia nervosa: a pilot study.

PubMed

Murray, Stuart B; Griffiths, Scott; Le Grange, Daniel

2014-05-01

In keeping with broader efforts to identify mediators and moderators of treatment outcome in anorexia nervosa, this pilot study investigated the association between collegial alliance, which refers to the perceived alliance between case-involved professionals, and treatment outcomes in adolescent patients undergoing family-based treatment (FBT) for anorexia nervosa. The self-reported collegial alliance scores of five FBT practitioners were collected, alongside weight- and cognitive-related outcomes for 29 consecutive cases of adolescent anorexia nervosa under their care. Collegial alliance discriminated between patients who dropped out of treatment and patients who completed treatment, t(27) = 3.68, p = .001, η(2)  = .33. Furthermore, there was a strong negative correlation between collegial alliance scores early on in treatment and disordered eating symptoms later in treatment, r(23) = -.67, p < .001. Moderate but non-significant associations were observed between early collegial alliance and patient's percentage of expected body weight later in treatment, r(23) = .32, p = .13. These findings have important implications for the augmentation of FBT, suggesting that unity amongst clinicians promotes positive treatment outcomes, particularly with regard to disordered eating symptomatology. Copyright © 2013 Wiley Periodicals, Inc.

A novel method for detecting neutralizing antibodies against therapeutic proteins by measuring gene expression.

PubMed

Yu, Yanbin; Piddington, Christopher; Fitzpatrick, Dan; Twomey, Brian; Xu, Ren; Swanson, Steven J; Jing, Shuqian

2006-10-20

The presence of neutralizing antibodies against protein therapeutics is a concern in the biomedical field. Such antibodies not only reduce the efficacy of protein therapeutics, but also impose potential dangers to the patients receiving them. To date, a small number of in vitro cell-based bioassays for detecting neutralizing antibodies against therapeutic proteins have been developed. Most of the existing assays, however, either involve the use of radioactive materials or have limited sensitivities and/or poor specificities. With advances in mRNA profiling and detection techniques, we have established a novel and non-radioactive bioassay system using branched DNA (bDNA) technology for detecting protein-therapeutic neutralizing antibodies in patient serum. Our assay measures the variations of target gene expression that reflect the biologic effect of the therapeutic agent and the capability of the antibodies, if present, to neutralize the therapeutics. Compared with most existing assays, the new assay is more sensitive and specific, and completely eliminates the use of radioactive materials. Application of the new assay system can be widely expanded if new target genes and responding cell lines for other therapeutics are identified or engineered.

Lethal coalitionary aggression and long-term alliance formation among Yanomamö men.

PubMed

Macfarlan, Shane J; Walker, Robert S; Flinn, Mark V; Chagnon, Napoleon A

2014-11-25

Some cross-cultural evidence suggests lethal coalitionary aggression in humans is the product of residence and descent rules that promote fraternal interest groups, i.e., power groups of coresident males bonded by kinship. As such, human lethal coalitions are hypothesized to be homologous to chimpanzee (Pan troglodytes) border patrols. However, humans demonstrate a unique metagroup social structure in which strategic alliances allow individuals to form coalitions transcending local community boundaries. We test predictions derived from the fraternal interest group and strategic alliance models using lethal coalition data from a lowland South American population, the Yanomamö. Yanomamö men who kill an enemy acquire a special status, termed unokai. We examine the social characteristics of co-unokais or men who jointly kill others. Analyses indicate co-unokais generally are (i) from the same population but from different villages and patrilines, (ii) close age mates, and (iii) maternal half-first cousins. Furthermore, the incident rate for co-unokai killings increases if men are similar in age, from the same population, and from different natal communities. Co-unokais who have killed more times in the past and who are more genetically related to each other have a higher probability of coresidence in adulthood. Last, a relationship exists between lethal coalition formation and marriage exchange. In this population, internal warfare unites multiple communities, and co-unokais strategically form new residential groups and marriage alliances. These results support the strategic alliance model of coalitionary aggression, demonstrate the complexities of human alliance formation, and illuminate key differences in social structure distinguishing humans from other primates.

Lethal coalitionary aggression and long-term alliance formation among Yanomamö men

PubMed Central

Macfarlan, Shane J.; Walker, Robert S.; Flinn, Mark V.; Chagnon, Napoleon A.

2014-01-01

Some cross-cultural evidence suggests lethal coalitionary aggression in humans is the product of residence and descent rules that promote fraternal interest groups, i.e., power groups of coresident males bonded by kinship. As such, human lethal coalitions are hypothesized to be homologous to chimpanzee (Pan troglodytes) border patrols. However, humans demonstrate a unique metagroup social structure in which strategic alliances allow individuals to form coalitions transcending local community boundaries. We test predictions derived from the fraternal interest group and strategic alliance models using lethal coalition data from a lowland South American population, the Yanomamö. Yanomamö men who kill an enemy acquire a special status, termed unokai. We examine the social characteristics of co-unokais or men who jointly kill others. Analyses indicate co-unokais generally are (i) from the same population but from different villages and patrilines, (ii) close age mates, and (iii) maternal half-first cousins. Furthermore, the incident rate for co-unokai killings increases if men are similar in age, from the same population, and from different natal communities. Co-unokais who have killed more times in the past and who are more genetically related to each other have a higher probability of coresidence in adulthood. Last, a relationship exists between lethal coalition formation and marriage exchange. In this population, internal warfare unites multiple communities, and co-unokais strategically form new residential groups and marriage alliances. These results support the strategic alliance model of coalitionary aggression, demonstrate the complexities of human alliance formation, and illuminate key differences in social structure distinguishing humans from other primates. PMID:25349394

How to address patients' defences: a pilot study of the accuracy of defence interpretations and alliance.

PubMed

Junod, Olivier; de Roten, Yves; Martinez, Elena; Drapeau, Martin; Despland, Jean-Nicolas

2005-12-01

This pilot study examined the accuracy of therapist defence interpretations (TAD) in high-alliance patients (N = 7) and low-alliance patients (N = 8). TAD accuracy was assessed in the two subgroups by comparing for each case the patient's most frequent defensive level with the most frequent defensive level addressed by the therapist when making defence interpretations. Results show that in high-alliance patient-therapist dyads, the therapists tend to address accurate or higher (more mature) defensive level than patients most frequent level. On the other hand, the therapists address lower (more immature) defensive level in low-alliance dyads. These results are discussed along with possible ways to better assess TAD accuracy.

Investigating the impact of alliance-focused training on interpersonal process and therapists' capacity for experiential reflection.

PubMed

Safran, Jeremy; Muran, J Christopher; Demaria, Anthony; Boutwell, Catherine; Eubanks-Carter, Catherine; Winston, Arnold

2014-01-01

In this article we present preliminary findings from a research program designed to investigate the value of alliance-focused training (AFT), a supervision approach designed to enhance therapists' ability to work constructively with negative therapeutic process. In the context of a multiple baseline design, all therapists began treating their patients using cognitive therapy and then joined AFT supervision groups at either session 8 or 16 of a 30 session protocol. Study I investigated the impact of AFT on patient and therapist interpersonal process as assessed through the Structural Analysis of Social Behavior (SASB). Study 2 investigated the impact of AFT on therapists' tendency to reflect on their relationships with their patients in an experientially grounded fashion, as assessed via the Experiencing Scale (EXP). Since one of the goals of AFT is to train therapists to use their own emerging feelings as important clues regarding what may be taking place in the therapeutic relationship, we hypothesized that they would show increased levels of EXP after undergoing AFT. The results of both studies 1 and 2 were for the most part consistent with hypotheses. Implications and future research directions are discussed.

The Pak-U.S. Alliance in the Fight Against Terrorism: A Cost-Benefit Analysis

DTIC Science & Technology

2011-12-01

Micro-Alliance, Entrepreneurship , Game Theoretical Approach, Perceptions and Realities, Military-Centric Assistance, Population-Centric Approach...40 4. Entrepreneurship and Micro-Alliances ...........................................41 E. SUMMARY...through educational reforms, trade and employment ( entrepreneurship ). 6 6. Hypothesis-3: Promoting converging interests/common goals and removing

Family Traditions, Cultural Values, and the Clinician's Countertransference: Therapeutic Assessment of a Young Sicilian Woman.

PubMed

Fantini, Francesca

2016-01-01

Despite recent advances in models and instruments to understand the role of a client's cultural background, clinical psychologists are not immune to implicit cultural biases that are potentially damaging to the therapeutic alliance. In this article, I present a Therapeutic Assessment with a young Sicilian woman conducted in a university-based student clinic in Italy. During the assessment, I assumed that because we were both Italians, my client shared my perspective (northern Italian) about family and individual values, which resulted in a therapeutic impasse when I responded on the basis of my individual and culturally shaped view of interpersonal and family relationships without appreciating important differences between my own and my client's microcultures. To overcome the impasse, I had to openly acknowledge such differences and reorient myself to my client's goals. I discuss the core processes involved in such a repair in the context of a cross-cultural psychological assessment.

Technology for community health alliances.

PubMed

Luce, Peggy; Phillips, Jill; Benjamin, Regina; Wasson, John H

2004-01-01

A community health alliance brings together divergent interests within a community for the betterment of personal and population health. In this report we describe how a community responsive strategy in Chicago is facilitating the improvement of healthcare by providing local information of what needs to be done, supporting change at the practice level to meet these needs, and initiating community-wide approaches to manage prevalent and important needs without waiting for direct involvement of health professionals.

Therapist effects and the outcome—alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia

PubMed Central

Barlow, David H.; Gorman, Jack M.; Shear, M. Katherine; Woods, Scott W.

2014-01-01

Although the alliance–outcome correlation is well established, no published studies to date have separated between therapists’ and patients’ contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists’ and patients’ contribution to the alliance on outcome and attrition in one trial. Alliance ratings were obtained from patients and therapists early and late in treatment (n = 133). Data were analyzed using multi-level modeling controlling for early symptom change. No therapist effects were found. The patients’ contribution to the alliance predicted outcome (in both panic severity and anxiety sensitivity) and attrition. The therapists’ contribution to the alliance predicted attrition but not outcome. Results suggest that the patient's contribution to the alliance plays an important role in CBT for PDA and that including common factors into research on CBT may help elucidate treatment processes. PMID:24275067

Published Research - NCI Alliance for Nanotechnology in Cancer

Cancer.gov

The NCI Alliance for Nanotechnology in Cancer has published much exciting and impactful research over the years. Find here a list of all of these listed in PubMed and others across the field of Cancer Nanotechnology.

ANTENATAL DETERMINANTS OF PARENTAL ATTACHMENT AND PARENTING ALLIANCE: HOW DO MOTHERS AND FATHERS DIFFER?

PubMed

Luz, Rita; George, Astrid; Vieux, Rachel; Spitz, Elisabeth

2017-03-01

Parental (parent-to-infant) attachment and parenting alliance are defined as two important components of psychoaffective adjustment to the parental role. This study aimed to build a predictive model of parental attachment and parenting alliance for mothers and fathers using partial least squares-structural equation modeling. Specifically, we were interested in assessing how adult romantic attachment, marital quality, and psychological distress influenced parental attachment (parent-to-infant) and parenting alliance. Forty heterosexual couples completed questionnaires during the third trimester of pregnancy and 2 months after childbirth. Results showed that adult romantic attachment, marital quality, and psychological distress were important antenatal determinants of parental attachment and parenting alliance, although they behaved differently for mothers and fathers. Hence, different predictive models were therefore proposed for mothers and fathers. Mothers' attachment to the child was influenced by internal factors as adult attachment dimensions; for fathers, it also depended on mothers' antenatal attachment to the child and on marital quality. Concerning parenting alliance, both mothers and fathers depended on own and partner's variables. Antenatal variables are important for what occurs during the transition to parenthood in terms of parenting adjustment and act differently for mothers and fathers. It thus is important to assess the psychological functioning of both mothers and fathers. © 2017 Michigan Association for Infant Mental Health.

School Climate, Individual Support, or Both? Gay-Straight Alliances and the Mental Health of Sexual Minority Youth

ERIC Educational Resources Information Center

Walls, N. Eugene; Wisneski, Hope; Kane, Sarah

2013-01-01

Using a sample of 284 sexual minority youth and young adults, this paper examines the relationships between mental health variables, the absence or presence of a gay-straight alliance, and membership status in a gay-straight alliance. The results suggest that the presence of a gay-straight alliance in a school or college, rather than actual…

Evaluation of an academic service partnership using a strategic alliance framework.

PubMed

Murray, Teri A; James, Dorothy C

2012-01-01

Strategic alliances involve the sharing of resources to achieve mutually relevant benefits and they are flexible ways to access resources outside of one's own institution. The recent landmark report from the Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, called for academic and health care organizations to strategically align around the future registered nurse workforce to improve the quality and safety of patient care. The dedicated education unit (DEU) is one practical way for 2 entities to align so that students can learn to administer safe, quality care. Because DEUs have great potential, it is critical to evaluate the alignment between the academic and service partner for appropriate fit, mutual benefit, and long-term success. In this article, we analyze the effectiveness of the Saint Louis University School of Nursing (SLUSON) and Mercy Hospital, St. Louis (MHSL) DEU project, an alliance between a medical center and school of nursing, using the Single Alliance Key Success Model. Copyright © 2012 Elsevier Inc. All rights reserved.

75 FR 70363 - Alliance Bancorp, Inc. of Pennsylvania, Broomall, PA; Approval of Conversion Application

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision [AC-54: OTS No. H-4752] Alliance Bancorp, Inc. of Pennsylvania, Broomall, PA; Approval of Conversion Application Notice is hereby given that on November 10, 2010, the Office of Thrift Supervision approved the application of Alliance Mutual Holding...

Management of Cultural Differences under Various Forms of China-UK Higher Education Strategic Alliances

ERIC Educational Resources Information Center

Li, Xiaoqing; Roberts, Joanne; Yan, Yanni; Tan, Hui

2016-01-01

International strategic alliances are notorious for their high failure rate. Increased inter-partner conflict resulting from ineffective cross-cultural management is perceived to be one of the key reasons for unsatisfactory alliance performance. Driven by globalization, universities are extending into foreign markets through the establishment of…

Miami's Third Sector Alliance for Community Well-being.

PubMed

Evans, Scotney D; Raymond, Catherine; Levine, Daniella

2014-01-01

Traditional capacity-building approaches tend to be organizationally focused ignoring the fact that community-based organizations learn and take action in a larger network working to promote positive community change. The specific aim of this paper was to outline a vision for a Third Sector Alliance to build organizational, network, and sector capacity for community well-being in Miami. Building a foundation for social impact requires a strategy for organizational, network, and sector capacity building. Organizational, network, and sector capacity building can best be achieved through a cooperative network approach driven by a solid community-university partnership. Although a Third Sector Alliance for Community Well-being does not yet exist in Miami, Catalyst Miami and the University of Miami (UM) have partnered closely to articulate a vision of what could be and have been working to make that vision a reality.

New US philanthropy alliance picks physicist as boss

NASA Astrophysics Data System (ADS)

Kruesi, Liz

2015-04-01

Marc Kastner, a physicist at the Massachusetts Institute of Technology (MIT), has become the first president of the Science Philanthropy Alliance (SPA) - a new group of six organizations aiming to increase private funding for fundamental research in the US.

A rational model for maximizing the effects of therapeutic relationship regulation in personality disorders with poor metacognition and over-regulation of affects.

PubMed

Dimaggio, Giancarlo; Carcione, Antonino; Salvatore, Giampaolo; Semerari, Antonio; Nicolò, Giuseppe

2010-11-01

The therapeutic relationship plays a key role in personality disorder (PD) psychotherapy. Some aspects of therapeutic relationship regulation appear important for treatment of PD clients, including those with constricted relational schemas, poor metacognition, and over-regulation of affects described here. AIM.: To propose a rational model for how and when to work on the therapeutic relationship by treating the underlying personality pathology. Formalize a step-by-step procedure for performing operations such as validation of clients' experiences, creating a sense of sharedness, assessing the quality of the therapeutic relationship in order to prevent and repair ruptures in the alliance, self-disclosing by the therapist, and metacommunication on the basis of clients' responses to treatment. We discuss the implications of this model for further research into the PD therapy process. 2010 The British Psychological Society.

The Shi’a Crescent: A Misconception of Shi’a Alliance

DTIC Science & Technology

2014-12-01

wear the hijab , set up illegal sharia courts, and imposed their own brutal penalties.”47 The country’s demography was tolerant toward a sectarian... A MISCONCEPTION OF SHI’A ALLIANCE by Rowaida Alamiri December 2014 Thesis Advisor: Anne Marie Baylouny Second Reader Mohammed Hafez...Master ’s Thesis 4. TITLE AND SUBTITLE 5. FUNDING NUMBERS THE SHI’ A CRESCENT: A MISCONCEPTION OF SHI’ A ALLIANCE 6. AUTHOR(S) Rowaida Alamiri 7

Physicians in health care management: 9. Strategic alliances and relationships between organizations.

PubMed Central

Leatt, P; Barnsley, J

1994-01-01

Health care organizations must increasingly develop strategic alliances with other groups and organizations. A variety of interorganizational relationships are possible: shared services, joint programs, umbrella organizations, health agency networks and mergers. As governments try to control health care costs, physicians will play an important role in developing and implementing these alliances. They will be expected to advocate on behalf of patients and communities to ensure that these new organizational arrangements facilitate coordinated care. PMID:8087752

About the Alliance | Division of Cancer Prevention

Cancer.gov

Objectives The major objective of the Alliance is to discover and develop molecular markers for early detection of cancer by conducting innovative, translational research in the field of complex carbohydrates. An important key to biomarker discovery is to understand the biological mechanisms by which changes in glycosylation promote cancer progression. Taking this

The Identification of Funding Options, Problems and Issues Associated with Sino-Foreign University Alliances

ERIC Educational Resources Information Center

Willis, Mike

2003-01-01

Many Chinese universities (there are over 1,080) have various forms of alliances with foreign universities to undertake the development and delivery of courses in China, participate in exchange activities, collaborate in research projects and engage in consulting programs. It is now quite common for these alliances to offer complete undergraduate…

Acronyms and the Law. Alliance Action Information Sheets

ERIC Educational Resources Information Center

Technical Assistance ALLIANCE for Parent Centers, 2007

2007-01-01

This paper presents acronyms related to early intervention, education, special education, and other laws important to individuals with disabilities and their families. For related information, also read Acronyms and Agencies. [For related report, "Acronyms and Agencies. Alliance Action Information Sheets," see ED534053.

Coalition for Global Clinical Surgical Education: The Alliance for Global Clinical Training.

PubMed

Graf, Jahanara; Cook, Mackenzie; Schecter, Samuel; Deveney, Karen; Hofmann, Paul; Grey, Douglas; Akoko, Larry; Mwanga, Ali; Salum, Kitembo; Schecter, William

Assessment of the effect of the collaborative relationship between the high-income country (HIC) surgical educators of the Alliance for Global Clinical Training (Alliance) and the low-income country surgical educators at the Muhimbili University of Health and Allied Sciences/Muhimbili National Hospital (MUHAS/MNH), Dar Es Salaam, Tanzania, on the clinical global surgery training of the HIC surgical residents participating in the program. A retrospective qualitative analysis of Alliance volunteer HIC faculty and residents' reports, volunteer case lists and the reports of Alliance academic contributions to MUHAS/MNH from 2012 to 2017. In addition, a survey was circulated in late 2016 to all the residents who participated in the program since its inception. Twelve HIC surgical educators provided rotating 1-month teaching coverage at MUHAS/MNH between academic years 2012 and 2017 for a total of 21 months. During the same time period 11 HIC residents accompanied the HIC faculty for 1-month rotations. HIC surgery residents joined the MUHAS/MNH Department of Surgery, made significant teaching contributions, performed a wide spectrum of "open procedures" including hand-sewn intestinal anastomoses. Most had had either no or limited previous exposure to hand-sewn anastomoses. All of the residents commented that this was a maturing and challenging clinical rotation due to the complexity of the cases, the limited resources available and the ethical and emotional challenges of dealing with preventable complications and death in a resource constrained environment. The Alliance provides an effective clinical global surgery rotation at MUHAS/MNH for HIC Surgery Departments wishing to provide such an opportunity for their residents and faculty. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Creating State-based Alliances to Support Earth and Space Science Education Reform

NASA Astrophysics Data System (ADS)

Geary, E. E.; Manduca, C. A.; Barstow, D.

2002-05-01

Seven years after the publication of the National Science Education Standards and adoption of new state science education standards, Earth and space science remains outside the mainstream K-12 curriculum. Currently, less than ten percent of high school students in the United States of America take an Earth or space science course before graduation. This state of affairs is simply unacceptable. "All of us who live on this planet have the right and the obligation to understand Earth's unique history, its dynamic processes, its abundant resources, and its intriguing mysteries. As citizens of Earth, with the power to modify our climate and ecosystems, we also have a personal and collective responsibility to understand Earth so that we can make wise decisions about its and our future". As one step toward addressing this situation, we support the establishment of state-based alliances to promote Earth and space science education reform. "In many ways, states are the most vital locus of change in our nation's schools. State departments of education define curriculum frameworks, establish testing policies, support professional development and, in some cases, approve textbooks and materials for adoption". State alliance partners should include a broad spectrum of K-16 educators, scientists, policy makers, parents, and community leaders from academic institutions, businesses, museums, technology centers, and not-for profit organizations. The focus of these alliances should be on systemic and sustainable reform of K-16 Earth and space science education. Each state-based alliance should focus on specific educational needs within their state, but work together to share ideas, resources, and models for success. As we build these alliances we need to take a truly collaborative approach working with the other sciences, geography, and mathematics so that collectively we can improve the caliber and scope of science and mathematics education for all students.

Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital.

PubMed

Plöderl, Martin; Kunrath, Sabine; Cramer, Robert J; Wang, Jen; Hauer, Larissa; Fartacek, Clemens

2017-05-15

Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM

Adherence to non-vitamin-K-antagonist oral anticoagulant medications based on the Pharmacy Quality Alliance measure.

PubMed

McHorney, Colleen A; Crivera, Concetta; Laliberté, François; Nelson, Winnie W; Germain, Guillaume; Bookhart, Brahim; Martin, Silas; Schein, Jeffrey; Lefebvre, Patrick; Deitelzweig, Steven

2015-12-01

CMS Star Ratings help inform beneficiaries about the performance of health and drug plans. Medication adherence is currently weighted at nearly half of a Part D plan's Star Ratings. Including the adherence to non-vitamin-K-antagonist oral anticoagulants (NOACs) as a measure in the Star Ratings program may increase a plan's incentives to improve patient adherence. To assess the adherence to medication of patients who used the NOACs rivaroxaban, dabigatran, or apixaban in 2014 based on the Pharmacy Quality Alliance (PQA) adherence measure. Healthcare claims from the Humana database between July 2013 and December 2014 were analyzed. Adult patients with ≥2 dispensings of NOAC agents in 2014, at least 180 days apart, with >60 days of supply, and ≥180 days of continuous enrollment prior to the index NOAC were identified. The PQA measure was calculated as the percentage of patients who had a proportion of days covered (PDC) ≥0.8. Multivariate logistic regression analyses were also conducted adjusting for baseline confounders. A total of 11,095 rivaroxaban, 6548 dabigatran, and 3532 apixaban users were identified. Based on the PQA adherence measure (PDC ≥0.8), a significantly higher proportion of rivaroxaban users (72.7%) was found to be adherent compared to dabigatran (67.2%: p < 0.001) and apixaban (69.5%: p < 0.001) users. Compared to apixaban users, the adjusted likelihood of being adherent was significantly higher for rivaroxaban users (unadjusted OR [95% CI]: 1.17 [1.08-1.27], p < 0.001; adjusted OR [95% CI]: 1.20 (1.10-1.31), p < 0.001) and significantly lower for dabigatran users (unadjusted OR [95% CI]: 0.90 [0.82-0.98], p = 0.019; adjusted OR [95% CI]: 0.85 [0.77-0.93], p < 0.001). Limitations of the study are potential inaccuracies in claims data, possible change in patterns over time, and the impossibility of knowing whether all supplied tablets were taken. Using the PQA's adherence measure, rivaroxaban users were found to have

77 FR 66541 - Safety Zone; Alliance Road Bridge Demolition; Black Warrior River, Locust Fork; Birmingham, AL

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-06

... 1625-AA00 Safety Zone; Alliance Road Bridge Demolition; Black Warrior River, Locust Fork; Birmingham... of the Alliance Road Bridge (Co. Rd. 61). Entry into, transiting or anchoring in this zone is.... [[Page 66542

Attachment style and its relationship to working alliance in the supervision of British clinical psychology trainees.

PubMed

Dickson, Joanne M; Moberly, Nicholas J; Marshall, Yehuda; Reilly, James

2011-01-01

Although the supervisory relationship is thought to be critical in training clinical psychologists, little is known about factors affecting the supervisory alliance. We conducted an Internet survey of British clinical doctoral trainees (N = 259) in which participants rated their supervisory working alliance, parental style during childhood, pathological adult attachment behaviours and attachment style for themselves and their supervisors. Trainees' ratings of the working alliance were associated with perceptions of supervisors' attachment style, but not with perceptions of trainees' own attachment styles. Path analysis supported a causal chain linking parental indifference, compulsive self-reliance, insecure supervisor attachment style and lower ratings of the working alliance. Our results broadly replicate data from a US sample and suggest that attachment theory is helpful in understanding clinical supervisory processes. Copyright © 2010 John Wiley & Sons, Ltd.

Strategic information technology alliances for effective health-care supply chain management.

PubMed

Shih, Stephen C; Rivers, Patrick A; Hsu, H Y Sonya

2009-08-01

To gain and sustain competitive advantage, health-care providers have to continuously review and renovate their operational and information technology (IT) strategies through collaborative and cooperative endeavour with their supply chain channel members. This paper explores new ways of enhancing a health-care organization's responsiveness to changes and increasing its competitiveness through implementing strategic information technology alliances among channel members in a health-care supply chain network. An overview of issues and problems (e.g. bullwhip effect, negative externalities and free-riding phenomenon in multichannel supply chains) presented in the health-care supply chains is first delineated. This paper further goes over the issues of health-care supply chain coordination and integration for strategic IT alliances, followed by the discussion of the spillover effect of IT investments. A number of viable IT practices (such as information sharing and Internet-enabled supply chain portal) for effective health-care supply chain collaboration and coordination are then examined in this research. Finally, the paper discusses how strategic IT alliances can help improve the effectiveness of health-care supply chain management.

78 FR 27974 - Proposed Collection; 60-Day Comment Request: National Cancer Institute (NCI) Alliance for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-13

... Comment Request: National Cancer Institute (NCI) Alliance for Nanotechnology in Cancer Platform... Nanotechnology Research, National Cancer Institute, 31 Center Drive, Bldg. 31 A, Rm. 10A52, Bethesda, MD 20892 or... Institute (NCI) Alliance for Nanotechnology in Cancer Platform Partnership Scientific Progress Reports, 0925...

Oregon Alliance for Program Improvement: 1989-90 Report.

ERIC Educational Resources Information Center

Dunham, Daniel B.

This annual report describes five projects of the Oregon Alliance for Program Improvement, which provides work-relevant education and training services in leadership, professional competence, and organizational effectiveness. First is an aggregated report of nearly 30 vocational education program improvement field study projects conducted between…

The Alliance Hypothesis for Human Friendship

PubMed Central

DeScioli, Peter; Kurzban, Robert

2009-01-01

Background Exploration of the cognitive systems underlying human friendship will be advanced by identifying the evolved functions these systems perform. Here we propose that human friendship is caused, in part, by cognitive mechanisms designed to assemble support groups for potential conflicts. We use game theory to identify computations about friends that can increase performance in multi-agent conflicts. This analysis suggests that people would benefit from: 1) ranking friends, 2) hiding friend-ranking, and 3) ranking friends according to their own position in partners' rankings. These possible tactics motivate the hypotheses that people possess egocentric and allocentric representations of the social world, that people are motivated to conceal this information, and that egocentric friend-ranking is determined by allocentric representations of partners' friend-rankings (more than others' traits). Methodology/Principal Findings We report results from three studies that confirm predictions derived from the alliance hypothesis. Our main empirical finding, replicated in three studies, was that people's rankings of their ten closest friends were predicted by their own perceived rank among their partners' other friends. This relationship remained strong after controlling for a variety of factors such as perceived similarity, familiarity, and benefits. Conclusions/Significance Our results suggest that the alliance hypothesis merits further attention as a candidate explanation for human friendship. PMID:19492066

The content of our cooperation, not the color of our skin: an alliance detection system regulates categorization by coalition and race, but not sex.

PubMed

Pietraszewski, David; Cosmides, Leda; Tooby, John

2014-01-01

Humans in all societies form and participate in cooperative alliances. To successfully navigate an alliance-laced world, the human mind needs to detect new coalitions and alliances as they emerge, and predict which of many potential alliance categories are currently organizing an interaction. We propose that evolution has equipped the mind with cognitive machinery that is specialized for performing these functions: an alliance detection system. In this view, racial categories do not exist because skin color is perceptually salient; they are constructed and regulated by the alliance system in environments where race predicts social alliances and divisions. Early tests using adversarial alliances showed that the mind spontaneously detects which individuals are cooperating against a common enemy, implicitly assigning people to rival alliance categories based on patterns of cooperation and competition. But is social antagonism necessary to trigger the categorization of people by alliance--that is, do we cognitively link A and B into an alliance category only because they are jointly in conflict with C and D? We report new studies demonstrating that peaceful cooperation can trigger the detection of new coalitional alliances and make race fade in relevance. Alliances did not need to be marked by team colors or other perceptually salient cues. When race did not predict the ongoing alliance structure, behavioral cues about cooperative activities up-regulated categorization by coalition and down-regulated categorization by race, sometimes eliminating it. Alliance cues that sensitively regulated categorization by coalition and race had no effect on categorization by sex, eliminating many alternative explanations for the results. The results support the hypothesis that categorizing people by their race is a reversible product of a cognitive system specialized for detecting alliance categories and regulating their use. Common enemies are not necessary to erase important social

Canadian biotechnology start-ups, 1991-1997: the role of incumbents' patents and strategic alliances in controlling competition.

PubMed

Calabrese, T; Baum, J A; Silverman, B S

2000-12-01

Fligstein (1996) contends that organizations act to exploit the institutional context in which they are embedded so as to stabilize the competition they face. Drawing on Fligstein's theoretical analysis, we conceptualize incumbent biotechnology firms' patent-ing and alliance-building activities as attempts to stabilize and control potential competition and analyze how these activities shape rates of founding in the Canadian biotechnology industry. We find that increases in the level and concentration of incumbents' patenting discourage founding, particularly in human application sectors of the industry where development and approval processes are more costly and time consuming. Incumbents' horizontal alliances depress start-ups; vertical alliances stimulate start-ups. Our findings highlight how technology appropriation and strategic alliances structure the competitive dynamics and evolution of high-technology, knowledge-intensive industries.

Refining the COPES to Measure Social Climate in Therapeutic Residential Youth Care

ERIC Educational Resources Information Center

Leipoldt, Jonathan D.; Kayed, Nanna S.; Harder, Annemiek T.; Grietens, Hans; Rimehaug, Tormod

2018-01-01

Background: Previous studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the…

The Content of Our Cooperation, Not the Color of Our Skin: An Alliance Detection System Regulates Categorization by Coalition and Race, but Not Sex

PubMed Central

Pietraszewski, David; Cosmides, Leda; Tooby, John

2014-01-01

Humans in all societies form and participate in cooperative alliances. To successfully navigate an alliance-laced world, the human mind needs to detect new coalitions and alliances as they emerge, and predict which of many potential alliance categories are currently organizing an interaction. We propose that evolution has equipped the mind with cognitive machinery that is specialized for performing these functions: an alliance detection system. In this view, racial categories do not exist because skin color is perceptually salient; they are constructed and regulated by the alliance system in environments where race predicts social alliances and divisions. Early tests using adversarial alliances showed that the mind spontaneously detects which individuals are cooperating against a common enemy, implicitly assigning people to rival alliance categories based on patterns of cooperation and competition. But is social antagonism necessary to trigger the categorization of people by alliance—that is, do we cognitively link A and B into an alliance category only because they are jointly in conflict with C and D? We report new studies demonstrating that peaceful cooperation can trigger the detection of new coalitional alliances and make race fade in relevance. Alliances did not need to be marked by team colors or other perceptually salient cues. When race did not predict the ongoing alliance structure, behavioral cues about cooperative activities up-regulated categorization by coalition and down-regulated categorization by race, sometimes eliminating it. Alliance cues that sensitively regulated categorization by coalition and race had no effect on categorization by sex, eliminating many alternative explanations for the results. The results support the hypothesis that categorizing people by their race is a reversible product of a cognitive system specialized for detecting alliance categories and regulating their use. Common enemies are not necessary to erase important

Schools without Fear. Proceedings of the Annual International Alliance for Invitational Education Conference (14th). International Alliance for Invitational Education.

ERIC Educational Resources Information Center

Francis, Adrianna Hayes, Ed.

Papers presented at the fourteenth Annual Conference of the Alliance for Invitational Education are (1) "Caring, Sharing, Daring: Three Tests to Help Develop More Inviting Policies, Programmes, and Procedures" (M. Ayers); (2) "Project: Gentlemen on the Move - Combating the Poor Academic and Social Performance of African American Male Youth" (D. F.…

Working Alliance and Stages of Change for Employment: The Intermediary Role of Autonomous Motivation, Outcome Expectancy and Vocational Rehabilitation Engagement.

PubMed

Iwanaga, Kanako; Chan, Fong; Tansey, Timothy N; Strauser, David; Ritter, Ellen; Bishop, Malachy; Brooks, Jessica

2018-05-30

Purpose Working alliance is one of the most important common factors for successful counseling/psychotherapy outcomes. Based on the empirical literature about working alliance, it seems that self-determination and self-efficacy theory (SDT/SET) can potentially be used as a motivational model to explain the relationship between working alliance and vocational rehabilitation (VR) outcomes. The purpose of this study is to evaluate three primary SDT/SET constructs, autonomous motivation, expectancy and engagement, as mediators for the relationship between working alliance and stages of change (SOC) for employment. Methods A serial multiple mediation analysis (SMMA) was computed to evaluate autonomy, outcome expectancy, and VR engagement as mediators of the relationship between working alliance and SOC for employment in a sample of 277 people with chronic illness and disability (CID) receiving services from state VR agencies in the United States. Results The SMMA results indicated that working alliance was positively associated with SOC for employment (total effect), while the direct effect between working alliance and SOC for employment was not significant after controlling for the effects of the mediators, indicating significant mediation effects. The mediation effects were estimates of the indirect effects for working alliance on SOC for employment through (a) autonomous motivation, (b) outcome expectancy, (c) VR engagement, and (d) autonomous motivation, outcome expectancy and VR engagement together. Conclusions The results indicated that a strong working alliance has the benefit of helping consumers develop autonomous motivation to work and increasing their vocational outcome expectancy and engagement in VR services, leading to employment.

Alliances in the Dutch BeweegKuur Lifestyle Intervention

ERIC Educational Resources Information Center

den Hartog, Franciska; Wagemakers, Annemarie; Vaandrager, Lenneke; van Dijk, Marieke; Koelen, Maria A.

2014-01-01

Objective: BeweegKuur (Exercise Therapy) is a Dutch lifestyle programme in which participants are referred by a general practitioner (GP) to a lifestyle advisor. To support participants, regional and local alliances are established. The present study explored the successes and challenges associated with collaboration processes in local BeweegKuur…

The EarthConnections San Bernardino Alliance: Addressing Diversity in the Geosciences Using a Collective Impact Model

NASA Astrophysics Data System (ADS)

McGill, S. F.; Benthien, M. L.; Castillo, B. A.; Fitzsimmons, J.; Foutz, A.; Keck, D.; Manduca, C. A.; Noriega, G. R.; Pandya, R. E.; Taber, J. J.; Vargas, B.

2017-12-01

The EarthConnections San Bernardino Alliance is one of three regional alliances supported by the national EarthConnections Collective Impact Alliance, funded by a pilot grant from the National Science Foundation INCLUDES program. All three of the regional alliances share a common vision, focused on developing a diverse geoscience workforce through connecting existing programs and institutions into regional pathways that support and guide students from engagement at an early age with Earth science linked to issues facing the local community, through the many steps and transitions to geoscience-related careers. The San Bernardino Alliance began with collaboration between one university, one community college and one high school and also includes the Southern California Earthquake Center as well as professional geologists in the region. Based on discussions at an opening round table event, the Alliance has chosen to capitalize on existing geology student clubs and deeply engaged faculty and alumni at the founding high school, community college and university members of the Alliance to plan joint field trips, service learning projects, guest speakers, and visits to dinner meetings of the local professional societies for students at participating institutions at various stages along the pathway. The underlying motivation is to connect students to their peers and to mentors at institutions that represent the next step on the pathway, as well as to expose them to careers in geology and to geoscience issues that impact the local community. A second type of intervention we are planning is to promote high quality teaching in introductory Earth science courses at the university, community college and high school levels, including the development of high school honors courses in Earth science. To this end we are hosting an NAGT traveling workshop focused on using active learning and societally relevant issues to develop engaging introductory geoscience courses. This teaching

Reciprocal Influence of Alliance to the Group and Outcome in Day Treatment for Eating Disorders

ERIC Educational Resources Information Center

Tasca, Giorgio A.; Lampard, Amy M.

2012-01-01

The nature of the alliance-outcome relationship is still emerging. This study examined the reciprocal influence of change in alliance to the group and change in urge to restrict in eating-disordered individuals attending a group-based day treatment. Participants (N = 238) were a transdiagnostic or mixed diagnostic sample of eating-disordered…

Applying Lessons from Industry to Intra-Campus Alliances.

ERIC Educational Resources Information Center

Turner, Walter L.

To break out of the mold of the modern college compartmentalized setting, alliances can and must be formed between different disciplines on campus. Knowledge the students gain from the differing perspectives will enhance their ability to communicate; oral and written communication; and effective listening have been identified as factors that help…

Research on the Rural Express Alliance based on ANP improved profit Allocation

NASA Astrophysics Data System (ADS)

Zhuang, Yufeng; Zhang, Bin

2018-01-01

Online shopping platform in rural distribution difficulties, leading to rural online shopping market and logistics market development is slow. At present, China Post and other private courier companies are not possible to do. So we need to build distribution alliances. Reasonable profit allocation mechanism is the key to the stable development of this distribution alliance. So we proposed the Shapley Value Method and the ANP Improved Model to allocate profits. Finally, the rationality of the method is proved by numerical analysis before and after using the corrected Shapley Value.

Fracturing alliance allows massive diatomite oil reserves to be economically produced at Lost Hills, California: A case study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klins, M.A.; Stewart, D.W.; Pferdehirt, D.J.

1995-12-31

As North American oilfield operations mature, there is a perceptible loosening of the autocratic ties between oil companies and contractors. They are being replaced by alliances or partnerships designed to minimize cost while improving profitability of the companies involved. Many papers have been written concerning alliance theory, but little documentation exists detailing actual performance. This paper evaluates a mature alliance, its implementation, structure and results. In Lost Hills, California, the diatomite formation requires hydraulic fracturing to allow oil recovery at profitable production rates. Because hydraulic fracturing is approximately two-thirds of the total well cost, it is imperative that fracturing investmentsmore » be optimized to allow field development to proceed at optimum levels. Therefore, in 1990, a fracturing alliance (the first of its kind) was initiated between Chevron and Schlumberger Dowell. Over 1 billion lbm of sand has been successfully placed during approximately 2,000 fracture stimulation jobs. Through this prototype fracturing alliance, many major accomplishments are being achieved. The most notable are the hydraulic fracturing costs that have been reduced by 40% while improving the profitability of both companies. This paper illustrates the benefits of an alliance and justifies the change in management style from a low-bid operating strategy to a win-win customer/supplier attitude.« less

Educator Effectiveness Research Alliance: Using Research and Data to Understand and Improve Educator Preparation and Evaluation

ERIC Educational Resources Information Center

Regional Educational Laboratory Southwest, 2018

2018-01-01

Research shows that teachers affect student learning more than any other factor. The Educator Effectiveness Research Alliance, a collaborative partnership of educators, policymakers, and researchers, seeks to improve educator quality through research and analytic technical support. Initially focused on Texas, the alliance has expanded to include…

Protecting Sacred Sites on Public Land: Religion and Alliances in the Mato Tipila-Devils Tower Litigation

ERIC Educational Resources Information Center

Freedman, Eric

2007-01-01

This article traces the Devils Tower litigation in the context of the "Bear Lodge" alliance's theoretical underpinnings, particularly the interrelationship among culture, geographic place, and religion, as well as the institutional mechanisms that regulate litigation alliances in the U.S. judicial system. It discusses principal factors…

A design of strategic alliance based on value chain of surveying and mapping enterprises in China

NASA Astrophysics Data System (ADS)

Duan, Hong; Huang, Xianfeng

2007-06-01

In this paper, we use value chain and strategic alliance theories to analyzing the surveying and mapping Industry and enterprises. The value chain of surveying and mapping enterprises is highly-contacted but split by administrative interference, the enterprises are common small scale. According to the above things, we consider that establishing a nonequity- Holding strategic alliance based on value chain is an available way, it can not only let the enterprises share the superior resources in different sectors of the whole value chain each other but avoid offending the interests of related administrative departments, by this way, the surveying and mapping enterprises gain development respectively and totally. Then, we give the method to building up the strategic alliance model through parting the value chain and the using advantage of companies in different value chain sectors. Finally, we analyze the internal rule of strategic alliance and prove it is a suitable way to realize the development of surveying and mapping enterprises through game theory.

E-virtual reality exposure therapy in acrophobia: A pilot study.

PubMed

Levy, Fanny; Leboucher, Pierre; Rautureau, Gilles; Jouvent, Roland

2016-06-01

Virtual reality therapy is already used for anxiety disorders as an alternative to in vivo and in imagino exposure. To our knowledge, however, no one has yet proposed using remote virtual reality (e-virtual reality). The aim of the present study was to assess e-virtual reality in an acrophobic population. Six individuals with acrophobia each underwent six sessions (two sessions per week) of virtual reality exposure therapy. The first three were remote sessions, while the last three were traditional sessions in the physical presence of the therapist. Anxiety (STAI form Y-A, visual analog scale, heart rate), presence, technical difficulties and therapeutic alliance (Working Alliance Inventory) were measured. In order to control the conditions in which these measures were made, all the sessions were conducted in hospital. None of the participants dropped out. The remote sessions were well accepted. None of the participants verbalized reluctance. No major technical problems were reported. None of the sessions were cancelled or interrupted because of software incidents. Measures (anxiety, presence, therapeutic alliance) were comparable across the two conditions. e-Virtual reality can therefore be used to treat acrophobic disorders. However, control studies are needed to assess online feasibility, therapeutic effects and the mechanisms behind online presence. © The Author(s) 2015.

Alliance Building in the Information and Online Database Industry.

ERIC Educational Resources Information Center

Alexander, Johanna Olson

2001-01-01

Presents an analysis of information industry alliance formation using environmental scanning methods. Highlights include why libraries and academic institutions should be interested; a literature review; historical context; industry and market structures; commercial and academic models; trends; and implications for information providers,…

Phylogeny and classification of the East Asian Amitostigma alliance (Orchidaceae: Orchideae) based on six DNA markers.

PubMed

Tang, Ying; Yukawa, Tomohisa; Bateman, Richard M; Jiang, Hong; Peng, Hua

2015-05-26

Tribe Orchideae dominates the orchid flora of the temperate Northern Hemisphere but its representatives in East Asia had been subject to less intensive phylogenetic study than those in Eurasia and North America. Although this situation was improved recently by the molecular phylogenetic study of Jin et al., comparatively few species were analyzed from the species-rich and taxonomically controversial East Asian Amitostigma alliance. Here, we present a framework nrITS tree of 235 accessions of Orchideae plus an in-depth analysis of 110 representative accessions, encompassing most widely recognized species within the alliance, to elucidate their relationships. We used parsimony, likelihood and Bayesian approaches to generate trees from data for two nuclear (nrITS, low-copy Xdh) and four chloroplast (matK, psbA-trnH, trnL-F, trnS-trnG) markers. Nuclear and plastid data were analyzed separately due to a few hard incongruences that most likely reflect chloroplast capture. Our results suggest key phylogenetic placements for Sirindhornia and Brachycorythis, and confirm previous assertions that the Amitostigma alliance is monophyletic and sister to the Eurasian plus European clades of subtribe Orchidinae. Seven robust clades are evident within the alliance, but none corresponds precisely with any of the traditional genera; the smaller and more morphologically distinct genera Tsaiorchis, Hemipilia, Neottianthe and Hemipiliopsis are monophyletic but each is nested within a polyphyletic plexus of species attributed to either Ponerorchis or the most plesiomorphic genus, Amitostigma. Two early-divergent clades that escaped analysis by Jin et al. undermine their attempt to circumscribe an expanded monophyletic genus Ponerorchis. We provide a new framework on the complex phylogenetic relationships between Amitostigma and other genera traditionally included in its alliance; based on which, we combine the entire Amitostigma alliance into a morphologically and molecularly

Overview of the Oral HIV/AIDS Research Alliance Program

PubMed Central

Shiboski, C.H.; Webster-Cyriaque, J.Y.; Ghannoum, M.; Greenspan, J.S.; Dittmer, D.

2011-01-01

The Oral HIV/AIDS Research Alliance is part of the AIDS Clinical Trials Group, the largest HIV clinical trial organization in the world, and it is funded by the National Institute of Dental and Craniofacial Research, in collaboration with the National Institute of Allergy and Infectious Diseases. The alliance’s main objective is to investigate the oral complications associated with HIV/AIDS as the epidemic is evolving—in particular, the effects of potent antiretrovirals on the development of oral mucosal lesions and associated fungal and viral pathogens. Furthermore, oral fluids are being explored for their potential monitoring and diagnostic role with respect to HIV disease and coinfections. This article presents an overview of the alliance, its scientific agenda, and an outline of the novel interventional and noninterventional clinical studies ongoing and developing within the AIDS Clinical Trials Group infrastructure in the United States and internationally. PMID:21441477

Common and specific process factors in cardiac rehabilitation: independent and interactive effects of the working alliance and self-efficacy.

PubMed

Burns, John W; Evon, Donna

2007-11-01

Therapeutic processes in cardiac rehabilitation programs are virtually unexamined. Models were tested by which changes in the working alliance between patient and staff (agreement on goals/tasks; emotional bond) may affect outcomes in conjunction with changes in patient self-efficacy to change their diets and increase exercise. Cardiac patients (n = 79) participated in a 12-week program, and completed assessments at early, mid, and late treatment. Changes in cardiac depression, physical health, perceived exertion during exercise, rate/pressure product at submaximal exercise tolerance, weight loss, return to work, total fat intake. Early-treatment changes in agreement on goals/tasks were related to changes in psychosocial factors and perceived exertion during exercise independent of effects of changes in self-efficacy. Early-treatment changes in goals/tasks and self-efficacy interacted to predict changes in cardiorespiratory fitness, weight loss, and return to work such that patients high on both goals/tasks and self-efficacy showed the most gains. Sound therapeutic relationships between patients and staff may play an important role in facilitating the achievement of a wide-range of salutary outcomes during cardiac rehabilitation. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

The National Special Education Alliance: One Year Later.

ERIC Educational Resources Information Center

Green, Peter

1988-01-01

The National Special Education Alliance (a national network of local computer resource centers associated with Apple Computer, Inc.) consists, one year after formation, of 24 non-profit support centers staffed largely by volunteers. The NSEA now reaches more than 1000 disabled computer users each month and more growth in the future is expected.…

Predictors of Working Alliance Efficacy among State VR Counselors as a Function of Ex-Offender Status

ERIC Educational Resources Information Center

Bates, Julie K.

2012-01-01

The purpose of this study was to determine if statistically significant relationships existed between burnout, stigma, flourishing, caseload size, experience, and working alliance self-efficacy and to assess the predictive power of these variables on levels of working alliance self-efficacy with clients with disabilities alone and clients with…

Washington: International District Housing Alliance (A Former EPA CARE Project)

EPA Pesticide Factsheets

The International District Housing Alliance (IDHA) is the recipient of a Level I CARE cooperative agreement. This cooperative agreement provides the opportunity to demonstrate the CARE program in an Asian and Pacific Islander community.

Professional Development and the Teaching Schools Experiment in England: Leadership Challenges in an Alliance's First Year

ERIC Educational Resources Information Center

Dowling, Simon

2016-01-01

This article reports findings from the first year of a longitudinal, mixed-methods case study of a large teaching school alliance in England. This national initiative is intended to drive improvement at system level by grouping schools around formally designated teaching schools. These "alliances" work collaboratively to share learning,…

Humanism and multiculturalism: an evolutionary alliance.

PubMed

Comas-Diaz, Lillian

2012-12-01

Humanism and multiculturalism are partners in an evolutionary alliance. Humanistic and multicultural psychotherapies have historically influenced each other. Humanism represents the third force in psychotherapy, while multiculturalism embodies the fourth developmental stage. Multiculturalism embraces humanistic values grounded in collective and social justice contexts. Examples of multicultural humanistic constructs include contextualism, holism, and liberation. Certainly, the multicultural-humanistic connection is a necessary shift in the evolution of psychotherapy. Humanism and multiculturalism participate in the development of an inclusive and evolutionary psychotherapy. (c) 2012 APA, all rights reserved.

Association between executive function and outcome measure of treatment in therapeutic community among cocaine dependent individuals.

PubMed

Vergara-Moragues, Esperanza; Verdejo-García, Antonio; Lozano, Oscar M; Santiago-Ramajo, Sandra; González-Saiz, Francisco; Betanzos Espinosa, Patricia; Pérez García, Miguel

2017-07-01

The aim of this study was to examine the association between baseline executive functioning and outcome measure of treatment in 226 cocaine dependent individuals who initiated treatment in therapeutic communities TCs. The study was conducted across six TCs located in the region of Andalusia (southern Spain). Neuropsychological testing included tests of working memory, reasoning, inhibition, switching, attention interference and decision making. The outcome measures were type of discharge (treatment dropout vs. therapeutic discharge) and clinical impression of the TC outcome (clinically significant vs. non-significant changes). In the present study a prospective comparative design was used. We found significant performance differences on selective executive components which account for the type of discharge: treatment quitters had poorer attention response inhibition and attention switching than non-quitters, and the individuals who failed to achieve therapeutic objectives had poorer attention interference and inhibitory control than compliers. No significant differences were found between the outcome measure and the neuropsychological performance score on the other tasks. The results provide important information about the impact of executive components on in-treatment follow-up outcomes among dependence disorders in TC. Copyright © 2017 Elsevier Inc. All rights reserved.

Arms and alliance in Japanese public opinion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Umemoto, T.

1985-01-01

This thesis analyzes the transformation of Japanese public opinion concerning the nation's security posture during the past decade. Until the early 1970s, the peculiar strength of a neutralist-pacifist outlook among the Japanese people, which arose in large part from the absence of a serious external threat severely encumbered Tokyo's defense efforts in the context of the alliance with the United States. In particular, such state of domestic opinion gave rise to what the author has elected to call the institutionalized constraints - limitations deriving from constitutional interpretation, the Three Non-Nuclear Principles, and the Three Principles on Weapons Exports - onmore » the scope of such endeavors. It moreover prepared the condition for the Government's adoption of restrictive military buildup policies in the National Defense Program Outline. Over the past decade, however, as Japan's security environment has deteriorated with the growth of the putative Soviet threat, and as the United States and China have come to expect greater Japanese defense efforts, the climate of opinion within Japan has gradually shifted in favor of a security posture based on the Mutual Security Treaty (MST) and the Self-Defense Forces (SDFs). Opinion polls have come to indicate solid popular approval of maintenance of armament and participation in alliance.« less

The Research Data Alliance

NASA Astrophysics Data System (ADS)

Fontaine, K. S.

2015-12-01

The Research Data Alliance (RDA) is an international organization created in 2012 to provide researchers with a forum for identifying and removing barriers to data sharing. Since then, RDA has gained over 3000 individual members, over three dozen organizational members, 47 Interest Groups, and 17 Working Groups, all focused on research data sharing. Interoperability is one instantiation of data sharing, but is not the only barrier to overcome. Technology limitations, discipline-specific cultures that do not support sharing, lack of best-practices, or lack of good definitions, are only three of a long list of situations preventing researchers from sharing their data. This presentation will cover how RDA has grown, some details on how the first eight solutions contribute to interoperability and sharing, and a sneak peek at what's in the pipeline.

An academic, business, and community alliance to promote evidence-based public health policy: the case of primary seat belt legislation.

PubMed

Goldzweig, Irwin A; Schlundt, David G; Moore, Wayne E; Smith, Patricia E; Zoorob, Roger J; Levine, Robert S

2013-08-01

An academic, business, and community alliance comprising 285 organizations, including 43 national groups represented on a Blue Ribbon Panel organized by the U.S. Secretary of Transportation, targeted Arkansas, Florida, Mississippi, Minnesota, Tennessee, and Wisconsin for high involvement/intervention consisting of community organization and other political action to support passage of primary seat belt laws. State-level alliance activities began in January 2003. All six states enacted a primary seat belt law between 2004 and 2009. From January 2003 to May 2010, passage of primary legislation was 4.5 times as likely (95% CI 1.90, 10.68) in states with high versus low alliance involvement. Positive interaction between high alliance involvement and offers of federal incentives may have occurred as well. This evidence of success suggests that academic-business-community alliances for action to promote evidence-based public health policy may be effective.

NOAA Office of Exploration and Research > Education > Alliance Partners

Science.gov Websites

Organization Guiding Documents Organizational Structure Map of Staff and Affiliate Locations Strategic Plan Evaluation Education Alliance Partners Home About OER Overview Organization Guiding Documents Organizational Structure Map of Staff and Affiliate Locations Strategic Plan 2014 Funding Opportunities Contact Us Program

Alliances and Arguments: A Case Study of a Child with Persisting Speech Difficulties in Peer Play

ERIC Educational Resources Information Center

Tempest, Alison; Wells, Bill

2012-01-01

The ability to argue and to create alliances with peers are important social competencies for all children, including those who have speech, language and communication needs. In this study, we investigated the management of arguments and alliances by a group of 5-year-old male friends, one of whom has a persisting speech difficulty (PSD). Twelve…

Advisory Working Alliance, Perceived English Proficiency, and Acculturative Stress

ERIC Educational Resources Information Center

Wei, Meifen; Tsai, Pei-Chun; Chao, Ruth Chu-Lien; Du, Yi; Lin, Shu-Ping

2012-01-01

The aim of this study was to examine the moderators of (a) general or cross-cultural advisory working alliances and (b) perceived English proficiency on the association between acculturative stress and psychological distress. A total of 143 East Asian international students completed an online survey. Results from a hierarchical regression…

Iowa Distance Education Alliance. Final Evaluation Report. Abbreviated Version.

ERIC Educational Resources Information Center

Sorenson, Chris; And Others

This report describes 2-year outcomes of the Iowa Distance Education Alliance (IDEA), a partnership involving educational institutions across Iowa that received funding from the federal Star Schools Program to demonstrate the use of the Iowa Communication Network's (ICN's) fiber-optic technology for K-12 instruction. First-year project activities…

Alliance for Sustainable Colorado Renovation Raises Its Energy Performance to New Heights, Commercial Building Energy Efficiency (Fact Sheet); Energy Efficiency & Renewable Energy (EERE)

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

The Alliance for Sustainable Colorado (The Alliance) is a nonprofit organization aiming to transform sustainability from vision to reality. Part of its mission is to change the operating paradigms of commercial building design to make them more sustainable. Toward that end The Alliance uses its headquarters, The Alliance Center at 1536 Wynkoop Street in Denver, as a living laboratory, conductingpilot studies of innovative commercial-building-design solutions for using and generating energy.

Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults.

PubMed

Haug, Thomas; Nordgreen, Tine; Öst, Lars-Göran; Tangen, Tone; Kvale, Gerd; Hovland, Ole Johan; Heiervang, Einar R; Havik, Odd E

2016-02-01

The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder (SAD) and panic disorder (PD). Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses. Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout. The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

The alliance in reflective supervision: a commentary on Tomlin, Weatherston, and Pavkov's critical components of reflective supervision.

PubMed

Watkins, C Edward

2015-01-01

What are the critical components of reflective supervision? In this commentary, I offer a complementary perspective on A.M. Tomlin, D.J. Weatherston, and T. Pavkov's (2014) seminal study about that very question. I consider their findings within the context of what we now know about the supervisory alliance-a highly robust, heuristic, and eminently practical construct that appears to capture the spirit of reflection, collaboration, and regularity at its best. Matters of alliance theory, practice, and research are briefly addressed, and effort is made to consider the implications of the supervisory alliance as fundamental, foundational, and quintessentially organizational for reflective supervision practice. © 2015 Michigan Association for Infant Mental Health.

Working alliance and empathy as mediators of brief telephone counseling for cigarette smokers who are not ready to quit

PubMed Central

Klemperer, Elias M.; Hughes, John R.; Callas, Peter W.; Solomon, Laura J.

2016-01-01

Working alliance and empathy are believed to be important components of counseling, though few studies have empirically tested this. We recently conducted a randomized controlled trial in which brief motivational and reduction counseling failed to increase the number of participants who made a quit attempt (QA) in comparison to usual care (i.e., brief advice to quit). Our negative findings could have been due to non-specific factors. This secondary analysis used a subset of participants (n=347) to test a) whether, in comparison to usual care, brief telephone-based motivational or reduction counseling predicted greater working alliance or empathy, b) whether changes in these non-specific factors predicted an increased probability of a QA at a 6-month follow-up, and c) whether counseling affected the probability of a QA via working alliance or empathy (i.e., mediation). Findings were similar for both active counseling conditions (motivational and reduction) vs usual care. In comparison to usual care, active counseling predicted greater working alliance (p<.001) and empathy (p<.05). Greater working alliance predicted a greater probability of a QA (p<.001) but, surprisingly, greater empathy predicted a decreased probability of a QA (p<.05) at the 6-month follow-up. Both working alliance (p<.001) and empathy (p<.05) mediated the active counseling's effects on the probability of a QA. One explanation for our motivational and reduction interventions' failure to influence QAs in comparison to usual care is that working alliance and empathy had opposing effects on quitting. Our analyses illustrate how testing non-specific factors as mediators can help explain why a treatment failed. PMID:28165273

Working alliance and empathy as mediators of brief telephone counseling for cigarette smokers who are not ready to quit.

PubMed

Klemperer, Elias M; Hughes, John R; Callas, Peter W; Solomon, Laura J

2017-02-01

Working alliance and empathy are believed to be important components of counseling, although few studies have empirically tested this. We recently conducted a randomized controlled trial in which brief motivational and reduction counseling failed to increase the number of participants who made a quit attempt (QA) in comparison to usual care (i.e., brief advice to quit). Our negative findings could have been due to nonspecific factors. This secondary analysis used a subset of participants (n = 347) to test (a) whether, in comparison to usual care, brief telephone-based motivational or reduction counseling predicted greater working alliance or empathy; (b) whether changes in these nonspecific factors predicted an increased probability of a QA at a 6-month follow-up; and (c) whether counseling affected the probability of a QA via working alliance or empathy (i.e., mediation). Findings were similar for both active counseling conditions (motivational and reduction) versus usual care. In comparison to usual care, active counseling predicted greater working alliance (p < .001) and empathy (p < .05). Greater working alliance predicted a greater probability of a QA (p < .001) but, surprisingly, greater empathy predicted a decreased probability of a QA (p < .05) at the 6-month follow-up. Working alliance (p < .001) and empathy (p < .05) mediated the active counseling's effects on the probability of a QA. One explanation for our motivational and reduction interventions' failure to influence QAs in comparison to usual care is that working alliance and empathy had opposing effects on quitting. Our analyses illustrate how testing nonspecific factors as mediators can help explain why a treatment failed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

76 FR 78043 - Notice Pursuant to the National Cooperative Research and Production Act of 1993-Pistoia Alliance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-15

... Production Act of 1993--Pistoia Alliance, Inc Notice is hereby given that, on November 3, 2011, pursuant to Section 6(a) of the National Cooperative Research and Production Act of 1993, 15 U.S.C. 4301 et seq. (``the Act''), Pistoia Alliance, Inc. has filed written notifications simultaneously with the Attorney...

The Cognition and Neuroergonomics (CaN) Collaborative Technology Alliance (CTA): Scientific Vision, Approach, and Translational Paths

DTIC Science & Technology

2012-09-01

The Cognition and Neuroergonomics (CaN) Collaborative Technology Alliance (CTA): Scientific Vision, Approach, and Translational Paths by...The Cognition and Neuroergonomics (CaN) Collaborative Technology Alliance (CTA): Scientific Vision, Approach, and Translational Paths Kelvin S. Oie...REPORT DATE (DD-MM-YYYY) September 2012 2. REPORT TYPE Final 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE The Cognition and Neuroergonomics

National Alliance of Business Sales Techniques and Results (STAR).

ERIC Educational Resources Information Center

Golightly, Steven J.

This paper presents an overview of the Sales Techniques and Results (STAR) training program developed by the National Alliance of Business in conjunction with IBM. The STAR training program can be used to help vocational directors, teachers, and counselors to be better salespersons for cooperative education or job placement programs. The paper…

The role of psychodynamic and personality assessment in psychopharmacotherapy of suicidal psychotic patients.

PubMed

Marčinko, Darko; Radanović Ćorić, Sanda; Šeparović Lisak, Maja; Rudan, Duško; Jeleč, Vjeko; Bilić, Vedran

2018-06-01

Optimal psychopharmacotherapy is based upon the results of many different factors. One of the main factors is therapeutic alliance. The role of psychodynamic is very important in the context of good therapeutic alliance. Lack of mentalizing capacity implies disturbed view of psychopharmacotherapy. Therapeutic relationship and optimal alliance offers the frame for acceptance of psychiatric drugs as positive and useful for psychological growth. Our literature search of a recent papers relating psychopharmacology and psychodynamic have revealed progress in psychoanalytic theory related to medication.

Active Learning Classrooms and Educational Alliances: Changing Relationships to Improve Learning

ERIC Educational Resources Information Center

Baepler, Paul; Walker, J. D.

2014-01-01

This chapter explores the "educational alliance" among students and between students and instructors. We contend that this is a framework that can help us understand how active learning classrooms facilitate positive educational outcomes.

Alliance-focused therapy for anorexia nervosa: integrative relational and behavioral change treatments in a single-case experimental design.

PubMed

Satir, Dana A; Goodman, David M; Shingleton, Rebecca M; Porcerelli, John H; Gorman, Bernard S; Pratt, Elizabeth M; Barlow, David H; Thompson-Brenner, Heather

2011-12-01

Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention and poor outcome. One explanation for drop-out is weak treatment alliances. A single-case experimental analysis accompanied by in-depth qualitative description is presented for Ms. O, who received a novel treatment for AN called Alliance Focused Treatment (AFT) that attends to ruptures in the alliance, interpersonal difficulties and emotional avoidance. At intake Ms. O met diagnostic criteria for AN, Major Depressive Disorder, and Social Phobia. She was characterized as having symptoms of Obsessive Compulsive, Avoidant, and Depressive personality disorders. Treatment began with a Baseline followed by the experimental (AFT) and comparison treatments (Behavioral Change Treatment [BCT]) using a replicated experimental single-case phase change design. Graphs of slopes of kilocalorie and alliance change facilitated observation of treatment effects. Ms. O participated in 16 sessions of AFT and 8 sessions of BCT with specific benefits. Ratings of the treatment alliance were consistently high and she evidenced significant changes in weight, quality of life, and personality pathology. Associations between rupture/repair episodes and kilocalorie increases were observed. The utility of the treatment relationship in facilitating emotional expression was evident. At posttreatment, Ms. O endorsed cognitive AN symptoms, although these were not explicitly treated. This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN. Further research on emotion regulation in AN and its effect on the treatment relationship are needed.

Leadership, organizational climate, and working alliance in a children's mental health service system.

PubMed

Green, Amy E; Albanese, Brian J; Cafri, Guy; Aarons, Gregory A

2014-10-01

The goal of this study was to examine the relationships of transformational leadership and organizational climate with working alliance, in a children's mental health service system. Using multilevel structural equation modeling, the effect of leadership on working alliance was mediated by organizational climate. These results suggest that supervisors may be able to impact quality of care through improving workplace climate. Organizational factors should be considered in efforts to improve public sector services. Understanding these issues is important for program leaders, mental health service providers, and consumers because they can affect both the way services are delivered and ultimately, clinical outcomes.

Leadership, Organizational Climate, and Working Alliance in a Children's Mental Health Service System

PubMed Central

Green, Amy E.; Albanese, Brian J.; Cafri, Guy; Aarons, Gregory A.

2014-01-01

The goal of this study was to examine the relationships of transformational leadership and organizational climate with working alliance, in a children's mental health service system. Using multilevel structural equation modeling, the effect of leadership on working alliance was mediated by organizational climate. These results suggest that supervisors may be able to impact quality of care through improving workplace climate. Organizational factors should be considered in efforts to improve public sector services. Understanding these issues is important for program leaders, mental health service providers, and consumers because they can affect both the way services are delivered and ultimately, clinical outcomes. PMID:24323137

Forging Alliances with Protection and Advocacy Systems: A Training Manual for Parents of Children with Emotional Disorders.

ERIC Educational Resources Information Center

Petr, Christopher G.

This manual is intended to be used in conjunction with a 1-day training workshop to help parents of children with emotional disorders establish working alliances with protection and advocacy agencies for people with mental illness (PAMIs). The workshop prepares parents for developing specific plans for forging alliances with the state PAMI. The…

Therapist and Patient Perceptions of Alliance and Progress in Psychological Therapy for Women Diagnosed with Gynecological Cancers

ERIC Educational Resources Information Center

Manne, Sharon L.; Kashy, Deborah A.; Rubin, Stephen; Hernandez, Enrique; Bergman, Cynthia

2012-01-01

Objective: The goal was to understand both therapist and patient perspectives on alliance and session progress for women in treatment for gynecological cancer. We used a longitudinal version of the one-with-many design to partition variation in alliance and progress ratings into therapist, patient/dyad, and time-specific components. We also…

[Adherence: definitions and measurement methods: characteristics of adherence to topical treatments].

PubMed

Halioua, B

2012-01-01

Taking into account topical treatment compliance is extremely important given its fundamental place in the dermatologist's armamentarium. After reviewing the definition of compliance, adherence, alliance, and clinical inertia, the direct methods used to measure compliance with a topical treatment (counting tubes administered, MEMS system performance, measuring circulating blood or urine rate of a medication or its metabolite, and observation of medication intake by a third party) and indirect methods (questioning the patient, the dermatologist's opinion) will be reviewed. The question of frequency, more important than compliance in cases of topical treatments compared to systemic treatments, has given rise to controversial opinions. Six factors related to topical treatment that play a role in therapeutic compliance can be cited: the perception of efficacy, the feeling of harmlessness, the treatment's simplicity, the treatment's duration, the galenic formulation, and the cost. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Establishing a compulsory drug treatment prison: Therapeutic policy, principles, and practices in addressing offender rights and rehabilitation.

PubMed

Birgden, Astrid; Grant, Luke

2010-01-01

A Compulsory Drug Treatment Correctional Center (CDTCC) was established in Australia in 2006 for repeat drug-related male offenders. Compulsory treatment law is inconsistent with a therapeutic jurisprudence approach. Despite the compulsory law, a normative offender rehabilitation framework has been established based on offender moral rights. Within moral rights, the offender rehabilitation framework addresses the core values of freedom (supporting autonomous decision-making) and well-being (supporting support physical, social, and psychological needs). Moral rights are underpinned by a theory or principle which, in this instance, is a humane approach to offender rehabilitation. While a law that permits offenders to choose drug treatment and rehabilitation is preferable, the article discusses the establishment of a prison based on therapeutic policy, principles, and practices that respond to participants as both rights-violators and rights-holders. The opportunity for accelerated community access and a therapeutic alliance with staff has resulted in offenders actively seeking to be ordered into compulsory drug treatment and rehabilitation. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

International Planetary Data Alliance (IPDA) Information Model

NASA Technical Reports Server (NTRS)

Hughes, John Steven; Beebe, R.; Guinness, E.; Heather, D.; Huang, M.; Kasaba, Y.; Osuna, P.; Rye, E.; Savorskiy, V.

2007-01-01

This document is the third deliverable of the International Planetary Data Alliance (IPDA) Archive Data Standards Requirements Identification project. The goal of the project is to identify a subset of the standards currently in use by NASAs Planetary Data System (PDS) that are appropriate for internationalization. As shown in the highlighted sections of Figure 1, the focus of this project is the Information Model component of the Data Architecture Standards, namely the object models, a data dictionary, and a set of data formats.

Vested Interests in addiction research and policy. Alliance between tobacco and alcohol industries to shape public policy.

PubMed

Jiang, Nan; Ling, Pamela

2013-05-01

The tobacco and alcohol industries share common policy goals when facing regulation, opposing policies such as tax increases and advertising restrictions. The collaboration between these two industries in the tobacco policy arena is unknown. This study explored if tobacco and alcohol companies built alliances to influence tobacco legislation and, if so, how those alliances worked. Analysis of previously secret tobacco industry documents. In the early 1980s, tobacco companies started efforts to build coalitions with alcohol and other industries to oppose cigarette excise taxes, clean indoor air policies and tobacco advertising and promotion constraints. Alcohol companies were often identified as a key partner and source of financial support for the coalitions. These coalitions had variable success interfering with tobacco control policy-making. The combined resources of tobacco and alcohol companies may have affected tobacco control legislation. These alliances helped to create the perception that there is a broader base of opposition to tobacco control. Advocates should be aware of the covert alliances between tobacco, alcohol and other industries and expose them to correct this misperception. © 2013 Society for the Study of Addiction.

Alliances in Human Biology: The Harvard Committee on Industrial Physiology, 1929-1939.

PubMed

Oakes, Jason

2015-08-01

In 1929 the newly-reorganized Rockefeller Foundation funded the work of a cross-disciplinary group at Harvard University called the Committee on Industrial Physiology (CIP). The committee's research and pedagogical work was oriented towards different things for different members of the alliance. The CIP program included a research component in the Harvard Fatigue Laboratory and Elton May's interpretation of the Hawthorne Studies; a pedagogical aspect as part of Wallace Donham's curriculum for Harvard Business School; and Lawrence Henderson's work with the Harvard Pareto Circle, his course Sociology 23, and the Harvard Society of Fellows. The key actors within the CIP alliance shared a concern with training men for elite careers in government service, business leadership, and academic prominence. But the first communications between the CIP and the Rockefeller Foundation did not emphasize training in human biology. Instead, the CIP presented itself as a coordinating body that would be able to organize all the varied work going on at Harvard that did not fit easily into one department, and it was on this basis that the CIP became legible to the President of Harvard, A. Lawrence Lowell, and to Rockefeller's Division of Social Sciences. The members of the CIP alliance used the term human biology for this project of research, training and institutional coordination.

The Relation of Secondary Traumatization to Therapists' Perceptions of the Working Alliance with Clients Who Commit Sexual Abuse

ERIC Educational Resources Information Center

Carmel, Melissa J. Sheehy; Friedlander, Myrna L.

2009-01-01

The authors assessed burnout, compassion fatigue, secondary trauma symptoms, and compassion satisfaction in relation to experienced therapists' perceptions of the working alliance. Participants, 106 specialists in the treatment of clients who commit sexual abuse, completed the Working Alliance Inventory-Short Form (T. J. Tracey & A. M.…

The Balancer Policy Reviewed from the Perspective of the ROK-U.S. Alliance: Toward a Mature ROK-U.S. Alliance

DTIC Science & Technology

2006-12-01

one of Korea’s ancient three kingdoms, existed for 700 years ruled by 26 wise kings ) in the papers of the Northeast Project, a government-funded...Relations,” in Korea-U.S. Relations in Transition, ed. Baek Jong-chun and Lee Sang-hyun (Sungnam: Sejong Institute, 2002). 51 military alliance it was...President, President’s Roh’s Inauguration Announcement, Vol. 1, Secretary Office, 2003. 62 Sejong Laboratory, National strategy for 21st century

Ethnocultural variations in mental illness discourse: some implications for building therapeutic alliances.