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Sample records for measuring therapeutic alliance

  1. Measuring Therapeutic Alliance with Children in Residential Treatment and Therapeutic Day Care

    ERIC Educational Resources Information Center

    Roest, Jesse; van der Helm, Peer; Strijbosch, Eefje; van Brandenburg, Mariëtte; Stams, Geert Jan

    2016-01-01

    Purpose: This study examined the construct validity and reliability of a therapeutic alliance measure (Children's Alliance Questionnaire [CAQ]) for children with psychosocial and/or behavioral problems, receiving therapeutic residential care or day care in the Netherlands. Methods: Confirmatory factor analysis of a one-factor model ''therapeutic…

  2. Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research

    PubMed Central

    Ardito, Rita B.; Rabellino, Daniela

    2011-01-01

    This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. A summary of how the concept of alliance has evolved over time and the more popular alliance measures used in literature to assess the level of alliance are presented. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. In our opinion, with regard to the relationship between the therapeutic alliance and outcome of psychotherapy, future research should pay special attention to the comparison between patients’ and therapists’ assessments of the therapeutic alliance. This topic, along with a detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects. PMID:22028698

  3. [Therapeutic alliance and analytic setting].

    PubMed

    Zukerfeld, R

    2001-01-01

    The goal of this work is to study the relationship between the therapeutic alliance, the subjective perception of improvement, the frequency of sessions and the type of analytic interventions, in both psychoanalysts and non-psychoanalysts patients. 39 subjects under psychoanalytic treatment lasting one to six years (mean 4.2 years) were interviewed. It was performed: a) a therapeutic alliance evaluation scale (HRQ); b) a subjetive improvement perception scale (PSM); c) a scale to evaluate the style of the psychoanalytic interventions (EI). The sample was divided in two groups: 1) 18 non-psychoanalysts under psychoanalytic treatment, who assited to a mean of 1.15 sessions per week (group 1) and b) 21 psychoanalysts receiving two kinds of psychoanalytic treatments: a) one following the international Psychoanalytc Associations rules (group 2A), b) the other with 1.65 mean sessions per week (group 2B). a) patients in groups 1 and 2A showed similar HRQ scores, and both were higher than that shown by group 2B (21.53 vs 21.51 vs 17.22) No differences were found neither in PSM scores (3.61 vs 3.85 vs 3.85 respectively) nor in the EI scores (3.61 vs 3.71 vs 3.71). It was observed a positive correlation between HRQ and PSM (group 1: r: 0.55 and gorup 2, r: 0.31) but no correlation was found neither with the number of sessions per week (group 1, r:0.13; group 2, r: 0.30) nor with EI score (group 1, r: -0.21; group 2, r: 0.08). DISCUSION AND CONCLUSIONS: a) intensity of perceived therapeutic alliance is correlated with improvement but b) is not correlated with sessions frequency or style of psychoanalytic interventions. It is also discussed which psychic changes are related with the therapeutic alliance with regards with different psychoanalytic theoretical frames.

  4. Therapeutic alliance in a randomized clinical trial for bulimia nervosa

    PubMed Central

    Accurso, Erin C.; Fitzsimmons-Craft, Ellen E.; Ciao, Anna; Cao, Li; Crosby, Ross D.; Smith, Tracey L.; Klein, Marjorie H.; Mitchell, James E.; Crow, Scott J.; Wonderlich, Stephen A.; Peterson, Carol B.

    2015-01-01

    Objective This study examined the temporal relation between therapeutic alliance and outcome in two treatments for bulimia nervosa (BN). Method Eighty adults with BN symptoms were randomized to 21 sessions of integrative cognitive-affective therapy (ICAT) or enhanced cognitive-behavioral therapy (CBT-E). Bulimic symptoms (i.e., frequency of binge eating and purging) were assessed at each session and post-treatment. Therapeutic alliance (Working Alliance Inventory) was assessed at sessions 2, 8, 14, and post-treatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine differences in alliance growth by treatment and patient characteristics. Mixed-effects models examined the relation between alliance and symptom improvement. Results Overall, patients in both treatments reported strong therapeutic alliances. Regardless of treatment, greater therapeutic alliance between (but not within) subjects predicted greater reductions in bulimic behavior; reductions in bulimic behavior also predicted improved alliance. Patients with higher depression, anxiety, or emotion dysregulation had a stronger therapeutic alliance in CBT-E than ICAT, while those with more intimacy problems had greater improvement in therapeutic alliance in ICAT compared to CBT-E. Conclusions Therapeutic alliance has a unique impact on outcome, independent of the impact of symptom improvement on alliance. Within- and between-subject effects revealed that changes in alliance over time did not predict symptom improvement, but rather that individuals who had a stronger alliance overall had better bulimic symptom outcomes. These findings indicate that therapeutic alliance is an important predictor of outcome in the treatment of BN. PMID:25894667

  5. Therapeutic alliance in a randomized clinical trial for bulimia nervosa.

    PubMed

    Accurso, Erin C; Fitzsimmons-Craft, Ellen E; Ciao, Anna; Cao, Li; Crosby, Ross D; Smith, Tracey L; Klein, Marjorie H; Mitchell, James E; Crow, Scott J; Wonderlich, Stephen A; Peterson, Carol B

    2015-06-01

    This study examined the temporal relation between therapeutic alliance and outcome in two treatments for bulimia nervosa (BN). Eighty adults with BN symptoms were randomized to 21 sessions of integrative cognitive-affective therapy (ICAT) or enhanced cognitive-behavioral therapy (CBT-E). Bulimic symptoms (i.e., frequency of binge eating and purging) were assessed at each session and posttreatment. Therapeutic alliance (Working Alliance Inventory) was assessed at Sessions 2, 8, 14, and posttreatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine differences in alliance growth by treatment and patient characteristics. Mixed-effects models examined the relation between alliance and symptom improvement. Overall, patients in both treatments reported strong therapeutic alliances. Regardless of treatment, greater therapeutic alliance between (but not within) subjects predicted greater reductions in bulimic behavior; reductions in bulimic behavior also predicted improved alliance. Patients with higher depression, anxiety, or emotion dysregulation had a stronger therapeutic alliance in CBT-E than ICAT, while those with more intimacy problems had greater improvement in therapeutic alliance in ICAT compared to CBT-E. Therapeutic alliance has a unique impact on outcome, independent of the impact of symptom improvement on alliance. Within- and between-subjects effects revealed that changes in alliance over time did not predict symptom improvement, but rather that individuals who had a stronger alliance overall had better bulimic symptom outcomes. These findings indicate that therapeutic alliance is an important predictor of outcome in the treatment of BN. (c) 2015 APA, all rights reserved).

  6. Therapeutic Alliance Between Youth and Staff in Residential Group Care: Psychometrics of the Therapeutic Alliance Quality Scale

    PubMed Central

    Duppong Hurley, Kristin; Lambert, Matthew C.; Van Ryzin, Mark; Sullivan, Justin; Stevens, Amy

    2012-01-01

    Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service provider, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time. PMID:23264715

  7. Suicide Ideation Is Related to Therapeutic Alliance in a Brief Therapy for Attempted Suicide.

    PubMed

    Gysin-Maillart, Anja C; Soravia, Leila M; Gemperli, Armin; Michel, Konrad

    2017-01-02

    The objective of this study was to investigate the role of therapeutic alliance on suicide ideation as outcome measure in a brief therapy for patients who attempted suicide. Sixty patients received the 3-session therapy supplemented by follow-up contact through regular letters. Therapeutic alliance was measured with the Helping Alliance Questionnaire (HAQ). Outcome at 6 and 12 months was measured with the Beck Scale for Suicide Ideation (BSS). Therapeutic alliance increased from session 1 to session 3. Higher alliance measures correlated with lower suicidal ideation at 12 months follow-up. A history of previous attempts and depression had a negative affect on therapeutic alliance. The results suggest that in the treatment of suicidal patients therapeutic alliance may be a moderating factor for reducing suicide ideation.

  8. Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement.

    PubMed

    Labouliere, Christa D; Reyes, J P; Shirk, Stephen; Karver, Marc

    2015-06-04

    Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth literature; however, past research frequently suffered measurement issues that obscured temporal relationships between alliance and symptomatology by measuring variables later in therapy, thereby precluding examination of important early changes. The current study aimed to explore the directions of effect between alliance and outcome early in therapy with adolescents by examining associations between first- and fourth-session therapeutic alliance and symptomatology. Thirty-four adolescents (∼63% female, 38% ethnic/racial minority) participated in a school-based cognitive-behavioral therapy for adolescents with depression. Participants completed the Beck Depression Inventory at baseline and Session 4, and therapeutic alliance was coded from audiotapes of Sessions 1 and 4 by objective coders using the Alliance Observation Coding System. Autoregressive path analyses determined that first-session therapeutic alliance was a strong significant predictor of Session 4 depression symptoms, but pretreatment depression scores were not significantly predictive of subsequent therapeutic alliance. Adding reciprocal effects between alliance and depression scores did not adversely affect model fit, suggesting that reciprocal effects may exist. Early therapeutic alliance with adolescents is critical to fostering early gains in depressive symptomatology. Knowing alliance's subsequent effect on youth outcomes, clinicians should increase effort to foster a strong relationship in early sessions and additional research should be conducted on the reciprocal effects of therapeutic alliance and treatment outcome in adolescence.

  9. Establishing therapeutic alliance across cultural barriers.

    PubMed

    Cravener, P

    1992-12-01

    1. The therapeutic alliance is a mutually defined helping relationship that encompasses mutual respect and acceptance of ethnocultural variance, predicated upon empathic rapport. 2. Sensitivity to two psycholinguistic phenomena may help establish a transcultural relationship: the detachment effect (limited expression of affect and reduced access to developmental events between languages) and code switching (a complete or partial change of language or dialect within a single utterance or conversation). 3. Issues related to differing sociocultural expectations of nurses and clients will be increasingly encountered as ease of travel combines with economic and political unrest to produce increasing numbers of displaced persons.

  10. Therapeutic alliance and binge-eating outcomes in a group therapy context.

    PubMed

    Tasca, Giorgio A; Compare, Angelo; Zarbo, Cristina; Brugnera, Agostino

    2016-07-01

    The therapeutic alliance in individual and group psychotherapy is associated with treatment outcomes for a variety of disorders. However, debate persists about the centrality of the alliance in determining positive outcomes. We examined the alliance-outcome relationship across 20 sessions of emotionally focused group therapy (EFGT) for binge-eating disorder (BED). We hypothesized that (1) previous session alliance increase will predict lower subsequent session binge eating level while controlling for previous session binge eating level; and (2) previous session binge eating decline will predict higher subsequent session alliance level while controlling previous session alliance level. Participants were 118 individuals with BED who received 20 sessions of EFGT in 8 groups. Levels of binge eating and therapeutic alliance to the therapist were measured weekly. Linear growth in alliance during group therapy was associated with reduced binge eating at 6 months' posttreatment. We also found that the group's and the individual's alliance scores and binge-eating episodes were significantly associated across treatment, suggesting a mutual influence of the group's and individual's experience of the alliance with the therapist. Regarding the first hypothesis, previous session alliance increase was significantly associated with lower subsequent session binge eating. Regarding the second hypothesis, previous session binge-eating decline was not significantly related to higher subsequent session alliance. The findings provide evidence in a group therapy context for a model in which alliance change influences subsequent symptom levels, but not the other way around. (PsycINFO Database Record

  11. Child, caregiver, and therapist perspectives on therapeutic alliance in usual care child psychotherapy.

    PubMed

    Accurso, Erin C; Garland, Ann F

    2015-03-01

    This study examined the temporal stability and cross-informant agreement on multiple perspectives of child and caregiver alliance with therapists in usual care psychotherapy. Baseline predictors of alliance were also examined. Children with disruptive behavior problems (n = 209) and their caregivers were followed for up to 16 months after initiating psychotherapy at a community-based clinic. Alliance was rated by children, caregivers, and therapists every 4 months for as long as families participated in treatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine whether child and caregiver alliance differed across time, as well to examine factors associated with each perspective on alliance. Intraclass correlations between child, caregiver, and therapist reports of alliance were also examined. Alliance was rated relatively high overall across perspectives. Clients (children and caregivers) tended to report the strongest and most stable alliance, while therapists reported the weakest alliance and perceived deteriorations in child alliance over time. Inter-informant agreement was variable for child and caregiver alliance; agreement was moderate between clients and therapists. Several predictors of alliance emerged, including child gender, anxiety diagnosis, caregiver race/ethnicity, and therapist experience. This study provides methodological information about reports of therapeutic alliance across time and informants that can inform current efforts to understand the alliance-outcome association.

  12. Therapeutic alliance, expressed emotion, and treatment outcome for anorexia nervosa in a family-based partial hospitalization program.

    PubMed

    Rienecke, Renee D; Richmond, Rebekah; Lebow, Jocelyn

    2016-08-01

    Adolescent therapeutic alliance has been found to be associated with improvements in eating disorder cognitions and with early weight gain. The current study assessed patient and parent therapeutic alliance, correlates of parent alliance, and relationship between alliance and treatment outcome. Fifty-six patients with anorexia nervosa completed measures of therapeutic alliance and eating disorder symptoms. Patients' parents completed measures of therapeutic alliance, expressed emotion, and psychopathology. Patients' alliance predicted cognitive and behavioral symptomatology at end of treatment (β=-0.39, p=0.001), though it was not related to changes in weight (β=0.12, p=0.377). Maternal hostility was associated with lower maternal alliance (r=-0.34, p=0.05). Findings suggest that maternal hostility should be addressed in treatment, and that patient alliance may be important in achieving psychological recovery from disordered eating.

  13. Disentangling the change-alliance relationship: Observational assessment of the therapeutic alliance during change and stuck episodes.

    PubMed

    Mellado, Augusto; Suárez, Nicolás; Altimir, Carolina; Martínez, Claudio; Pérez, Janet; Krause, Mariane; Horvath, Adam

    2017-09-01

    The therapeutic alliance is considered the most robust process variable associated with positive therapeutic outcome in a variety of psychotherapeutic models [Alexander, L. B., & Luborsky, L. (1986). The Penn Helping Alliance Scales. In L. S. Greenberg & W. M. Pinsoff (Eds.), The psychotherapeutic process: A research handbook (pp. 325-356). New York: Guilford Press; Horvath, A. O., Gaston, L., & Luborsky, L. (1993). The alliance as predictor of benefits of counseling and therapy. In N. Miller, L. Luborsky, J. Barber, & J. P. Docherty (Eds.), Psychodynamic treatment research: A handbook for clinical practice (pp. 247-274). New York, NY: Basic Books; Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9-16; Orlinky, D., Grawe, K., & Parks, B. (1994). Process and outcome in psychotherapy: Noch einmal. In A. Bergin & J. S. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 270-378). New York, NY: Wiley and Sons]. The relationship between alliance and outcome has traditionally been studied based on measures that assess these therapy factors at a global level. However, the specific variations of the alliance process and their association with therapy segments that are relevant for change have not yet been fully examined. The present study examines the variations in the therapeutic alliance in 73 significant in-session events: 35 change and 38 stuck episodes identified through the observation of 14 short-term therapies of different theoretical orientations. Variations in the alliance were assessed using the VTAS-SF [Shelef, K., & Diamond, G. (2008). Short form of the revised Vanderbilt Therapeutic Alliance Scale: Development, reliability, and validity. Psychotherapy Research, 18, 433-443]. Nested analyses (HLM) indicate a statistically significant better quality of the alliance during change episodes.

  14. 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…

  15. 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…

  16. Therapeutic alliance and obesity management in primary care - a cross-sectional pilot using the Working Alliance Inventory.

    PubMed

    Sturgiss, E A; Sargent, G M; Haesler, E; Rieger, E; Douglas, K

    2016-12-01

    Therapeutic alliance is a well-recognized predictor of patient outcomes within psychological therapy. It has not been applied to obesity interventions, and Bordin's theoretical framework shows particular relevance to the management of obesity in primary health care. This cross-sectional study of a weight management programme in general practice aimed to determine if therapeutic alliance was associated with patient outcomes. The Working Alliance Inventory short revised version (WAI-SR) was administered to 23 patients and 11 general practitioners (GPs) at the end of a 6-month weight management programme. Use of the WAI-SR indicated that the strength of therapeutic alliance varied between different patient-GP relationships in this pilot intervention. A robust therapeutic alliance was strongly associated with patient engagement in the weight management programme indicated by number of appointments. It was also associated with some general health and quality of life outcomes. These are promising results that require confirmation with larger studies in primary health care. The measurement of therapeutic alliance using the WAI-SR may predict patient attendance and outcomes in obesity interventions in primary healthcare settings.

  17. Emotional experience and alliance contribute to therapeutic change in psychodynamic therapy.

    PubMed

    Fisher, Hadar; Atzil-Slonim, Dana; Bar-Kalifa, Eran; Rafaeli, Eshkol; Peri, Tuvia

    2016-03-01

    Accumulating evidence suggests that the therapeutic alliance and clients' contact with emotions during therapy sessions can be effective in reducing their suffering outside of sessions. However, the complex associations among these determinants are not yet clear. Using data collected in therapy on a session-by-session basis, this study explored (a) the temporal associations between emotional experience and the therapeutic alliance; (b) the temporal associations between emotional experience and clients' level of functioning; and (c) the direct and indirect associations among emotional experience, the therapeutic alliance, and functioning. Clients (N = 101) undergoing psychodynamic therapy completed a functioning and distress measure prior to each session, and reported on their emotional experience and perceived alliance strength following each session. Longitudinal multilevel models indicated that higher therapeutic alliance scores at the end of 1 session predicted a greater emotional experience in the next session but that emotional experience did not predict subsequent levels of alliance. The results provided evidence of reciprocal prediction in which a previous emotional experience predicted a subsequent change in functioning and vice versa. Finally, the alliance predicted emotional experience, which, in turn, predicted functioning; hence, alliance strength indirectly predicted clients' level of functioning. Findings indicate that emotional experience and the therapeutic alliance are important determinants of the therapeutic process, which contribute to predict clients' improvement in functioning within psychodynamic treatment.

  18. Therapeutic Alliance in Internet-Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety.

    PubMed

    Hadjistavropoulos, Heather D; Pugh, Nicole E; Hesser, Hugo; Andersson, Gerhard

    2016-04-06

    There has been limited research on therapeutic alliance in the context of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) when delivered in clinical practice. The present study investigated therapeutic alliance in ICBT delivered to patients seeking treatment for symptoms of depression (n = 83) or generalized anxiety (n = 112) as part of an open dissemination trial. ICBT was provided by 27 registered therapists or 28 graduate students working in six geographically dispersed clinics; therapist-assistance was delivered primarily through secure messages and occasionally telephone calls. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were collected pre-, mid- and post-treatment, and the Therapeutic Alliance Questionnaire was assessed mid- and post-treatment. Therapeutic alliance ratings were high both at mid-treatment and post-treatment (above 80%). There was no relationship between therapeutic alliance ratings and improvement on primary outcomes. Among patients treated for depression, lower ratings of mid-treatment alliance were associated with concurrent treatment by a psychiatrist and fewer phone calls and emails from their therapist. Among patients treated for generalized anxiety, ratings of mid-treatment alliance were higher among registered providers as compared to graduate students. Multiple directions for future research on therapeutic alliance in ICBT are offered, including suggestions for developing a new measure of therapeutic alliance specific to ICBT and measuring therapeutic alliance throughout the treatment process. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message: This research demonstrated that therapeutic alliance ratings were very strong at both mid- and post-treatment among patients who received Internet-delivered cognitive behaviour therapy (ICBT) for depression or anxiety in clinical practice. Among patients receiving ICBT for depression, lower ratings of therapeutic alliance

  19. Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

    PubMed Central

    Huff, Nidhi G.; Nadig, Nandita; Ford, Dee W.

    2015-01-01

    Rationale: Therapeutic alliance is a novel measure of the multifaceted caregiver–clinician relationship and a promising intervention target for improving patient-centered outcomes. However, therapeutic alliance has not been studied in an intensive care unit (ICU) setting. Objectives: To explore the relationships among caregiver-reported therapeutic alliance and psychological distress as well as patient, caregiver, and ICU clinician factors. Methods: In this cross-sectional study, we enrolled consecutive patient caregivers of mechanically ventilated patients discharged from all ICUs at Duke University and the Medical University of South Carolina Hospitals between December 2013 and August 2014. Measurements and Main Results: Caregivers completed an in-person, hospital-based interview that included measures of therapeutic alliance with the ICU physicians (Human Connection Scale) as well as patient centeredness of care; symptoms of depression, anxiety, and post-traumatic stress; decisional conflict; and quality of communication. We performed a multivariate regression to characterize associations between Human Connection Scale scores and key variables. A total of 56 caregivers were included in these exploratory analyses. Patients were largely disabled (47%) and Medicare insured (53%). Caregivers were highly educated and generally had high therapeutic alliance (median, 55; interquartile range, 48–58) with the ICU clinicians. Therapeutic alliance was strongly correlated with patient centeredness (r = 0.78) and poorly correlated with psychological distress (r < 0.2). Stepwise multivariate modeling revealed that higher therapeutic alliance was associated with fewer baseline patient comorbidities as well as caregiver report of greater trust in the ICU team, better quality of communication, and less decisional conflict (all P < 0.012). Conclusions: Therapeutic alliance encompasses measures of trust, communication, and cooperation, which are intuitive to

  20. Toward a conceptual alliance about therapeutic alliance: a voyage through the Inferno.

    PubMed

    Szajnberg, N M

    1996-01-01

    I suggest that there is not a conceptual consensus in psychoanalysis regarding the therapeutic alliance. Some argue that the unobjectionable part of the transference should be facilitated; some argue that there is no unobjectionable part of the transference, that all parts should be subjected to analysis. There are those who argue that the therapeutic alliance exists in early treatment; others who argue that it exists later. I suggest using a classical text, Dante's Inferno, as a paradigm for a journey of self-discovery. By reviewing the moments of hesitation that Dante experiences with Virgil and how these are overcome, we cast light on our current problem on the nature of the therapeutic alliance and how to facilitate it. The components of the unobjectionable are related to Winnicott's idea of the maturational processes and Hartmann's (1958) ideas of the primary and secondary autonomous function. Based on their considerations, we make recommendations for use of the therapeutic alliance.

  1. 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…

  2. 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…

  3. 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…

  4. 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…

  5. Patient-centred communication is associated with positive therapeutic alliance: a systematic review.

    PubMed

    Pinto, Rafael Zambelli; Ferreira, Manuela L; Oliveira, Vinicius C; Franco, Marcia R; Adams, Roger; Maher, Christopher G; Ferreira, Paulo H

    2012-01-01

    During the patient-therapist encounter, which communication factors correlate with constructs of therapeutic alliance? Systematic review. Clinicians and patients in primary, secondary or tertiary care settings. Studies had to investigate the association between communication factors (interaction styles, verbal factors or non-verbal factors) and constructs of the therapeutic alliance (collaboration, affective bond, agreement, trust, or empathy), measured during encounters between health practitioners and patients. Among the twelve studies that met the inclusion criteria, 67 communication factors were identified (36 interaction styles, 17 verbal factors and 14 non-verbal factors). The constructs of therapeutic alliance in the included studies were rapport, trust, communicative success and agreement. Interaction styles that showed positive large correlations with therapeutic alliance were those factors that help clinicians to engage more with patients by listening to what they have to say, asking questions and showing sensitivity to their emotional concerns. Studies of verbal and non-verbal factors were scarce and inconclusive. The limited evidence suggests patient-centred interaction styles related to the provision of emotional support and allowing patient involvement in the consultation process enhance the therapeutic alliance. Clinicians can use this evidence to adjust their interactions with patients to include communication strategies that strengthen the therapeutic alliance. Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.

  6. Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder.

    PubMed

    Gersh, Elon; Hulbert, Carol A; McKechnie, Ben; Ramadan, Reem; Worotniuk, Tamara; Chanen, Andrew M

    2017-03-01

    This study aimed to investigate alliance rupture and repair processes in psychotherapy for youth with borderline personality disorder. It sought to examine whether alliance processes differ between treatments, across the phases of therapy, and what associations these processes might have with therapeutic outcomes. The study involves repeated measurement of both process and outcome measures. Hypotheses were addressed using within- and between-subjects analyses. Forty-four people, aged 15-24, with a diagnosis of BPD were randomized to receive either 16 sessions of Cognitive Analytic Therapy (CAT) or a supportive treatment known as Befriending. In addition to pre-post outcome assessments, alliance processes were rated using the observer-based Rupture Resolution Rating Scale. Results indicated that CAT and Befriending did not differ in terms of number of ruptures, although CAT was associated with more stages of rupture resolution. Examination of alliance processes across time pointed to increasing ruptures, more frequent confrontation ruptures and increasing rupture resolution, suggesting increased volatility, directness and productivity in the therapeutic process across time. Contrary to hypotheses, there was no consistent link between alliance processes and outcome. However, two specific phases were significant. Early treatment ruptures were associated with poor outcome whereas greater late treatment resolution was associated with better outcomes. This study suggests that alliance processes can differ across treatments and the phases of therapy in psychotherapy for youth with BPD. Alliance ruptures are more likely to be problematic early in therapy but later in therapy, they appear to be opportunities for therapeutic growth. Alliance ruptures are more likely than not to occur in any given session with a young person with Borderline Personality Disorder. Early in therapy, withdrawal type ruptures are more frequent, whereas late in therapy, confrontation ruptures are

  7. 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.

  8. Assessment of the therapeutic alliance of youth and parents with team members in youth residential psychiatry.

    PubMed

    Lamers, Audri; Vermeiren, Robert R J M

    2015-10-01

    Although therapeutic alliance is widely acknowledged as a key component for therapeutic change, its role is almost unknown in youth residential psychiatry. A likely reason for the lack of research is the absence of assessment tools and procedures for youth residential settings. This study assesses the psychometric properties of the Dutch version of the Family Engagement Questionnaire (FEQ), an alliance measure completed by team members. In addition, agreement among team members is explored. Eleven youth psychiatric day and inpatient units participated. Parent counsellors and case managers of 86 patients from 6 to 17 years old reported on the therapeutic alliance. Exploratory factor analysis of team members' reports resulted in meaningful structures, with child and parent alliance scales primarily corresponding to the conceptualization of the developers and earlier factor analysis. Internal reliability and validity were good for most of the subscales. The hypothesis that team members would show low levels of agreement in their reports of the therapeutic alliance was confirmed, demonstrating the need to include multiple team members in assessment procedures. Overall, this study underscores the psychometric properties of the Dutch version of the FEQ. Team members in residential youth psychiatric settings are encouraged to reflect regularly with their colleagues on the youth and parent therapeutic alliance.

  9. Patterns of Therapeutic Alliance: Rupture-Repair Episodes in Prolonged Exposure for PTSD

    PubMed Central

    McLaughlin, AnnaMaria Aguirre; Keller, Stephanie M.; Feeny, Norah C.; Youngstrom, Eric A.; Zoellner, Lori A.

    2014-01-01

    Objective To better understand the role of therapeutic alliance in PTSD treatment, we examined patterns of and shifts in alliance. First, we identified individuals with repaired ruptures, unrepaired ruptures, and no ruptures in alliance. Then, we explored group differences in these alliance events for clients with common clinical correlates (i.e., co-occurring depression and childhood abuse history) and whether or not the presence of these events influenced treatment outcome. Method At pre-treatment, clients (N = 116); 76.1% female; 66% Caucasian; age M = 36.7 years (SD = 11.3) completed measures assessing PTSD diagnosis and severity (PTSD Symptom Scale Interview and Self-Report), depression diagnosis and severity (Structured Clinical Interview for DSM-IV and Beck Depression Inventory), and trauma history. During ten weeks of prolonged exposure therapy, alliance (California Psychotherapy Alliance Scale) measures were completed. At post-treatment, PTSD and depression were re-assessed. Results Ruptures in alliance were quite common (46%). No significant differences emerged in the frequency of repaired ruptures, unrepaired ruptures, or no ruptures between those with and without co-occurring MDD, X2 (2, N = 82) = 2.69, p =. 26, or those with and without a history of childhood abuse, X2 (2, N = 81) = 0.57, p = .75. Unrepaired ruptures predicted worse treatment outcome (β = .45, p = .001). Conclusions The current study underscores the importance of attending to discontinuities in alliance throughout treatment. PMID:24188510

  10. 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

  11. A study of the differential effects of Tomm's questioning styles on therapeutic alliance.

    PubMed

    Ryan, D; Carr, A

    2001-01-01

    To replicate and extend Dozier's (1992) test of Tomm's hypothesis about the differential effects of questioning styles on therapeutic alliance, an analogue study was conducted. Twenty-eight family triads, each including a son and his parents, viewed four videotaped, simulated family therapy scenarios in which Tomm's four questioning styles were separately portrayed. Participants were asked to identify with the client whose role corresponded to theirs (that is, father, mother, or son) and, on the basis of this, to rate the client's alliance with the therapist. They were also asked to rate the overall alliance between the family and the therapist. Finally, having viewed all four scenarios, they were invited to rate comparatively the quality of the therapeutic alliance across the four questioning styles. Compared with strategic and lineal questioning styles, circular and reflexive questions led to higher ratings of therapeutic alliance on all three measures. The results of this study support Tomm's hypothesis that questioning styles based on circular assumptions lead to a better therapeutic alliance at an individual and systemic level than do questions based on lineal assumptions.

  12. 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.

  13. 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…

  14. 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.

  15. 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…

  16. The Resolution of Ruptures in the Therapeutic Alliance.

    ERIC Educational Resources Information Center

    Safran, Jeremy D.; Muran, J. Christopher

    1996-01-01

    A rupture in the therapeutic alliance is a deterioration in the quality of the relationship between patient and therapist; it is an interpersonal marker that indicates an opportunity for exploring and understanding the processes that maintain a maladaptive interpersonal schema. Outlines features of a research program on ruptures in the therapeutic…

  17. The Importance of Empathy in the Therapeutic Alliance.

    ERIC Educational Resources Information Center

    Feller, Candi P.; Cottone, R. Rocco

    2003-01-01

    In this investigation of the construct of empathy, the authors report that the literature reflects strong evidence that empathy is an essential component of the therapeutic alliance across theories and that empathy is necessary in the counseling process. The concept of empathy continues to be a central component of new forms of counseling and…

  18. 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.

  19. The relationships between therapeutic alliance and internalizing and externalizing symptoms in Trauma-Focused Cognitive Behavioral Therapy.

    PubMed

    Zorzella, Karina P M; Muller, Robert T; Cribbie, Robert A

    2015-12-01

    Therapeutic alliance has been considered an important factor in child psychotherapy and is consistently associated with positive outcomes. Nevertheless, research on alliance in the context of child trauma therapy is very scarce. This study examined the relationships between child therapeutic alliance and psychopathology in an empirically supported child trauma therapy model designed to address issues related to trauma with children and their caregivers. Specifically, we examined the extent to which the child's psychopathology would predict the establishment of a positive alliance early in treatment, as well as the association between alliance and outcome. Participants were 95 children between the ages of 7 and 12 and their caregivers, who went through a community-based Trauma-Focused Cognitive Behavioral Therapy program in Canada. Caregivers filled out the CBCL prior to assessment and following treatment. Children and therapists completed an alliance measure (TASC) at three time points throughout treatment. Symptomatology and child gender emerged as important factors predicting alliance at the beginning of treatment. Girls and internalizing children developed stronger alliances early in treatment. In addition, a strong early alliance emerged as a significant predictor of improvement in internalizing symptoms at the end of treatment. Our findings indicate that symptomatology and gender influence the development of a strong alliance in trauma therapy. We suggest that clinicians should adjust therapeutic style to better engage boys and highly externalizing children in the early stages of therapy.

  20. The Relationship Between the Therapeutic Alliance and Treatment Outcome in Two Distinct Psychotherapies for Chronic Depression

    PubMed Central

    Arnow, Bruce A.; Steidtmann, Dana; Blasey, Christine; Manber, Rachel; Constantino, Michael J.; Klein, Daniel N.; Markowitz, John C.; Rothbaum, Barbara O.; Thase, Michael E.; Fisher, Aaron J.; Kocsis, James H.

    2013-01-01

    Objective This study tested whether the quality of the patient-rated working alliance, measured early in treatment, predicted subsequent symptom reduction in chronically depressed patients. Secondarily, the study assessed whether the relationship between early alliance and response to treatment differed between patients receiving Cognitive Behavioral Analysis System of Psychotherapy (CBASP) versus Brief Supportive Psychotherapy (BSP). Method 395 adults (57% female; Mage = 46; 91% Caucasian) who met criteria for chronic depression and did not fully remit during a 12-week algorithm-based, open-label pharmacotherapy trial were randomized to receive either 16–20 sessions of CBASP or BSP in addition to continued, algorithm-based antidepressant medication. Of these, 224 patients completed the Working Alliance Inventory-Short Form at weeks 2 or 4 of treatment. Blind raters assessed depressive symptoms at two-week intervals across treatment using the Hamilton Rating Scale for Depression. Linear mixed models tested the association between early alliance and subsequent symptom ratings while accounting for early symptom change. Results A more positive early working alliance was associated with lower subsequent symptom ratings in both the CBASP and BSP, F(1, 1236) =62.48, p<.001. In addition, the interaction between alliance and psychotherapy type was significant, such that alliance quality was more strongly associated with symptom ratings among those in the CBASP treatment group, F(1,1234) = 8.31, p =.004. Conclusions The present results support the role of the therapeutic alliance as a predictor of outcome across dissimilar treatments for chronic depression. Contrary to expectations, the therapeutic alliance was more strongly related to outcome in CBASP, the more directive of the two therapies. PMID:23339536

  1. Therapeutic alliance and cohesion variables as predictors of outcome in short-term group psychotherapy.

    PubMed

    Joyce, Anthony S; Piper, William E; Ogrodniczuk, John S

    2007-07-01

    The current study explored the relative ability of aggregate therapeutic alliance and cohesion variables to predict short-term group therapy outcome. Data were collected from a comparative trial of two forms of time-limited group psychotherapy for complicated grief (Piper, McCallum, Joyce, Rosie, & Ogrodniczuk, 2001). The therapeutic alliance and elements of the cohesion construct were measured from the perspectives of each patient and the group therapist at intervals during the groups; scores were aggregated across assessments. Hierarchical multiple regression analyses, adjusting for the effects of treatment approach (interpretive vs. supportive) and specific group membership, demonstrated that the patient-rated alliance was a consistent predictor of outcome. Two cohesion measures, reflecting other participants' (therapist, other members) views of the patient's "fit" with the group, also accounted for variation in outcome. Implications of the findings for research and clinical practice, and the limitations of the measurement approach taken in this study, are considered.

  2. 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

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

    PubMed

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

    2016-11-10

    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. (PsycINFO Database Record

  4. Psychotherapy role expectations and experiences - discrepancy and therapeutic alliance among patients with substance use disorders.

    PubMed

    Frankl, My; Philips, Björn; Wennberg, Peter

    2014-12-01

    The main aim of the study was to examine how the discrepancy between role expectations prior to psychotherapy and experiences of ongoing psychotherapy related to therapeutic alliance. We hypothesized that a similarity between patient role expectations and experiences would be associated with a stronger alliance. The study also examined whether different dimensions of psychotherapy role expectations predicted retention in psychotherapy. A naturalistic study design was used with data collected prior to therapy and during the first 6 months of therapy. Patients with substance use disorders completed the Psychotherapy Expectation Questionnaire-short version (PEX-S) at the time of therapy assessment. A subsample of these patients (n = 41; n = 24 in individual therapy and n = 17 in group therapy) provided data from therapy including psychotherapy experiences (also measured with PEX-S) and therapeutic alliance, measured with Working Alliance Questionnaire-short version. For patients in group therapy, discrepancy between role expectations and experiences correlated negatively with alliance. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention. The finding that disconfirmation of patients' role expectations in group therapy were associated with weaker therapeutic alliance highlights the importance of discussing psychotherapy expectations at an early stage in treatment. Expectations characterized by defensiveness predicted worse retention in psychotherapy, which indicates that the PEX-S can be helpful in detecting patients at risk for dropout. In targeting a patient's role expectancies prior to treatment, possible discrepancies between patient and therapist are made visible and possible to examine. Clarifying the patient's role expectations and the therapist's rationale might be a first step towards establishing a strong working alliance. Surveying the patient's defensiveness tendencies at the beginning of therapy

  5. The Relationship of Perfectionism, Depression, and Therapeutic Alliance during Treatment for Depression: Latent Difference Score Analysis

    ERIC Educational Resources Information Center

    Hawley, Lance L.; Ho, Moon-Ho Ringo; Zuroff, David C.; Blatt, Sidney J.

    2006-01-01

    The authors examined the longitudinal relationship of patient-rated perfectionism, clinician-rated depression, and observer-rated therapeutic alliance using the latent difference score (LDS) analytic framework. Outpatients involved in the Treatment for Depression Collaborative Research Program completed measures of perfectionism and depression at…

  6. The Relationship of Perfectionism, Depression, and Therapeutic Alliance during Treatment for Depression: Latent Difference Score Analysis

    ERIC Educational Resources Information Center

    Hawley, Lance L.; Ho, Moon-Ho Ringo; Zuroff, David C.; Blatt, Sidney J.

    2006-01-01

    The authors examined the longitudinal relationship of patient-rated perfectionism, clinician-rated depression, and observer-rated therapeutic alliance using the latent difference score (LDS) analytic framework. Outpatients involved in the Treatment for Depression Collaborative Research Program completed measures of perfectionism and depression at…

  7. 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.

  8. The Therapeutic Alliance in Adolescent Substance Abuse Treatment: A One-with-Many Analysis

    ERIC Educational Resources Information Center

    Marcus, David K.; Kashy, Deborah A.; Wintersteen, Matthew B.; Diamond, Guy S.

    2011-01-01

    Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398…

  9. Clients' and therapists' views of the therapeutic alliance: similarities, differences and relationship to therapy outcome.

    PubMed

    Bachelor, Alexandra

    2013-01-01

    To better understand how clients' and therapists' views of the therapeutic alliance differ and overlap, this study investigated, first, the components of the alliance that are relevant to the therapy participants; second, their relationship to post-therapy outcome; and third, the relationships between participants' alliance constructs. To identify participants' views, exploratory factor analyses were performed on clients' (n = 176) and therapists' (n = 133 observations) ratings of the Working Alliance Inventory (short form), the Helping Alliance Questionnaire and the California Psychotherapy Alliance Scales and conducted both on each measure separately and on the three measures combined. The results of the separate analyses indicated in general poor correspondence between the participant-derived components and each measure's a priori constructs. Results of the joint analyses suggested that clients view the alliance in terms of six basic components (Collaborative Work Relationship, Productive Work, Active Commitment, Bond, Non-disagreement on Goals/Tasks and Confident Progress), five of which were found to predict client-rated and/or therapist-rated post-therapy outcome. Results for therapists suggested four basic components (Collaborative Work Relationship, Therapist Confidence & Dedication, Client Commitment & Confidence, Client Working Ability), of which three predicted post-therapy outcome. Findings of significant, but modest to low moderate, correlations between several client and therapist joint factors suggested that despite similarities, the therapy partners' views of the alliance differ in important ways. Compared with therapists, clients appear to place greater emphasis on helpfulness, joint participation in the work of therapy and negative signs of the alliance. Implications of these findings are discussed. Therapists should not assume that their views of the therapeutic relationship and therapeutic work are shared by their clients and are encouraged to

  10. Improving the therapeutic relationship in inpatient psychiatric care: Assessment of the therapeutic alliance and empathy after implementing evidence-based practices resulting from participatory action research.

    PubMed

    Moreno-Poyato, Antonio R; Delgado-Hito, Pilar; Suárez-Pérez, Raquel; Lluch-Canut, Teresa; Roldán-Merino, Juan F; Montesó-Curto, Pilar

    2017-09-13

    To examine how evidence about the therapeutic alliance gleaned from participatory action project affected the level of this alliance and the degree of empathy of psychiatric nurses. Quasi-experimental study in two psychiatric units. In one group, evidence-based practices that affected the therapeutic alliance were implemented; in the comparison group, there was no such intervention. The nurses from the intervention group improved their degree of empathy and factors such as agreement on objectives and tasks with the patient. The results confirm the possibility of measuring and improving the therapeutic relationship in psychiatric care. © 2017 Wiley Periodicals, Inc.

  11. Within treatment therapeutic alliance ratings profiles predict posttreatment frequency of alcohol use.

    PubMed

    Prince, Mark A; Connors, Gerard J; Maisto, Stephen A; Dearing, Ronda L

    2016-03-01

    Although past research has demonstrated a positive relationship between the therapeutic alliance (TA) and improved drinking outcomes, specific aspects of the alliance have received less attention. In this study, we examined the association between alliance characteristics during treatment and 4-month follow-up drinking reports. Sixty-five treatment-seeking alcohol dependent clients who participated in 12 weeks of individual outpatient treatment provided weekly TA ratings during treatment and reported on pretreatment, during treatment, and posttreatment alcohol use. Latent profile analysis was conducted to discern distinct profiles of client and therapist ratings of therapeutic alliance with similar alliance characteristics. TA profiles were based on clients' and therapists' mean alliance rating, minimum alliance rating, maximum alliance rating, the range of alliance ratings, and the difference in session number between maximum and minimum alliance ratings. One- through 4-class models were fit to the data. Model fit was judged by comparative fit indices, substantive interpretability, and parsimony. Wald tests of mean equality determined whether classes differed on follow-up percentage of days abstinent (PDA) at 4-months posttreatment. Three-profile solutions provided the best fit for both client and therapist ratings of the therapeutic alliance. Client alliance rating profiles predicted drinking in the follow-up period, but therapist rating profiles did not. These results suggest that distinct profiles of the therapeutic alliance can be identified and that client alliance rating profiles are associated with frequency of alcohol use following outpatient treatment.

  12. Within treatment therapeutic alliance ratings profiles predict posttreatment frequency of alcohol use

    PubMed Central

    Prince, Mark A.; Connors, Gerard J.; Maisto, Stephen A.; Dearing, Ronda L.

    2016-01-01

    While past research has demonstrated a positive relationship between the therapeutic alliance (TA) and improved drinking outcomes, specific aspects of the alliance have received less attention. In this study, we examined the association between alliance characteristics during treatment and 4-month follow-up drinking reports. 65 treatment-seeking alcohol dependent clients who participated in 12 weeks of individual outpatient treatment provided weekly TA ratings during treatment and reported on pre-treatment, during treatment, and post-treatment alcohol use. Latent profile analysis was conducted to discern distinct profiles of client and therapist ratings of therapeutic alliance with similar alliance characteristics. TA profiles were based on clients’ and therapists’ mean alliance rating, minimum alliance rating, maximum alliance rating, the range of alliance ratings, and the difference in session number between maximum and minimum alliance ratings. 1- through 4- class models were fit to the data. Model fit was judged by comparative fit indices, substantive interpretability, and parsimony. Wald tests of mean equality determined whether classes differed on follow-up percentage of days abstinent (PDA) at 4 months posttreatment. 3-profile solutions provided the best fit for both client and therapist ratings of the therapeutic alliance. Client alliance rating profiles predicted drinking in the follow-up period, but therapist rating profiles did not. These results suggest that distinct profiles of the therapeutic alliance can be identified and that client alliance rating profiles are associated with frequency of alcohol use following outpatient treatment. PMID:26999350

  13. Interpersonal predictors of early therapeutic alliance in a transdiagnostic cognitive-behavioral treatment for adolescents with anxiety and depression.

    PubMed

    Levin, Laura; Henderson, Heather A; Ehrenreich-May, Jill

    2012-06-01

    The importance of therapeutic alliance in predicting treatment success is well established, but less is known about client characteristics that predict alliance. This study examined alliance predictors in adolescents with anxiety and/or depressive disorders (n=31) who received a transdiagnostic cognitive-behavioral treatment, the Unified Protocol for the Treatment of Emotional Disorders in Youth (Ehrenreich, Buzzella, Trosper, Bennett, & Barlow, 2008) in the context of a larger randomized controlled trial. Alliance was assessed at session three by therapists, clients, and independent observers. Results indicated that alliance ratings across the three informant perspectives were significantly associated with one another, but that pretreatment interpersonal variables (e.g., social support, attachment security, and social functioning in current family and peer relationships) were differentially associated with varying informant perspectives. Adolescent and observer ratings of alliance were both predicted by adolescent self-reports on measures reflecting how they perceive their interpersonal relationships. In addition, adolescent-reported symptom severity at pretreatment predicted observer ratings of alliance such that adolescents who indicated greater anxiety and depressive symptoms were rated as having stronger early alliances by independent observers. Therapists perceived having weaker early alliances with adolescents evidencing clinically significant depression at intake as compared with adolescents diagnosed with anxiety disorders alone. Future research is needed to examine whether identification of relevant interpersonal factors at intake can help improve initial therapeutic engagement and resulting outcomes for the psychosocial treatment of adolescents with anxiety and depressive disorders.

  14. Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy

    PubMed Central

    Joyce, Anthony S.; Piper, William E.

    1998-01-01

    Patient and therapist expectancies regarding the “typical session” were measured during a controlled trial of short-term, time-limited individual psychotherapy. Relationships between expectancy ratings and measures of the therapeutic alliance and treatment outcome were examined. Significant relationships were tested in the presence of a competing predictor variable, either pre-therapy disturbance (depression) or the patient's quality of object relations (QOR). Expectancies were associated strongly with the alliance but only moderately with treatment outcome. In most instances, expectancy and QOR combined in an additive fashion to account for variation in alliance or outcome. The patient's capacity for mature relationships and expectancies for therapy appear to be important determinants of treatment process and outcome. The clinical value of establishing accurate, moderate expectancies prior to therapy is considered.(The Journal of Psychotherapy Practice and Research 1998; 7:236–248) PMID:9631345

  15. Early Therapeutic Alliance, Treatment Retention, and 12-Month Outcomes in a Healthy Lifestyles Intervention for People with Psychotic Disorders.

    PubMed

    Andrews, Michelle; Baker, Amanda L; Halpin, Sean A; Lewin, Terry J; Richmond, Robyn; Kay-Lambkin, Frances J; Filia, Sacha L; Castle, David; Williams, Jill M; Clark, Vanessa; Callister, Robin

    2016-12-01

    Engaging and retaining individuals with psychotic disorders in psychosocial treatments is difficult. Early therapeutic alliance, treatment retention, and 12-month outcomes were examined in a subsample of smokers with a psychotic disorder (N = 178) participating in a healthy lifestyles study comparing a telephone versus face-to-face delivered intervention. Therapeutic alliance was assessed using the Agnew Relationship Measure; primary outcomes were treatment retention and changes in symptoms and health behaviors. Contrary to expectations, early alliance did not predict treatment retention. However, elements of both client- and therapist-rated alliance predicted some clinical outcomes (e.g., higher confidence in the therapeutic alliance at session 1 predicted improvements in 12-month depression). Some modest interactions between early alliance and intervention condition were also identified (e.g., clients initially with lower self-perceived initiative, or higher therapist-perceived bonding benefited preferentially from the telephone-delivered intervention), highlighting the need to further examine the interplay between therapeutic alliance and treatment modality.

  16. 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…

  17. 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…

  18. 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…

  19. 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.…

  20. 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…

  1. 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…

  2. Therapeutic Alliance, Subsequent Change, and Moderators of the Alliance-Outcome Association in Interpersonal Psychotherapy for Depression.

    PubMed

    Constantino, Michael J; Coyne, Alice E; Luukko, Emily K; Newkirk, Katie; Bernecker, Samantha L; Ravitz, Paula; McBride, Carolina

    2017-02-09

    The therapeutic alliance has historically emerged as a pantheoretical correlate of favorable psychotherapy outcomes. However, uncertainty remains about the direction of the alliance-outcome link, and whether it is affected by other contextual variables. The present study explored (a) if early alliance quality predicted subsequent symptom change while controlling for the effect of prior symptom change in interpersonal psychotherapy (IPT) for depression, and (b) whether baseline patient characteristics moderated the alliance-outcome relation (to help specify conditions under which alliance predicts change). Data derived from an open trial of 16 sessions of individual IPT delivered naturalistically to adult outpatients (N = 119) meeting criteria for major depression. Patients rated their sociodemographic, clinical, and interpersonal characteristics at baseline, their alliance with their therapist at Session 3, and their depressive symptoms at baseline, after every session, and at posttreatment. Data were analyzed using hierarchical linear modeling. Results indicated that alliance quality did not predict subsequent depression change, controlling for prior depression change. However, a significant education by alliance interaction emerged in predicting quadratic depression change (γ = .0007, p = .03); patients with higher levels of education who reported good early alliances with their therapists had the most positively accelerated change trajectory (i.e., faster depression reduction), whereas patients with higher levels of education who reported poorer early alliances had the most negatively accelerated change trajectory (i.e., slower depression reduction). The findings may help clarify a specific condition under which alliance quality influences subsequent improvement in an evidence-based treatment for depression. (PsycINFO Database Record

  3. The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting: A mixed-methods study.

    PubMed

    Zugai, Joel S; Stein-Parbury, Jane; Roche, Michael

    2017-07-05

    To develop a greater understanding of the nature of the inpatient therapeutic alliance between nurses and consumers with Anorexia Nervosa (AN). Consumers with AN value interpersonal relationships with nurses, finding these relationships meaningful and therapeutic. It is established that the therapeutic alliance enhances outcomes for consumers with AN. However, establishing the therapeutic alliance in the inpatient setting is considered challenging. This study employed a two-phase mixed-method explanatory sequential design. An initial quantitative survey, phase one, was followed by the collection and analysis of qualitative data, phase two. Phase one employed validated survey instruments, measuring the perceived degree of therapeutic alliance and elements of ward milieu. Phase two involved semi-structured interviews that focused on therapeutic relationships between nurses and consumers, with specific exploration of the results from phase one. Data collection commenced May 2014 and concluded February 2015. The therapeutic alliance involved interpersonal engagement and a balanced application of authority. In a therapeutic alliance, nurses cared for consumers with interpersonal finesse, whilst maintaining clear distinction between the consumer as an individual and AN as an illness. Nurses also developed a therapeutic alliance by occupying their position of power with consistent yet individualised expectations and by maintaining appropriate professional boundaries. The therapeutic alliance between nurses and consumers with AN is not developed through negotiation of equal partners. Rather, the therapeutic alliance is dependent on nurses' capacity to maintain their position of power, whilst demonstrating their trustworthiness to the consumer. In trusting nurses, consumers felt safer in investing in a new concept of well-being. By understanding the nature of the therapeutic alliance as it is described in this study, nurses have an enhanced capacity to develop effective

  4. 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

  5. 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.

  6. 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…

  7. 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…

  8. 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…

  9. 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…

  10. Enhancing therapeutic impact and therapeutic alliance through electronic mail homework assignments.

    PubMed

    Murdoch, J W; Connor-Greene, P A

    2000-01-01

    Homework assignments can enhance therapeutic impact and increase therapy effectiveness by encouraging patients to focus on therapy-related issues between sessions. Computer technology provides a new avenue for reporting, monitoring, and feedback of patient homework assignments through electronic mail (e-mail). In two case examples, e-mail was used as an extension of therapy to enhance patient involvement in treatment. In both cases, patient reports suggest that therapeutic alliance and therapeutic impact improved with the use of e-mail homework reporting. The costs and benefits of the use of e-mail as an adjunct to therapy are discussed.

  11. Enhancing Therapeutic Impact and Therapeutic Alliance Through Electronic Mail Homework Assignments

    PubMed Central

    Murdoch, Janice W.; Connor-Greene, Patricia A.

    2000-01-01

    Homework assignments can enhance therapeutic impact and increase therapy effectiveness by encouraging patients to focus on therapy-related issues between sessions. Computer technology provides a new avenue for reporting, monitoring, and feedback of patient homework assignments through electronic mail (e- mail). In two case examples, e-mail was used as an extension of therapy to enhance patient involvement in treatment. In both cases, patient reports suggest that therapeutic alliance and therapeutic impact improved with the use of e-mail homework reporting. The costs and benefits of the use of e-mail as an adjunct to therapy are discussed. PMID:11069136

  12. The impact of shame on the therapeutic alliance and intimate relationships.

    PubMed

    Black, Rebecca S A; Curran, David; Dyer, Kevin F W

    2013-06-01

    This study examined the role of shame coping styles and state shame in predicting the therapeutic alliance and intimate relationship functioning in individuals with mental health problems. A sample of 50 treatment-receiving adults aged 21 to 67 years with a mix of common mental health difficulties was recruited from a clinical psychology service. Participants were given questionnaire measures of shame states, shame coping styles, intimate relationship functioning, and the therapeutic alliance. Regression analyses indicated that the shame coping strategy of physical and psychological withdrawal was the primary risk factor for development of a less effective therapeutic alliance. Both withdrawal and attack self coping styles were significant predictors of impaired intimate relationship functioning. These findings have implications for the theoretical role of shame in mental health presentations as well as the potential for internalizing shame coping styles (i.e., withdrawal, attack self) to act as a barrier to successful therapy and interpersonal relationships. The inclusion of shame-focused assessments and interventions in the initial stages of treatment with clients exhibiting these strategies could improve prognosis. © 2013 Wiley Periodicals, Inc.

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

    PubMed Central

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

    2010-01-01

    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 outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations. PMID:16551149

  14. Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression.

    PubMed

    Constantino, Michael J; Schwaiger, Elizabeth M; Smith, Julianna Z; DeGeorge, Joan; McBride, Carolina; Ravitz, Paula; Zuroff, David C

    2010-09-01

    The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only.

  15. Adolescent and parent therapeutic alliances as predictors of dropout in multidimensional family therapy.

    PubMed

    Robbins, Michael S; Liddle, Howard A; Turner, Charles W; Dakof, Gayle A; Alexander, James F; Kogan, Steven M

    2006-03-01

    The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response. Copyright 2006 APA, all rights reserved.

  16. The relationship of therapeutic alliance and treatment delivery fidelity with treatment retention in a multisite trial of twelve-step facilitation.

    PubMed

    Campbell, Barbara K; Guydish, Joseph; Le, Thao; Wells, Elizabeth A; McCarty, Dennis

    2015-03-01

    This study examined associations of therapeutic alliance and treatment delivery fidelity with treatment retention in Stimulant Abusers to Engage in Twelve-Step (STAGE-12), a community-based trial of 12-Step Facilitation (TSF) conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN). The STAGE-12 trial randomized 234 stimulant abusers enrolled in 10 outpatient drug treatment programs to an eight-session, group and individual TSF intervention. During the study, TSF participants rated therapeutic alliance using the Helping Alliance questionnaire-II. After the study, independent raters evaluated treatment delivery fidelity of all TSF sessions on adherence, competence, and therapist empathy. Poisson regression modeling examined relationships of treatment delivery fidelity and therapeutic alliance with treatment retention (measured by number of sessions attended) for 174 participants with complete fidelity and alliance data. Therapeutic alliance (p = .005) and therapist competence (p = .010) were significantly associated with better treatment retention. Therapist adherence was associated with poorer retention in a nonsignificant trend (p = .061). In conclusion, stronger therapeutic alliance and higher therapist competence in the delivery of a TSF intervention were associated with better treatment retention whereas treatment adherence was not. Training and fidelity monitoring of TSF should focus on general therapist skills and therapeutic alliance development to maximize treatment retention. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  17. Institutional therapeutic alliance and its relationship with outcomes in a psychiatric day hospital program.

    PubMed

    Pulido, Ricardo; Monari, Marco; Rossi, Nicolino

    2008-10-01

    The article shows the results of a longitudinal study aimed to explore the institutional therapeutic alliance (ITA) that is the alliance formed by a patient and all the therapeutic staff. Fifty five patients who have psychiatric disorders in partial hospitalization were evaluated at admission (global functional level, social support, symptomatic condition, and treatment expectancies), at discharge, and after 3 months. ITA was assessed after 1 week of treatment and at discharge, from patient's and staff's perspectives. Preliminary findings suggest that the ITA represents a specific phenomenon different from the classical therapeutic alliance (patienttherapist), which would be particularly relevant for the treatment of patients who are severely disturbed.

  18. Ethnic background, therapeutic alliance, and treatment retention in functional family therapy with adolescents who abuse substances.

    PubMed

    Flicker, Sharon M; Turner, Charles W; Waldron, Holly B; Brody, Janet L; Ozechowski, Timothy J

    2008-02-01

    In this study, the authors examined the role of balance between adolescent-therapist and parent-therapist alliances in the retention of functional family therapy clients. Therapeutic alliances of mothers, fathers, and adolescents were assessed from videotapes of the 1st treatment session for 43 Hispanic and 43 Anglo families. Hispanic families who dropped out before completing the requisite number of sessions were found to have greater imbalance in alliance (parent-adolescent) than those who did complete therapy. However, this finding was not replicated with Anglo families. Results are interpreted in terms of previous research on family-level balanced alliance effects.

  19. A review of therapist characteristics and techniques positively impacting the therapeutic alliance.

    PubMed

    Ackerman, Steven J; Hilsenroth, Mark J

    2003-02-01

    The present review is a comprehensive examination of the therapist's personal attributes and in-session activities that positively influence the therapeutic alliance from a broad range of psychotherapy perspectives. Therapist's personal attributes such as being flexible, honest, respectful, trustworthy, confident, warm, interested, and open were found to contribute positively to the alliance. Therapist techniques such as exploration, reflection, noting past therapy success, accurate interpretation, facilitating the expression of affect, and attending to the patient's experience were also found to contribute positively to the alliance. This review reveals how these therapist personal qualities and techniques have a positive influence on the identification or repair of ruptures in the alliance.

  20. 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.

  1. Dropout and therapeutic alliance: a meta-analysis of adult individual psychotherapy.

    PubMed

    Sharf, Jennie; Primavera, Louis H; Diener, Marc J

    2010-12-01

    This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed.

  2. 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.

  3. Building a therapeutic alliance in brief therapy: the experience of community mental health nurses.

    PubMed

    Spiers, Judith A; Wood, Ava

    2010-12-01

    Current mental health trends in brief therapy require a new understanding of the nurse--client relationship. This qualitative focused ethnography explored the perceptions and actions of community mental health nurses in building a therapeutic alliance in the context of brief therapy and the factors that facilitate or impede its development. Informants were 11 nurses with at least 3 years of experience in community mental health nursing primarily providing brief therapy or consulting practice. Participants described therapeutic alliance as the point at which the clients recognize that the nurse is fully attuned to "being in the moment" as they connect to their own issues in a positive way. Building an alliance consisted of three nonlinear overlapping phases: "establishing mutuality," "finding the fit in reciprocal exchange," and "activating the power of the client." Implications include recommendations to enhance intentional alliance building and directions for further research to explore differing world views among nurses on alliance formation within the context of brief therapy and consultations.

  4. Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa

    PubMed Central

    2013-01-01

    Background Anorexia nervosa (AN) is associated with high rates of chronicity and relapse risk is a considerable therapeutic challenge in the disorder. The aim of the present study was to investigate the association of stages of change and outcome with a focus on the relapse struggle in the maintenance stage in patients with predominantly chronic AN. Further, therapeutic alliance and stages of change associations were explored. Methods As an instrument measuring relapse struggle in the maintenance stage, we applied the short form of the University of Rhode Island Change Assessment-Short (URICA-S). We assessed stages of change in 39 patients with a predominantly chronic course of AN in early, middle, and late stages of inpatient psychotherapy. General symptom severity as assessed by the SCL-90-R and weight change were investigated as outcome measures. Results In-line with earlier evidence, contemplation significantly predicted therapeutic alliance. Further, we demonstrated that relapse risk as operationalized by URICA-S maintenance is an important predictor of general psychopathology. BMI change was not predicted by stages of change. Conclusions The URICA-S maintenance scale might be applied to help identify patients at relapse risk. High URICA-S maintenance scores could be considered as one critical aspect of AN patients who might especially benefit from relapse-preventing aftercare programs. PMID:23570454

  5. Predictors of mental health care stigma and its association with the therapeutic alliance during the initial intake session.

    PubMed

    Nakash, Ora; Nagar, Maayan; Levav, Itzhak

    2015-01-01

    We investigated the association between socio-demographic and clinical variables with mental health care stigma, and the impact of the latter on the quality of the therapeutic alliance measured at intake. Consecutive clients (N = 236) filled questionnaires upon accessing services for a new episode of care. Immediately following the intake, a randomly selected sample of clients and their corresponding therapists (n = 102) completed the Working Alliance Inventory - Bond Scale. Lower mean years of education and higher emotional distress (both partial r = .17) were significantly associated with higher stigma. Higher care stigma negatively correlated with therapists' ratings of the therapeutic alliance during the intake (partial r = -.22), but not with those of clients. Care stigma is present among service-users and may affect outcomes of the intake.

  6. 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.

  7. Relationship between aggression, interpersonal style, and therapeutic alliance during short-term psychiatric hospitalization.

    PubMed

    Cookson, Amy; Daffern, Michael; Foley, Fiona

    2012-02-01

    Aggression during psychiatric hospitalization is frequent, problematic, and a major challenge for nurses and mental health services more generally. The strength of the therapeutic alliance between nursing staff and patients has been posited as an important protective factor that can limit the likelihood of aggression. This study examined the relationship between interpersonal style, perceived coercion, and psychiatric symptoms on the therapeutic alliance between patients and staff, and how each, in turn, is related to aggression. Participants in this study were 79 patients admitted to an acute psychiatric hospital. Each participant was interviewed to determine perceived coercion, symptoms of psychiatric illness, interpersonal style, and therapeutic alliance. Incidents of aggression were recorded at discharge through a review of incident forms, file review, and interviews with unit nursing staff. The results showed that a hostile-dominant interpersonal style and symptoms of paranoia predicted poor therapeutic alliance, contributing 14% of the variance in therapeutic alliance scores. A dominant interpersonal style predicted aggression towards staff. Therapeutic alliance, perceived coercion, and symptoms of psychiatric illness did not predict aggression. Implications for engagement in treatment and the prevention of aggression are discussed.

  8. 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.

  9. 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.

  10. Therapeutic Alliance during Prolonged Exposure Versus Client-Centered Therapy for Adolescent Posttraumatic Stress Disorder.

    PubMed

    Capaldi, Sandra; Asnaani, Anu; Zandberg, Laurie J; Carpenter, Joseph K; Foa, Edna B

    2016-10-01

    To examine the relationship between improvements in adolescent ratings of therapeutic alliance and reductions in posttraumatic stress disorder (PTSD) severity over time among adolescent girls during prolonged exposure therapy for adolescents (PE-A) versus client-centered therapy (CCT), as well as to examine differences in changes in alliance between treatment groups. A total of 61 adolescent girls (aged 13-18 years) with sexual assault-related PTSD received PE-A or CCT in a randomized controlled trial. Participants rated alliance at session 3, midtreatment, and posttreatment. The rate of improvement in adolescent-rated alliance was greater in PE-A than CCT over the course of treatment. In addition, improvement in adolescent-rated alliance significantly contributed to improvements in PTSD (regardless of treatment condition), but not vice versa. Contrary to beliefs that trauma-focused treatments fail to establish strong therapeutic alliance in sexually abused adolescents, improvement in adolescent ratings of alliance were greater in PE-A compared to CCT, and improvements in adolescent-rated alliance were significantly associated with better treatment outcome across both types of treatments. © 2016 Wiley Periodicals, Inc.

  11. 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…

  12. Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: probably necessary but definitely insufficient.

    PubMed

    Raykos, Bronwyn C; McEvoy, Peter M; Erceg-Hurn, David; Byrne, Susan M; Fursland, Anthea; Nathan, Paula

    2014-06-01

    The present paper assessed therapeutic alliance over the course of Enhanced Cognitive Behavioural Therapy (CBT-E) in a community-based sample of 112 patients with a diagnosis of bulimia nervosa (BN) or atypical BN. Temporal assessment of alliance was conducted at three time points (the start, middle and end of treatment) and the relationship between alliance and treatment retention and outcome was explored. Results indicated that the alliance between patient and therapist was strong at all stages of CBT-E, and even improved in the early stages of treatment when behaviour change was initiated (weekly in-session weighing, establishing regular eating, and ceasing binge-eating and compensatory behaviours). The present study found no evidence that alliance was related to treatment retention or outcomes, or that symptom severity or problematic interpersonal styles interacted with alliance to influence outcomes. Alliance was also unrelated to baseline emotional or interpersonal difficulties. The study provides no evidence that alliance has clinical utility for the prediction of treatment retention or outcome in CBT-E for BN, even for individuals with severe symptoms or problematic interpersonal styles. Early symptom change was the best predictor of outcome in CBT-E. Further research is needed to determine whether these results are generalizable to patients with anorexia nervosa.

  13. The Role of Psychopathic Traits in the Development of the Therapeutic Alliance Among Sexual Offenders.

    PubMed

    Walton, Ashleigh; Jeglic, Elizabeth L; Blasko, Brandy L

    2016-03-21

    There is a growing body of research demonstrating that the therapeutic alliance (TA) affects outcomes among specialized forensic populations, including sexual offenders. Despite this consensus, researchers continue to question whether higher levels of psychopathic traits are conducive to the formation of a therapeutic relationship for high-risk sexual offenders. Thus, the current study adds to the literature by examining the relationship between the TA and levels of psychopathy among a sample of incarcerated sexual offenders participating in sexual offender treatment. Overall, we found no significant relationships between Psychopathy Checklist-Revised (PCL-R) scores and the Working Alliance Inventory (WAI) for either client or therapist ratings. However, when we excluded those offenders who were participating in aftercare, a significant negative relationship was found between client ratings of the Bonds subscale and PCL-R total scores. Next, after controlling for risk and group status (aftercare/non-aftercare), we found no significant differences between either client or therapist total WAI scores when compared by level of psychopathy as measured by the PCL-R (low, >20; moderate, 20-30; and high, >30). Furthermore, when Factor 1 and Factor 2 scores of the PCL-R were examined individually, neither factor significantly predicted either client or therapist total WAI score after controlling for risk and group status. Findings are discussed as they pertain to the treatment of sexual offenders with elevated levels of psychopathic traits.

  14. Therapeutic Alliance Building During the Child Psychiatric Intake: Does VTC Make a Difference?

    DTIC Science & Technology

    2012-05-01

    Cozza, MC USA (Ret.)‡ ABSTRACT This study examined potential changes in perceptions of therapeutic (“working”) alliance during a child’s initial...FTF encounter relative to a VTC intervention. Participants were recruited and enrolled in two study cohorts between August 2000 and October 2005...alliance are stronger than they were before intake for those conducted in an FTF format as well as through VTC. INTRODUCTION Between 10% and 20% of all

  15. Therapeutic Alliance With a Fully Automated Mobile Phone and Web-Based Intervention: Secondary Analysis of a Randomized Controlled Trial

    PubMed Central

    Parker, Gordon; Manicavasagar, Vijaya; Hadzi-Pavlovic, Dusan; Fogarty, Andrea

    2016-01-01

    Background Studies of Internet-delivered psychotherapies suggest that clients report development of a therapeutic alliance in the Internet environment. Because a majority of the interventions studied to date have been therapist-assisted to some degree, it remains unclear whether a therapeutic alliance can develop within the context of an Internet-delivered self-guided intervention with no therapist support, and whether this has consequences for program outcomes. Objective This study reports findings of a secondary analysis of data from 90 participants with mild-to-moderate depression, anxiety, and/or stress who used a fully automated mobile phone and Web-based cognitive behavior therapy (CBT) intervention called “myCompass” in a recent randomized controlled trial (RCT). Methods Symptoms, functioning, and positive well-being were assessed at baseline and post-intervention using the Depression, Anxiety and Stress Scale (DASS), the Work and Social Adjustment Scale (WSAS), and the Mental Health Continuum-Short Form (MHC-SF). Therapeutic alliance was measured at post-intervention using the Agnew Relationship Measure (ARM), and this was supplemented with qualitative data obtained from 16 participant interviews. Extent of participant engagement with the program was also assessed. Results Mean ratings on the ARM subscales were above the neutral midpoints, and the interviewees provided rich detail of a meaningful and collaborative therapeutic relationship with the myCompass program. Whereas scores on the ARM subscales did not correlate with treatment outcomes, participants’ ratings of the quality of their emotional connection with the program correlated significantly and positively with program logins, frequency of self-monitoring, and number of treatment modules completed (r values between .32-.38, P≤.002). The alliance (ARM) subscales measuring perceived empowerment (r=.26, P=.02) and perceived freedom to self-disclose (r=.25, P=.04) also correlated significantly

  16. 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.

  17. 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…

  18. 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…

  19. 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.

  20. Relationship Between Patient SWAP-200 Personality Characteristics and Therapist-Rated Therapeutic Alliance Early in Treatment.

    PubMed

    Smith, Scott W; Levy, Saryn R; Hilsenroth, Mark J; Fiori, Katherine; Bornstein, Robert F

    2016-06-01

    In the present study, we assess the extent to which patient personality features and prototypes are associated with early treatment therapist-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic. Clinicians completed the Working Alliance Inventory (J Couns Psychol 36:223-233; Psychother Res 9:405-423) to assess their views of early alliance and the Shedler-Westen Assessment Procedure 200 (SWAP-200; Assessment 5:333-353, Am J Psychiatry 161:1350-1365, 1743-1754; Am J Psychiatry 156:258-272, 273-285) to assess patient personality. The SWAP-200 Narcissistic Clinical Prototype, Dysphoric Q-Factor, and Dysphoric/High-Functioning Neurotic Q-Subfactor significantly correlated with early therapist-rated alliance. Correlations that trended toward significance were also found. Also identified were specific SWAP-200 items that were found to relate to high early therapist-rated alliance scores. These results demonstrate some relationship, albeit small, between patient personality characteristics and therapists' views of the alliance that may serve to further a conceptual understanding of the alliance, specific personality syndromes, and the associated impact on the therapeutic interaction.

  1. 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.

  2. New Developments of the Therapeutic Alliance (TA): Good News for Psychodynamic Psychiatry.

    PubMed

    Auchincloss, Elizabeth L

    2016-03-01

    Clinicians have long known that successful psychotherapy, including successful psychodynamic psychotherapy, depends upon the interaction between therapist and patient. In other words, it is important to have a strong therapeutic alliance. This article presents the history of the concept of the therapeutic alliance (TA). It also explores three areas of research that have bearing on the TA. The importance of the TA and the extensive research work that pertains to it hold promise for psychodynamic psychiatry, both in terms of understanding, and in the treatment of mental suffering.

  3. 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.

  4. 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

  5. Therapeutic alliance and improvements in work performance over time in patients with schizophrenia.

    PubMed

    Davis, Louanne W; Lysaker, Paul H

    2007-04-01

    While therapeutic alliance (TA) in schizophrenia has been linked with treatment adherence and outcome, less is known about its relationship to rehabilitation outcome. To examine this issue, we classified persons who had been enrolled in a rehabilitation study as having higher or lower levels of TA based on an observer assessment midway through treatment and compared their work performance at weeks 1, 11, and 23. Repeated measures analysis of variance found group effects for Work Quality and Personal Presentation with the higher TA group having better overall performance on both. Time effects were found for Work Quality and Personal Presentation with the sample overall showing improvement over the course of rehabilitation. Interactions were found for Cooperativeness and Work Quality with the higher TA group showing steady increases, whereas the lower TA group showed initial improvement followed by a decline. Results suggest that forming a strong TA may enhance rehabilitation among persons with schizophrenia.

  6. Relationships among client-therapist personality congruence, working alliance, and therapeutic outcome.

    PubMed

    Taber, Brian J; Leibert, Todd W; Agaskar, Vaibhavee R

    2011-12-01

    Despite the importance of the working alliance in therapeutic outcome, little is known about the factors associated with its formation. We advance that personality similarity between client and therapist is one such factor pertinent to the working alliance. In this study, personality similarity in 32 client-therapist dyads was examined for its relations to the bond, task, and goal elements of the working alliance (Bordin, 1979, Psychotherapy: Theory, Research, and Practice, 16, 252-260) and therapeutic outcome. Personality similarity was conceptualized using Holland's (1997, Making vocational choices [3rd ed.]) congruence construct. Therapists completed the Self-Directed Search pretreatment and clients completed the Working Alliance Inventory-Short Revised and Self-Directed Search after the third session. Results indicated that (a) client-therapist personality congruence was associated with the bond, (b) bond was associated with task and goal, and (c) task and goal were associated with therapeutic outcome. Congruence was not associated with task, goal, or therapeutic outcome. Holland's theory provides a framework for adapting to clients of varying personality types. By understanding how client-therapist personalities relate to each other in therapy, client-therapist bonds may be more efficiently realized.

  7. 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,…

  8. Effect of shared decision-making on therapeutic alliance in addiction health care

    PubMed Central

    Joosten, EAG; de Weert, GH; Sensky, T; van der Staak, CPF; de Jong, CAJ

    2008-01-01

    Background In recent decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to examine the effect of a shared decision-making intervention (SDMI) for substance-dependent patients on patients’ and clinicians’ perceptions of therapeutic alliance. Methods Clinicians were randomly assigned to SDMI or usual procedures to reach a treatment agreement. SDMI is a structured, manualized, 5-session procedure to facilitate treatment agreement and consists of five standardized sessions. Results Patients’ perceptions of the therapeutic alliance were very favorable at start of treatment, and no differences were found between intervention groups. Clinicians’ scores on perceived helpfulness and on the overall therapeutic alliance were higher in the SDMI group than in the controls, after 8 weeks of treatment and at the end of treatment. Conclusion The present study has shown that a specific intervention to enhance shared decision-making results in favorable changes in clinicians’ perceptions of the therapeutic alliance. PMID:19920974

  9. 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…

  10. 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,…

  11. Therapeutic alliance building during the child psychiatric intake: does VTC make a difference?

    PubMed

    Penska, Keith; Michael, Robin; Messer, Stephen C; Smith, Ryan; Black, Nancy B; Cozza, Stephen

    2012-05-01

    This study examined potential changes in perceptions of therapeutic ("working") alliance during a child's initial diagnostic interview from the parent's perspective. The major study objective was to determine whether parental perceptions of alliance vary by group (video teleconferencing [VTC], face-to-face [FTF]) over time (Pre, Post intake). It was predicted that parental alliance would be more favorable after an FTF encounter relative to a VTC intervention. Participants were recruited and enrolled in two study cohorts between August 2000 and October 2005. Parents completed the Parental Perceptions of Alliance Questionnaire (PPAQ) immediately before (pre-PPAQ) and after (post-PPAQ) their interview. Analysis of variance (ANOVA) tests showed that the mean PPAQ scores of FTF groups being higher than that of VTC groups (controlling for time) was statistically significant, F (1,144) = 4.14, p = 0.04. However, upon further analysis, the interaction effect was not significant, F (1,144) = 1.20, p = 0.28. Findings from the current exploratory study suggest that, at least following an intake child psychiatric examination, parents' perceptions of therapeutic alliance are stronger than they were before intake for those conducted in an FTF format as well as through VTC.

  12. The influence of demand characteristics and social desirability on clients' ratings of the therapeutic alliance.

    PubMed

    Reese, Robert J; Gillaspy, J Arthur; Owen, Jesse J; Flora, Kevin L; Cunningham, Linda C; Archie, Danielle; Marsden, Troymichael

    2013-07-01

    To examine demand characteristics, social desirability on clients' rating of working alliance using the Session Rating Scale (SRS; Miller, Duncan, & Johnson, 2000). Clients (N = 102) at two sites were randomly assigned to one of three alliance feedback conditions: (a) IF--SRS completed in presence of therapist and the results discussed immediately afterward; (b) Next Session Feedback--SRS completed alone and results discussed next session; or (c) No Feedback--SRS completed alone and results not available to therapist. Clients completed the SRS for the first three sessions of treatment. No statistically significant differences in SRS scores across the feedback conditions were found. Additionally, the analysis showed that SRS scores were not correlated with a measure of social desirability but were correlated with an established alliance measure. The results indicate that alliance scores were not inflated due to the presence of a therapist or knowing that the scores would be observed by the therapist. © 2013 Wiley Periodicals, Inc.

  13. Case formulation and the therapeutic alliance in contemporary problem-solving therapy (PST).

    PubMed

    Nezu, Christine Maguth; Nezu, Arthur M; Colosimo, Meghan M

    2015-05-01

    In addition to providing psychoeducation and sharing clinical explanations and treatment goals, case formulation serves as a potential mechanism by which therapists may facilitate an alliance with their patients. This article illustrates how a case formulation shared with a patient early in the process of contemporary problem-solving therapy (PST) may yield both a road map to treatment and a means to build and adapt a therapeutic alliance based on patient attributes. We provide a description of a clinical case in which PST was carried out with a woman who, in the midst of alcohol recovery, experienced symptoms of anxiety, depression, and binge eating. © 2015 Wiley Periodicals, Inc.

  14. "Straight up": enhancing rapport and therapeutic alliance with previously-detained youth in the delivery of mental health services.

    PubMed

    Brown, James R; Holloway, Evan D; Akakpo, Tohoro F; Aalsma, Matthew C

    2014-02-01

    A strong therapeutic alliance has been shown to improve mental health treatment outcomes in adults, but this topic has not been fully explored with youth. Adolescents, particularly justice-involved youth, stand to benefit greatly from an improved treatment experience. One quality which can improve treatment is mental health providers' interpersonal skills when attempting to build a therapeutic rapport with adolescent clients. Semi-structured interviews were conducted with 19 youth who screened positive for mental health concerns while in juvenile detention. Four themes were identified as important to improving the therapeutic alliance: Empathy, client-directed care, sequencing, and positive rapport. Suggestions for strengthening a therapeutic alliance are provided.

  15. 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

  16. Interpersonal microprocesses predict cognitive-emotional processing and the therapeutic alliance in psychotherapy for depression.

    PubMed

    Altenstein, David; Krieger, Tobias; Grosse Holtforth, Martin

    2013-07-01

    Interpersonal theories of psychotherapy hypothesize that the success of therapy depends on the therapist's and patient's dominant and affiliative behaviors as well as their interplay (complementarity). This study sought to investigate (a) how in-session interpersonal microprocesses predict postsession evaluations of the therapeutic alliance as well as cognitive-emotional processing and (b) how complementarity develops over the course of a therapy session. Twenty depressed patients were treated at a university-based outpatient clinic with a variant of cognitive therapy. One session was analyzed from each therapy's middle phase using a novel real-time rating procedure (joystick method) to assess the patients' and therapists' affiliative and dominant behaviors as well as their resulting complementarity over the course of the session. The therapeutic alliance and cognitive-emotional processing were assessed by self-reports directly after the respective session. As predicted, more emotional arousal was associated with deviations from complementarity, whereas a positive alliance was related to affiliative patient behavior. Moreover, marginally significant trends suggest that refraining from answering to the pull of patient hostility might benefit both the alliance as well as cognitive-emotional processing. Overall, multilevel growth modeling revealed a significant cubic trend of complementarity over the course of the session. Implications for future research and practice are discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  17. 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…

  18. The Therapeutic Alliance in Cognitive-Behavioral Treatment of Children Referred for Oppositional, Aggressive, and Antisocial Behavior

    ERIC Educational Resources Information Center

    Kazdin, Alan E.; Marciano, Paul L.; Whitley, Moira K.

    2005-01-01

    The authors examined the therapeutic alliance in evidence-based treatment for children (N = 185, 47 girls, 138 boys; ages 3-14 years) referred clinically for oppositional, aggressive, and antisocial behavior. Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at 2 points over the course of…

  19. Valuing Clients' Perspective and the Effects on the Therapeutic Alliance: A Randomized Controlled Study of an Adjunctive Instruction

    ERIC Educational Resources Information Center

    Fluckiger, Christoph; Del Re, A. C.; Wampold, Bruce E.; Znoj, Hansjorg; Caspar, Franz; Jorg, Urs

    2012-01-01

    The patterns of growth and development of the therapeutic alliance over the course of therapy have been of continued interest to psychotherapy researchers. The purpose of this study was to investigate whether a simple institutional metacommunication intervention with clients had an effect on the development of the alliance. This adjunctive…

  20. Understanding Factors Associated with Early Therapeutic Alliance in PTSD Treatment: Adherence, Childhood Sexual Abuse History, and Social Support

    ERIC Educational Resources Information Center

    Keller, Stephanie M.; Zoellner, Lori A.; Feeny, Norah C.

    2010-01-01

    Objective: Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as…

  1. Understanding Factors Associated with Early Therapeutic Alliance in PTSD Treatment: Adherence, Childhood Sexual Abuse History, and Social Support

    ERIC Educational Resources Information Center

    Keller, Stephanie M.; Zoellner, Lori A.; Feeny, Norah C.

    2010-01-01

    Objective: Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as…

  2. Therapeutic Alliance in Patients With Schizophrenia: Introduction of a New Rating Instrument.

    PubMed

    Widschwendter, Christian G; Hofer, Alex; Baumgartner, Susanne; Edlinger, Monika; Kemmler, Georg; Rettenbacher, Maria A

    2016-07-01

    The quality of the patient-psychiatrist relationship can be seen as a cornerstone of adherence to medications in patients with chronic psychiatric disorders. Although therapeutic alliance in psychotherapy has been investigated broadly, it has received little attention in the context of medication adherence. The goal of this study was to develop and validate a user-friendly questionnaire for the assessment of therapeutic alliance in clinically stable outpatients with schizophrenia. The "Brief Questionnaire on Therapeutic Alliance" (BQTA) addresses both the physician and the patient, each of whom responds to 5 items that focus on important domains of the therapeutic alliance. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and patients' attitudes toward the illness and medication were assessed using the Drug Attitude Inventory (DAI). A total of 61 patients who met ICD-10 criteria for schizophrenia spectrum disorders and their treating psychiatrists were included in the study. Overall, patients and psychiatrists gave high (ie, favorable) ratings on all BQTA items. The 5 patient-related items showed high internal consistency (Cronbach α=0.77), whereas physician-related items showed slightly less internal consistency (Cronbach α=0.68). The concordance between patient and physician ratings was fair, although statistically significant (κ=0.33, P=0.007). Physicians' total score on the BQTA was moderately correlated with patients' PANSS total score and with the DAI total score and its compliance subscale, whereas patients' total score on the BQTA did not correlate with DAI or PANSS scores. The BQTA was found to cover crucial aspects of the doctor-patient relationship in chronically ill individuals with schizophrenia. Further validation will shed more light on the usefulness of this questionnaire.

  3. 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

  4. 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

  5. Interactive dynamics among therapist interventions, therapeutic alliance and metacognition in the early stages of the psychotherapeutic process.

    PubMed

    Locati, Francesca; Rossi, Germano; Parolin, Laura

    2017-04-19

    Several authors have identified a bidirectional link between patient metacognitive functioning and the therapeutic alliance. Specifically, metacognition might be enhanced by a positive alliance with the clinician, whereas metacognitive deficits might impede the alliance. Interestingly, the therapist's technical interventions might influence both therapeutic alliance and metacognitive functioning. However, little is known about the interactions between these dimensions. The aim of the present study is to explore these interactions more fully in the earliest phase of the therapeutic process. Participants included 24 patients and 12 therapists in training. The Metacognition Assessment Scale-Revised, Collaborative Interaction Scale, and Psychodynamic Intervention Rating Scale were employed in the first three sessions of psychotherapy. Sequential analyses revealed that different therapist interventions co-occurred with three different levels of the therapeutic alliance: A first level characterized by a positive collaboration, a second characterized by a neutral collaboration, and a third characterized by ruptures. Importantly, the patient's metacognitive functioning was found to mediate the relationship between the therapeutic intervention and the therapeutic alliance in the positive and neutral levels of collaboration but not in the ruptures one. These findings suggest that a specific interdependence exists among the therapeutic alliance, technical intervention, and metacognitive functioning. Clinical or methodological significance of this article: From a methodological standpoint, the originality of the present study lies in the combination of an interactionist approach, which conceives process factors as interrelated dimensions interacting in non-additive and often nonlinear ways, with analyses at both micro- and macro-analytic levels (i.e., sequential and mediation analyses). From a theoretical standpoint, findings of the present study indicate that specific

  6. Avoiding Emotional Bonds: An Examination of the Dimensions of Therapeutic Alliance Among Cannabis Users

    PubMed Central

    Healey, Alison; Kay-Lambkin, Frances; Bowman, Jenny; Childs, Steven

    2013-01-01

    There is a growing need to provide treatment for cannabis users, yet engaging and maintaining this population in treatment is particularly difficult. Although past research has focused on the importance of therapeutic alliance on drug treatment outcomes, this is the first study to examine the dimensions of therapeutic alliance for cannabis users compared with users of alcohol or other drugs in a naturalistic setting. The acceptability of Internet-delivered interventions for drug and alcohol treatments is also investigated. Participants (n = 77) included clients who were receiving outpatient drug and alcohol treatment at a publicly funded health service, including a Specialist Cannabis Clinic. The results indicated that one particular domain of alliance, Bond, was consistently lower, from both client and clinician perspectives, for current cannabis users relative to those not currently using cannabis. Client perceptions of Bond decreased as the severity of cannabis use increased (r = −0.373, p = 0.02). Cannabis Clinic clients did not report a significantly lower Bond with their clinicians, suggesting that specialized cannabis services may be better placed to provide appropriate treatment for this population than embedding cannabis treatment within traditional drug and alcohol treatment teams. In addition, Internet/computer-based treatments may be one potential way to engage, transition, or retain cannabis users in treatment. PMID:23885242

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. Client and therapist therapeutic alliance, session evaluation, and client reliable change: a moderated actor-partner interdependence model.

    PubMed

    Kivlighan, Dennis M; Marmarosh, Cheri L; Hilsenroth, Mark J

    2014-01-01

    Actor-partner interdependence modeling (APIM; Kashy & Kenny, 2000) was used to study the early therapeutic alliance in 74 clients being treated by 29 therapists to explore the relationship between the alliance and treatment progress, while prioritizing the dyadic nature of the alliance. The APIM examines collaboration/influence by modeling the impact of one dyad member's alliance ratings on the other member's session impact rating (partner effects). In terms of the alliance, the results revealed significant client-actor effects for client ratings of session depth and positivity as well as significant therapist-actor effects for therapist ratings of session smoothness and positivity. For client-rated alliance, there were also significant client-partner effects for therapist ratings of session depth. For clients who made a reliable change in treatment, an increase in client-reported alliance was related to therapist reporting more arousal in the 3rd session. For clients who did not make a reliable change in treatment, client-reported alliance was not related to therapist arousal. Limitations of the study and implications of the findings are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  12. 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

  13. Patients' pre-treatment interpersonal problems as predictors of therapeutic alliance in long-term psychodynamic psychotherapy.

    PubMed

    Ollila, Pekka; Knekt, Paul; Heinonen, Erkki; Lindfors, Olavi

    2016-07-30

    Information on how the patient's interpersonal problems predict alliance development during long-term therapy is lacking. The aim of this study was to explore how the patient's pre-treatment interpersonal problems predict the development of alliance in long-term psychotherapy. Altogether 128 adult outpatients experiencing mood or anxiety disorder were assigned to long-term psychodynamic psychotherapy in the Helsinki Psychotherapy Study. The Inventory of Interpersonal Problems (IIP) total score and the eight octant scores, assessed at baseline, were used as predictors. The trajectories of change in patient- and therapist-rated Working Alliance Inventory (WAI) were used as outcome measures at 7, 12, and 36 months of follow-up after baseline. Study of the changes by time showed that the patient-rated alliance was significantly improved by the 36-month follow-up, i.e. the most usual end-point of therapy, in persons with higher pre-treatment level of the IIP total score. Low total IIP score and low to moderate level of hostile type problems showed no slope of improvement of patient-rated alliance during follow-up. The therapist-rated alliance showed a similar course as the patient-rated alliance with the exception of a faster improvement for higher IIP scores. In conclusion, a higher level of patients' interpersonal problems predicted favorable alliance development.

  14. 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

  15. 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.

  16. 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

  17. 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…

  18. 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…

  19. 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).

  20. 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).

  1. 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…

  2. 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…

  3. 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…

  4. 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…

  5. The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder.

    PubMed

    Bedics, Jamie D; Atkins, David C; Harned, Melanie S; Linehan, Marsha M

    2015-03-01

    The purpose of the present study was to explore facets of the client- and therapist-rated therapeutic alliance as predictors of suicide attempts, nonsuicidal self-injury, depression, and introject during the course of 2 psychosocial treatments for borderline personality disorder. A total of 101 women meeting Diagnostic and Statistical Manual of Mental Disorders-IV DSM-IV criteria for borderline personality disorder participated in a randomized controlled trial of dialectical behavior therapy (DBT) versus community treatment by experts. Clients and therapists rated the therapeutic alliance at 4 time points during 1 year of treatment. Multilevel models showed no significant differences in client ratings of the alliance by treatment condition. DBT therapists reported greater working strategy consensus early in treatment and an overall greater alliance during treatment. Client ratings of commitment and working capacity were associated with fewer suicide attempts in DBT. Client ratings of commitment were also associated with reduced nonsuicidal self-injury in DBT only. Therapist ratings of the alliance were predictive of reduced suicide attempts in both treatments. Therapist ratings of the alliance in community treatment by experts were predictive of increased nonsuicidal self-injury. Client and therapist ratings of the alliance were not significantly associated with changes in depression or introject across both treatments. The study supported theoretically predicted relationships between facets of the therapeutic alliance in DBT and suicidal behavior. Results are discussed in the context of recommendations for developing the therapeutic alliance in DBT.

  6. 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

  7. 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.

  8. Measuring Therapeutic Effectiveness.

    ERIC Educational Resources Information Center

    Callister, Sheldon L.

    In the recent past, there has been a great deal of effort directed toward developing techniques for documenting therapeutic outcome. Funding sources and the general public seem to be demanding more meaningful data which indicate, in a clear manner, whether or not the services they are paying for are of value. Mental health centers, like other…

  9. Measuring Therapeutic Effectiveness.

    ERIC Educational Resources Information Center

    Callister, Sheldon L.

    In the recent past, there has been a great deal of effort directed toward developing techniques for documenting therapeutic outcome. Funding sources and the general public seem to be demanding more meaningful data which indicate, in a clear manner, whether or not the services they are paying for are of value. Mental health centers, like other…

  10. Therapeutic Alliance in Antidepressant Treatment: Cause or Effect of Symptomatic Levels?

    PubMed Central

    Zilcha-Mano, Sigal; Roose, Steven P.; Barber, Jacques P.; Rutherford, Bret R.

    2015-01-01

    Background Previous studies have shown that in psychotherapy alliance is a predictor of symptomatic change, even while accounting for the temporal precedence between alliance and symptoms. However, the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result, rather than the cause, of symptomatic change. The current prospective study examined whether the alliance predicts outcomes in psychopharmacology, while controlling for previous symptomatic change throughout the course of treatment. Methods Data from a psychopharmacology randomized controlled trial for the treatment of adult major depression (N=42), including patients’ rating of the alliance with the physician, were analyzed. Multilevel models controlling for autoregressive lag of the dependent variable were used in all analyses to examine the effect of alliance on outcome. Results The effect of alliance on outcome, while controlling for prior symptomatic levels, was significant and restricted to the middle phase of treatment (week 4, p=0.005), when most of the reductions in symptoms were observed. Exploratory analyses of differences between placebo and medication conditions suggest that differences between patients in their average alliance levels predicted a greater reduction in symptoms in the placebo compared to the medication conditions (p=.008). The main limitation is the small cohort size. Conclusions Findings suggest an effect of alliance on outcome in psychopharmacology, which is not merely the result of previous symptomatic levels. This effect may be more robust in conditions that do not include active treatment (placebo), possibly serving as a compensatory effect. PMID:25832111

  11. 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

  12. Understanding and Measuring Coach-Teacher Alliance: A Glimpse Inside the 'Black Box'.

    PubMed

    Johnson, Stacy R; Pas, Elise T; Bradshaw, Catherine P

    2016-05-01

    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.

  13. Narcissism, solitude, friendship: notes on the therapeutic alliance in the context of the Freud-Jung relationship.

    PubMed

    Carta, Stefano

    2012-09-01

    This paper deals with friendship and therapeutic alliance as a transformation of the libidinal love that structures the Oedipal complex. The author considers the relationship between Jung and Freud as a formidable test that may shed light on their personalities and on the relevance of the Oedipal complex for both of them and for their particular theories and practices. The author discusses the possibility that the Oedipal complex may be seen under a finalistic frame of reference and discusses which implicit goals it may express. Such a goal has not been reached by either Freud nor Jung, but might be the key to underline and recognize the fundamental importance of the 'therapeutic alliance' within the analytical situation, seen as a potential relationship between the selves of the patient and of the analyst springing from a transformation of libidinal love into 'friendship' as it was described by Friedrich Nietzsche. © 2012, The Society of Analytical Psychology.

  14. Help Seeking and Satisfaction among Latinas: The Roles of Setting, Ethnic Identity, and Therapeutic Alliance

    ERIC Educational Resources Information Center

    Paris, Manuel, Jr.; Anez, Luis M.; Bedregal, Luis E.; Andres-Hyman, Raquel C.; Davidson, Larry

    2005-01-01

    This study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of…

  15. Cultural Difference and the Therapeutic Alliance: An Evidence-Based Analysis

    ERIC Educational Resources Information Center

    Vasquez, Melba J. T.

    2007-01-01

    The research on positive psychotherapy outcome consistently indicates that the quality of the alliance is important across different models of psychotherapy (D. E. Orlinsky, M. H. Ronnestad, & U. Willutzki, 2004; B. E. Wampold, 2000). Social psychological research has documented how "unintentional bias" can produce barriers to university…

  16. 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.

  17. 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.

  18. The Influence of Therapist Variance on the Dependability of Therapists' Alliance Scores: A Brief Comment on "The Dependability of Alliance Assessments: The Alliance-Outcome Correlation Is Larger than You Think" (Crits-Christoph et al., 2011)

    ERIC Educational Resources Information Center

    Baldwin, Scott A.; Imel, Zac E.; Atkins, David C.

    2012-01-01

    Objective: Crits-Christoph, Connolly Gibbons, Hamilton, Ring-Kurtz, and Gallop (2011) used generalizability theory to critique the measurement of the therapeutic alliance in psychotherapy research, showing that the dependability of alliance scores may be quite low, which in turn can lead to attenuated alliance-outcome correlation estimates. Method…

  19. The Influence of Therapist Variance on the Dependability of Therapists' Alliance Scores: A Brief Comment on "The Dependability of Alliance Assessments: The Alliance-Outcome Correlation Is Larger than You Think" (Crits-Christoph et al., 2011)

    ERIC Educational Resources Information Center

    Baldwin, Scott A.; Imel, Zac E.; Atkins, David C.

    2012-01-01

    Objective: Crits-Christoph, Connolly Gibbons, Hamilton, Ring-Kurtz, and Gallop (2011) used generalizability theory to critique the measurement of the therapeutic alliance in psychotherapy research, showing that the dependability of alliance scores may be quite low, which in turn can lead to attenuated alliance-outcome correlation estimates. Method…

  20. 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.

  1. 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.

  2. 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…

  3. 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…

  4. The Role of the Therapeutic Alliance in Psychotherapy and Pharmacotherapy Outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

    ERIC Educational Resources Information Center

    Krupnick, Janice L.; And Others

    1996-01-01

    Examined the relationship between therapeutic alliance and treatment outcome for depressed outpatients who received interpersonal psychotherapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Results indicate the…

  5. 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.

  6. 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

    2015-11-27

    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.

  7. Measurements for satellite validation made from R/V ``Alliance`` during October and November 1991

    SciTech Connect

    Minnett, P.J.

    1993-08-01

    Measurements of sea-surface temperature, surface meteorology and atmospheric profiles taken from the R/V Alliance between 1 October and 9 November 1991. During this time the ship sailed from Amsterdam to La Spezia and then was deployed in the western Mediterranean Sea. The measurements are presented in graphical form, and daily statistics are given as tables. True winds, net long-wave radiation and turbulent air-sea fluxes have been calculated and are also presented. The measurements were made for application to studies of the accuracies of the retrieval of sea-surface temperature and atmospheric precipitable water from satellite radiometers.

  8. The Effects of Bug-in-the-Eye Supervision on Therapeutic Alliance and Therapist Competence in Cognitive-Behavioural Therapy: A Randomized Controlled Trial.

    PubMed

    Weck, Florian; Jakob, Marion; Neng, Julia M B; Höfling, Volkmar; Grikscheit, Florian; Bohus, Martin

    2016-09-01

    Live supervision enables a supervisor to have direct insight into the psychotherapeutic process and allows him or her to provide immediate feedback to the trainee. Therefore, live supervision might be superior to traditional supervisory formats that only allow for the provision of delayed feedback. When considering the different live supervision formats, bug-in-the-eye (BITE) supervision is particularly promising because of its improved and less invasive procedure. The current study compared the efficacy of BITE supervision with that of delayed video-based (DVB) supervision. In the present study, 23 therapists were randomly assigned to either the BITE supervision or DVB supervision groups. The participants were psychotherapy trainees who treated 42 patients (19 under BITE supervision and 23 under DVB supervision) over 25 sessions of cognitive-behavioural therapy. Two independent raters blind to the treatment conditions evaluated therapeutic alliance and therapist competence based on 195 videotapes. Therapeutic alliance was significantly stronger among the treatments conducted under BITE supervision than those conducted under DVB supervision. Moreover, a higher level of therapeutic competence was found in the BITE condition than in the DVB condition. However, no differences between supervision conditions were found when the results were controlled for the level of therapeutic alliance and therapist competence demonstrated in the first session. No differences were observed between the supervision conditions with respect to patient outcomes. There is evidence that BITE supervision is able to improve therapeutic alliance and therapist competence. However, these findings should be interpreted with caution because possible pre-treatment differences between therapists might explain the superiority of BITE supervision. Copyright © 2015 John Wiley & Sons, Ltd.

  9. 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.

  10. Family psychoeducation and therapeutic alliance focused interventions for parents of a daughter or son with a severe mental illness.

    PubMed

    Levy-Frank, Itamar; Hasson-Ohayon, Ilanit; Kravetz, Shlomo; Roe, David

    2011-09-30

    This study compared the effectiveness of a family psychoeducational intervention (FPEI) and a therapeutic alliance focused intervention (TAFI) for parents of daughters and sons with severe mental illness (SMI). A process-outcome model was used to compare the effectiveness of the two interventions and to evaluate how they achieved their outcomes. Extent of effectiveness was assessed in terms of the family burden (FB) of the parents and the quality of life (QoL) and psychiatric symptoms of the daughters and sons. This study did not uncover a difference in effectiveness between the two interventions. However, at post-treatment, the participants in both interventions reported statistically significant less FB and attributed more QoL and less psychiatric symptoms to their daughters and sons than at pre-treatment. In addition, these pre- and post-treatment differences were mediated by specific mediating variables. These results are discussed in terms of the great psychotherapy debate (Wampold, 2001) as to the relative effectiveness of technique oriented interventions as compared to context oriented interventions. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Mediating role of illness representation among social support, therapeutic alliance, experience of medication side effects, and medication adherence in persons with schizophrenia.

    PubMed

    Rungruangsiripan, Malatee; Sitthimongkol, Yajai; Maneesriwongul, Wantana; Talley, Sandra; Vorapongsathorn, Thavatchai

    2011-08-01

    The purpose of this cross-sectional research study was to examine factors affecting medication adherence in Thai individuals with schizophrenia. The Common-Sense Model of Illness Representation was used to guide the study. Two hundred twenty-five subjects met the inclusion criteria and were interviewed. Variables of interest focused on experience of medication side effects, therapeutic alliance, social support, illness representation, and behavior change with medication adherence. Results indicated that therapeutic alliance and the experience of medication side effects enhanced illness representation, which in turn led to an intention to change adherence behavior. Social support did not alter illness representation or adherence behavior. Because illness representation positively influenced patients' intention to change adherence behavior, mental health nurses should promote patients' perception about their illness to enhance medication adherence.

  12. 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

  13. Remote "hovering" with individuals with psychotic disorders and substance use: feasibility, engagement, and therapeutic alliance with a text-messaging mobile interventionist.

    PubMed

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

    2014-01-01

    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. Seventeen participants with dual diagnosis were enrolled in a 12-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. Participants received an average of 139 text messages (SD = 37.5) each from the mobile interventionist over the 12-week trial. On average, participants responded to 87% of the mobile interventionist's messages that required a reply. More than 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 that 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. Our findings suggest that text-message "hovering" can be conducted

  14. [Questionnaire for Investigating Therapeutic Alliance in Forensic Setting (FTBF): Results of a Pilot Study].

    PubMed

    Vasic, N; Dudeck, M; Knein, A M; Rasche, K; Mentel, R; Streb, J; Connemann, B J; Sosic-Vasic, Z; Otte, S

    2015-12-01

    The relation between patient and therapist has a substantial effect on the success of psychotherapy. So far, in German-speaking regions questionnaires translated from English have been used, particularly for studying outpatients. Studies investigating and concerned with specialised features of hospitalised forensic psychiatry patients are sparse. The preliminary results of this study evaluating a recently developed questionnaire aimed to investigate the quality of the therapeutic relationship in forensic psychiatry ("Fragebogen zur therapeutischen Beziehung in der Forensik, FTBF") are reported. The data were collected both in general and forensic psychiatry departments. Factor analyses yielded two essential factors, namely "positive emotional aspects" (12 items, main features trust, respect, helpfulness, harmony, and sympathy; Cronbach's α = .933) and "negative emotional aspects" (4 items, main features power divide and punishment; Cronbach's α = .805). Forensic patients experienced power divide and punishment tendencies more intensively than general psychiatry patients (p < 0.001). Our questionnaire therefore demonstrates not only excellent reliabilities but also differential validity, enabling a differentiation between general and forensic psychiatry patients. Studies with larger samples would enable conclusions about the impact of the therapists' perspective, specific diagnostic subgroups and different psychotherapeutic orientations, on the patient-therapist relationship in forensic psychiatry.

  15. Evaluation of an interdisciplinary team intervention to improve therapeutic alliance in post-acute brain injury rehabilitation.

    PubMed

    Evans, Clea C; Sherer, Mark; Nakase-Richardson, Risa; Mani, Tanja; Irby, James W

    2008-01-01

    Evaluate an intervention to improve an alliance between an interdisciplinary team and clients with traumatic brain injury attending post-acute brain injury rehabilitation. Prospective design, 2 consecutive samples-historical control (CNT) and treatment (TX). Sample of 104 clients (69 CNT, 35 TX) admitted to post-acute brain injury rehabilitation completed admit/discharge questionnaires. The TX group had higher functional status at discharge than the CNT group. Stronger team alliance was associated with program completion, return to productivity, stronger client alliance, less family discord, and fewer depressive symptoms. Findings provide direction for a larger study examining the effectiveness of this intervention to improve outcome after traumatic brain injury.

  16. Internet-delivered Cognitive Behaviour Therapy for Depressive Symptoms: An Exploratory Examination of Therapist Behaviours and their Relationship to Outcome and Therapeutic Alliance.

    PubMed

    Schneider, Luke H; Hadjistavropoulos, Heather D; Faller, Y Nichole

    2016-11-01

    A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.

  17. The reciprocal relationship between alliance and symptom improvement across treatment of childhood anxiety

    PubMed Central

    Marker, Craig D.; Comer, Jonathan S.; Abramova, Viktoriya; Kendall, Philip C.

    2012-01-01

    Objective This study examined changes in the therapeutic alliance and in self-reported anxiety over the course of 16 weeks of manual-based family treatment for child anxiety disorders. Method 86 children (51.3% female; aged 7.15 to 14.44; 86.2% Caucasian, 14.8% minority) with a principal diagnosis of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, and their parents, received family treatment for anxiety disorders in youth. Child, therapist, and parent ratings of therapeutic alliance and child ratings of state anxiety were measured each session. Latent difference score growth modeling investigated the interacting relationship. Results Therapeutic alliance change, as rated by the mother and by the therapist, was a significant predictor (medium effect) of latter change in child anxiety (with greater therapeutic alliance leading to later reduction in anxiety). However, changes in child-reported anxiety also predicted latter change in father- and therapist-reported alliance (small-to-medium effect). Prospective relationships between child-reported therapeutic alliance and child-reported symptom improvement were not significant. Conclusions Results provide partial support for a reciprocal model in which therapeutic alliance improves outcome, and anxiety reduction improves therapeutic alliance. PMID:23009693

  18. The reciprocal relationship between alliance and symptom improvement across the treatment of childhood anxiety.

    PubMed

    Marker, Craig D; Comer, Jonathan S; Abramova, Viktoriya; Kendall, Philip C

    2013-01-01

    This study examined changes in the therapeutic alliance and in self-reported anxiety over the course of 16 weeks of manual-based family treatment for child anxiety disorders. Eighty-six children (51.3% female; aged 7.15-14.44; 86.2% Caucasian, 14.8% minority) with a principal diagnosis of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, and their parents, received family treatment for anxiety disorders in youth. Child, therapist, and parent ratings of therapeutic alliance and child ratings of state anxiety were measured each session. Latent difference score growth modeling investigated the interacting relationship. Therapeutic alliance change, as rated by the mother and by the therapist, was a significant predictor (medium effect) of latter change in child anxiety (with greater therapeutic alliance leading to later reduction in anxiety). However, changes in child-reported anxiety also predicted latter change in father- and therapist-reported alliance (small-to-medium effect). Prospective relationships between child-reported therapeutic alliance and child-reported symptom improvement were not significant. Results provide partial support for a reciprocal model in which therapeutic alliance improves outcome, and anxiety reduction improves therapeutic alliance.

  19. 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…

  20. 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…

  1. Alliance and outcome in cognitive-behavioral therapy for adolescent depression.

    PubMed

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

    2008-07-01

    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 adolescent perspectives, and change in depressive symptoms was assessed by structured interview and self-report. Two models of alliance-outcome relations were assessed, one direct and one through treatment participation. Results showed significant associations between adolescent-reported alliance and change in depressive symptoms, even after controlling for number of sessions completed. Therapist-reported alliance was only marginally related to outcomes but was predictive of number of sessions completed. On average, alliance showed a modest relation with outcomes (r = .26). Results are discussed in the context of differential alliance-outcome relations in prior studies of cognitive-behavioral compared to nonbehavioral therapy with children and adolescents.

  2. 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…

  3. 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…

  4. 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…

  5. Genetic Alliance

    MedlinePlus

    ... educate consumers around appropriate testing and public health services, and help individuals navigate the complex health care delivery system. Highlights Genetic Alliance Internship Program Learn about ...

  6. NPARC Alliance

    NASA Technical Reports Server (NTRS)

    DeBonis, James R.

    2001-01-01

    The NPARC Alliance is a cooperative effort between the United States Air Force's Arnold Engineering Development Center, NASA's Glenn Research Center and The Boeing Company. The mission of the Alliance is to develop, validate, and support an integrated, general purpose computational flow simulator for the U.S. aerospace community. The Alliance provides a state of the art simulation system that includes geometry manipulation, flow solution, and post-processing capabilities. The system is centered around the WIND flow solver. This presentation provides an overview of the Alliance and the flowfield simulation system. Several example computations are provided.

  7. A Systematic Review of Therapeutic Alliance, Group Cohesion, Empathy, and Goal Consensus/Collaboration in Psychotherapeutic Interventions in Cancer: Uncommon Factors?

    PubMed Central

    Schnur, Julie B.; Montgomery, Guy H.

    2010-01-01

    The effects of four empirically supported therapeutic relationship factors (therapeutic alliance, empathy, goal consensus/collaboration, and group cohesion) on the outcome of psychotherapeutic interventions conducted with individuals living with cancer were systematically reviewed. PubMed, PsycINFO, and CINAHL were searched from their inception through November 13, 2008. Studies of psychotherapeutic interventions targeted to individuals living with cancer, which also empirically assessed the association between any of these therapeutic relationship factors and psychotherapy outcome were included in the review (8 of 742 papers initially reviewed). Information on study methodology and results were abstracted independently by the authors using a standardized form. Results indicated that therapist-rated rapport and group cohesion were significantly related to positive psychotherapeutic outcomes. No studies examined empathy. The literature on collaboration was mixed, but showed some support for increased collaboration being related to positive therapeutic outcomes. Overall the current literature on the role of therapeutic relationship factors in the context of individuals living with cancer is scant, and much more research is needed to determine the overall contribution of these four relationship elements to the outcomes of psychotherapeutic interventions for individuals living with cancer. Results of such studies could have important clinical and research implications. PMID:20006414

  8. Angioma Alliance

    MedlinePlus

    ... new program plans, events, and more. READ MORE Chicago Proclaims Oct 24th Cavernous Angioma Awareness Day Angioma ... first Clinical Center of Excellence at University of Chicago. LEARN MORE Free Genetic Testing through Angioma Alliance ...

  9. Alliance-focused training.

    PubMed

    Eubanks-Carter, Catherine; Muran, J Christopher; Safran, Jeremy D

    2015-06-01

    Alliance-focused training (AFT) aims to increase therapists' ability to recognize, tolerate, and negotiate alliance ruptures by increasing the therapeutic skills of self-awareness, affect regulation, and interpersonal sensitivity. In AFT, therapists are encouraged to draw on these skills when metacommunicating about ruptures with patients. In this article, we present the 3 main supervisory tasks of AFT: videotape analysis of rupture moments, awareness-oriented role-plays, and mindfulness training. We describe the theoretical and empirical support for each supervisory task, provide examples based on actual supervision sessions, and present feedback about the usefulness of the techniques from trainees in our program. We also note some of the challenges involved in conducting AFT and the importance of maintaining a strong supervisory alliance when using this training approach.

  10. 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…

  11. Theoretical Perspectives on the Importance of the Therapeutic Alliance and Their Implications for the Use of Technology.

    ERIC Educational Resources Information Center

    Smith, Peggy H.

    Two questions facing the therapeutic community right now are: Can machines replace therapists? and Can therapy occur without a therapist? This paper attempts to respond to these questions through an examination of some major Western and Eastern theories in the field of psychological therapy. It reviews existing writings in the field to emphasize…

  12. The Impact of Acculturation, Motivation and the Therapeutic Alliance on Treatment Retention and Outcomes for Hispanic Drug Involved Probationers

    PubMed Central

    Brocato, Jo

    2013-01-01

    Factors associated with retention and outcomes for Hispanic offenders mandated to treatment for substance use disorders have been overlooked in the literature resulting in an impediment to providing evidence-based, culturally relevant treatment services. This project examined the roles of motivational factors, the therapeutic relationship, and acculturation in predicting treatment retention and recidivism among Hispanic male probationers mandated to residential treatment. By following a treatment cohort over one hundred and twenty days, this research identifies factors that may be targeted to improve interventions and policies. The following conclusions are supported: among Hispanic offenders, the number of days in treatment is positively related to motivation to change and level of acculturation. PMID:23976877

  13. How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis.

    PubMed

    Flückiger, 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 (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome. Multilevel longitudinal analysis was used to investigate the following moderators of the alliance-outcome correlation: (a) research design (RCT or other), (b) use of disorder-specific manuals, (c) specificity of outcomes, (d) cognitive and/or behavioral therapy (CBT) or other types of treatments, (e) researcher allegiance, and (f) time of alliance assessment. RCT, disorder-specific manual use, specificity of primary and secondary outcomes, and CBT did not moderate the alliance-outcome correlation. Early alliance-outcome correlations were slightly higher in studies conducted by investigators with specific interest in alliance than were those in studies conducted by researchers without such an allegiance. Over the course of therapy, these initial differences disappeared. Apart from this trend, none of the variables previously proposed as potential moderators or mediators of the alliance-outcome relation, alone or in combination, were found to have a mediating impact.

  14. The relationship between perceived injustice and the working alliance: a cross-sectional study of patients with persistent pain attending multidisciplinary rehabilitation.

    PubMed

    Scott, Whitney; Milioto, Maria; Trost, Zina; Sullivan, Michael J L

    2016-12-01

    Accumulating research suggests that perceived injustice is a risk factor for adverse recovery following painful injury. Presently, however, little is known about the processes by which perceived injustice influences rehabilitation outcomes. It is plausible that perceived injustice and associated anger impact rehabilitation outcomes by compromising the quality of the therapeutic working alliance; however, research has not previously examined the relationship between perceived injustice and the working alliance. Therefore, the present study investigated the association between perceived injustice, anger, and the working alliance. Sixty-six patients with persistent pain following musculoskeletal injury participated in this study. All participants were enrolled in a standardized multidisciplinary rehabilitation programme. Participants completed self-report measures of perceived injustice, pain intensity, disability, anger intensity and regulation style, depressive symptoms, and a measure of the working alliance with their principal rehabilitation clinician. Each participant's principal clinician also completed the working alliance measure. Greater perceptions of injustice were associated with poorer client ratings of the working alliance. Results also showed that anger expression mediated the association between perceived injustice and the working alliance. Strategies to enhance the working alliance between rehabilitation professionals and clients with elevated levels of perceived injustice are needed. Implications for Rehabilitation Perceived injustice is associated with poor progress in rehabilitation programmes for people with musculoskeletal pain following injury. Perceived injustice is negatively associated with the quality of the therapeutic working alliance. Strategies to enhance the working alliance between rehabilitation professionals and clients with elevated levels of perceived injustice are needed.

  15. [Therapeutic errors and dose measuring devices].

    PubMed

    García-Tornel, S; Torrent, M L; Sentís, J; Estella, G; Estruch, M A

    1982-06-01

    In order to investigate the possibilities of therapeutical error in syrups administration, authors have measured the capacity of 158 home spoons (x +/- SD). They classified spoons in four groups: group I (table spoons), 49 units (11.65 +/- 2.10 cc); group II (tea spoons), 41 units (4.70+/-1.04 cc); group III (coffee spoons), 41 units (2.60 +/- 0.59 cc), and group IV (miscellaneous), 27 units. They have compared the first three groups with theoreticals values of 15, 5 and 2.5 cc, respectively, ensuring, in the first group, significant statistical differences. In this way, they analyzed information that paediatricians receive from "vademecums", which they usually consult and have studied two points: If syrup has a meter or not, and if it indicates drug concentration or not. Only a 18% of the syrups have a meter and about 88% of the drugs indicate their concentration (mg/cc). They conclude that to prevent errors of dosage, the pharmacological industry must include meters in their products. If they haven't the safest thing is to use syringes.

  16. 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…

  17. 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…

  18. The alliance negotiation scale: psychometric construction and preliminary reliability and validity analysis.

    PubMed

    Doran, Jennifer M; Safran, Jeremy D; Waizmann, Vanina; Bolger, Kelly; Muran, J Christopher

    2012-01-01

    Current measures of the working alliance tend to emphasize the degree of agreement or collaboration between patient and therapist about therapeutic tasks and goals. There are, however, both theoretical and empirical grounds to suggest that the degree to which patient and therapist are able to constructively negotiate disagreements about tasks and goals is another important dimension of the alliance. The present study outlines the preliminary development and evaluation of a measure to operationalize this dimension. This measure, the alliance negotiation scale (ANS), is a 12-item patient self-report instrument. Exploratory factor analysis and expert ratings informed the development of the scale, which consists of two distinct factors that demonstrate good internal consistency. Correlations between these factors and the working alliance offer preliminary support for its construct validity. A working version of the ANS is presented and the need for further validation is discussed.

  19. 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.

  20. Untangling the Alliance-Outcome Correlation: Exploring the Relative Importance of Therapist and Patient Variability in the Alliance

    ERIC Educational Resources Information Center

    Baldwin, Scott A.; Wampold, Bruce E.; Imel, Zac E.

    2007-01-01

    Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331…

  1. Untangling the Alliance-Outcome Correlation: Exploring the Relative Importance of Therapist and Patient Variability in the Alliance

    ERIC Educational Resources Information Center

    Baldwin, Scott A.; Wampold, Bruce E.; Imel, Zac E.

    2007-01-01

    Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331…

  2. 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.

  3. 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.

  4. Better Buildings Alliance, Advanced Rooftop Unit Campaign: Rooftop Unit Measurement and Verification (Fact Sheet)

    SciTech Connect

    Not Available

    2014-09-01

    This document provides facility managers and building owners an introduction to measurement and verification (M&V) methods to estimate energy and cost savings of rooftop units replacement or retrofit projects to estimate paybacks or to justify future projects.

  5. The dynamics of empirically derived factors in the therapeutic relationship.

    PubMed

    Nuetzel, Eric J; Larsen, Randy J; Prizmic, Zvjezdana

    2007-01-01

    The therapeutic relationship is the source of major concepts in psychoanalytic clinical theory. Such concepts as resistance, transference, countertransference, and the alliance are fundamental, even though there may be shifts in meaning between theoretical schools and clinical contexts. In the clinical psychoanalytic literature, disagreement exists over the nature of the alliance and its essential components. Empirical studies using reliable patient, therapist, and observer scales to assess the alliance demonstrate a correlation with psychotherapeutic gains. In the study reported here, thirteen patients were followed for 6 to 33 months of psychodynamic psychotherapy, during which time their views of the therapeutic relationship were assessed, and several experiential measures taken, all on a weekly basis. Statistical analyses reveal that the therapeutic relationship, as reflected in the patients' weekly responses to the St. Louis Therapeutic Relationship Rating Scale, has four distinct components: therapeutic alliance, resistance, transference love, and negative transference. On a week-by-week basis, the therapeutic alliance was the strongest predictor of improvement in patient-reported general adjustment, as reflected in such areas as self-esteem, positive affect, social relations, work productivity, satisfaction, and optimism. Time plots of the variables show the typical time course for the components of the therapeutic relationship, as well as for improvement on the experiential variables. Results indicate that the therapeutic alliance, transference, and resistance are central components of the psychotherapeutic relationship, which in turn predict the ongoing life experience of the patient.

  6. Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit.

    PubMed

    Wiler, Jennifer L; Welch, Shari; Pines, Jesse; Schuur, Jeremiah; Jouriles, Nick; Stone-Griffith, Suzanne

    2015-05-01

    The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.

  7. 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 Central

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

    2014-01-01

    Background and Objectives: 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. Methods: Sample consisted of 117 women on a women-only acute inpatient unit (PwSA = 50, PwoSA = 67). Results: 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. Conclusions and Scientific Significance: 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. PMID:24131164

  8. 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.

  9. The role of therapists' treatment adherence, professional experience, therapeutic alliance, and clients' severity of psychological problems: Prediction of treatment outcome in eight different psychotherapy approaches. Preliminary results of a naturalistic study.

    PubMed

    Tschuschke, Volker; Crameri, Aureliano; Koehler, Miriam; Berglar, Jessica; Muth, Katharina; Staczan, Pia; Von Wyl, Agnes; Schulthess, Peter; Koemeda-Lutz, Margit

    2015-01-01

    In this naturalistic study, 262 audiotaped psychotherapy sessions--randomly drawn from 81 individual therapies from eight different psychotherapy approaches--were rated completely on treatment adherence using a newly developed rating manual. In the therapy sessions, a relatively low percentage of treatment specific interventions (ranging from 4.2% to 27.8%) was found for all eight approaches, 50% to 73% of the interventions were nonspecific or common, and approximately 18% to 27% were intervention techniques from other approaches. Different types of psychotherapy differed highly significantly in levels of treatment adherence. There was no statistically significant association between the type of psychotherapy and its outcome, or between the degree of therapists' treatment fidelity and the treatment outcome. However, there were significant associations between therapists' degree of professional experience, clients' initial psychological burden, and treatment response. Clients' severity of psychological problems prior to treatment predicted quality of therapeutic alliance while therapists' treatment adherence was predicted by therapists' professional experience and by the quality of the therapeutic alliance. We discuss the seemingly indirect importance of treatment adherence for psychotherapy outcome that we found in this study in relation to findings from other studies and in the context of the role of schools within psychotherapy.

  10. A new AMPHORA: an introduction to the project Alcohol Measures for Public Health Research Alliance.

    PubMed

    Gual, Antoni; Anderson, Peter

    2011-03-01

    The AMPHORA Project is a 4 years project funded by the 7th Framework Programme of the European Commission which aims to contribute with new evidence on scarcely explored or unexplored areas of alcohol consumption and alcohol-related harm in Europe. In this introductory article we describe the background of the Project and its main features. The research areas covered by AMPHORA are wide and diverse. Some of the most relevant are: an update on European epidemiological data; the definition of standard common indicators of alcohol consumption and harm; the measurement of the strength of alcohol policies; the study of contextual determinants of alcohol consumption, the analysis of the impact of marketing on youth; the availability of treatments at a European level; and two areas of harm reduction (contamination of illegal or surrogate alcohols and the reduction of harm in drinking venues). © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

  11. Group Climate, Cohesion, Alliance, and Empathy in Group Psychotherapy: Multilevel Structural Equation Models

    ERIC Educational Resources Information Center

    Johnson, Jennifer E.; Burlingame, Gary M.; Olsen, Joseph A.; Davies, D. Robert; Gleave, Robert L.

    2005-01-01

    This study examined the definitional and statistical overlap among 4 key group therapeutic relationship constructs--group climate, cohesion, alliance, and empathy--across member-member, member-group, and member-leader relationships. Three multilevel structural equation models were tested using self-report measures completed by 662 participants…

  12. Therapist and client perspectives on the alliance in the treatment of traumatized adolescents

    PubMed Central

    Ormhaug, Silje M.; Shirk, Stephen R.; Wentzel-Larsen, Tore

    2015-01-01

    Objective Client ratings of the therapeutic alliance are an important predictor of outcome in the treatment of traumatized adolescents and adults, but less is known about the therapists’ perspective. The aim of this study was to investigate how therapists’ ratings relate to the adolescents’ perspective, how individual therapist and adolescent ratings relate to change in symptoms and treatment satisfaction, and whether discrepant alliance perspectives impact treatment outcome. Method The sample consisted of 156 youth (mean age 15.1, range 10–18), randomized to trauma-focused cognitive behavioral therapy or treatment as usual, and alliance ratings from 62 therapists. Alliance was measured midtreatment with the Therapeutic Alliance Scale for Children, and the factor structure of the two scales was analyzed with exploratory factor analyses. A change in posttraumatic symptoms was assessed with the Child PTSD Symptom Scale (CPSS) and the Clinicial-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Results Therapist and client perspectives on the alliance were significantly, but moderately, associated (intraclass correlations [ICC]=0.54, p<0.001). Both scales predicted adolescent treatment satisfaction but only the client scale was significantly related to change in symptoms. Factor analyses revealed differences in factor structure with therapist ratings organized around bond and task dimensions and adolescent ratings organized by item valence. Higher therapist ratings compared to adolescent ratings predicted higher residual PTS symptoms. Discussion Although adolescent and therapist alliance ratings are moderately associated, results suggest that the ratings are differentially associated with outcomes. These findings, along with results indicating important differences in factor structure, imply that adolescent and therapist ratings are not interchangeable. Future studies should investigate how therapists can improve their judgments of adolescents

  13. 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

  14. Alliance ruptures, impasses, and enactments: a relational perspective.

    PubMed

    Safran, Jeremy D; Kraus, Jessica

    2014-09-01

    Alliance ruptures, impasses, and transference-countertransference enactments are inevitable in therapy. A growing body of evidence suggests that repairing ruptures in the alliance is related to positive outcome (Safran, Muran, & Eubanks-Carter, 2011). Our research program has led to the development of training methods to enhance therapists' abilities to detect and work constructively with alliance ruptures and negative therapeutic process (Safran et al., 2014). This article outlines relevant theoretical underpinnings, intervention principles, and empirical findings.

  15. Relational Patterns and the Development of the Alliance: A Systematic Comparison of two Cases.

    PubMed

    Schattner, Emanuel; Tishby, Orya; Wiseman, Hadas

    2016-05-17

    A systematic case study approach was taken to explore the impact of client and therapist relational patterns on the development of the therapeutic alliance and symptom reduction in two cases of psychodynamic psychotherapy treated by the same therapist. The cases were selected from a larger sample and represent two distinct trajectories of alliance development: improvement versus deterioration. The comparison was based on participants' ongoing narratives about each other and about significant others, using the Relationship Anecdote Paradigm (RAP) interview. The qualitative findings were triangulated with process and outcome measures assessed at four time points during the year of treatment. We hypothesized that different therapeutic processes, including different handling by the therapist of interpersonal difficulties as they arose in treatment, could explain the two distinct trajectories of alliance development and symptom change within the caseload of one therapist. Results indicate two linked elements that may explain a steady increase in alliance and decrease in symptoms in one case, compared with the second case that started with an increase in alliance and symptom improvement, but gradually reached an impasse and a setback in symptoms. One element was the extent to which client's and therapist's relational patterns clashed, impacting each other negatively. The second was the extent to which differences and disagreements were stated openly and negotiated so that the therapist could flexibly adapt to meet the client's relational patterns in one case versus inability to do so in the other. Implications for training and other psychotherapy orientations are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

  16. 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

  17. Understanding Alliance Formation Patterns

    DTIC Science & Technology

    2015-12-01

    different periods. The thesis concludes that alliance formation behaviors differ depending on the prevailing system- level conditions in the different...historical periods, especially under conditions of war and peace and based on the polarity of the international system. The approach presented in the...alliance formation, historical periods, geographical proximity, trade exchange, regime type, national material capability, system-level conditions 15

  18. Building Alliances Series: Education

    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,…

  19. 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…

  20. 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"…

  1. 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"…

  2. Comparing two methods of identifying alliance rupture events.

    PubMed

    Coutinho, Joana; Ribeiro, Eugénia; Sousa, Inês; Safran, Jeremy D

    2014-09-01

    This study compared two methods of detecting ruptures in therapy sessions, a procedure based on a self-report measure, the Working Alliance Inventory (WAI), and an observational Rupture Resolution Rating System (3RS). We anticipated that the 3RS would detect more ruptures than the WAI. We examined the longitudinal data of 38 patient-therapist dyads in a cognitive-behavioral therapy condition. The sample included cases that did not complete treatment (dropped cases) as well as good-outcome and poor-outcome cases. At the end of each session, patients completed the WAI self-report questionnaire. Six judges were trained to observe and detect the occurrence of ruptures, and then rated 201 videotaped sessions. Longitudinal statistical models were applied to the data retrieved from the WAI questionnaires completed by patients. We found discrepancies in the ability of the two methods to detect rupture events with the observational 3RS detecting more ruptures than the WAI. Thus, the use of observational systems for the detection of alliance ruptures is crucial for effectively assessing the quality of the therapeutic alliance over the course of treatment. Furthermore, observational systems proven to detect ruptures can be used to improve clinical practice and training of new clinicians.

  3. 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.

  4. 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.

  5. Family Caregiver Alliance

    MedlinePlus

    ... on your schedule. Look for our launch soon! FAMILY CARE NAVIGATOR ─ Click on Your State AL AK ... County Smart Patients Caregivers Community In partnership with Family Caregiver Alliance Learn more Caregiver Research Veterans suffer ...

  6. Alliance ruptures and repairs in psychotherapy in primary care.

    PubMed

    Larsson, Mattias Holmqvist; Falkenström, Fredrik; Andersson, Gerhard; Holmqvist, Rolf

    2016-05-03

    The association between alliance level and outcome in psychotherapy has been extensively studied. One way to expand this knowledge is to study alliance patterns. The main aims of this study were to examine how frequent alliance patterns with ruptures or rupture-repair episodes were in a naturalistic sample of psychotherapies in primary care, and if three alliance patterns (a Rupture pattern, a Repair pattern, and a No Rupture pattern) were differentially associated with treatment outcome. The psychotherapies (N = 605) included a wide range of different treatment orientations and patient diagnoses. Alliance patterns were studied at session-to-session level, using patient-rated alliance scores. Outcome data were analyzed using longitudinal multilevel modeling with a slopes-as-outcomes model. The Repair pattern accounted for 14.7% (n = 89) of the treatments, 10.7% (n = 65) exhibited a Rupture pattern, and 74.5% (n = 451) contained no ruptures. The Rupture pattern was associated with inferior treatment outcomes. The Repair pattern was, in longer treatments, associated with better outcomes than the No Rupture pattern. The results support theory about the importance of ruptures in the therapeutic alliance and suggest that identification of alliance ruptures is important in alliance-outcome research, for feedback purposes in clinical practice, and in training of therapists.

  7. Mars Museum Visualization Alliance

    NASA Astrophysics Data System (ADS)

    Sohus, A. M.; Viotti, M. A.; de Jong, E. M.

    2004-11-01

    The Mars Museum Visualization Alliance is a collaborative effort funded by the Mars Public Engagement Office and supported by JPL's Informal Education staff and the Solar System Visualization Project to share the adventure of exploration and make Mars a real place. The effort started in 2002 with a small working group of museum professionals to learn how best to serve museum audiences through informal science educators. By the time the Mars Exploration Rovers landed on Mars in January 2004, over 100 organizations were partners in the Alliance, which has become a focused community of Mars educators. The Alliance provides guaranteed access to images, information, news, and resources for use by the informal science educators with their students, educators, and public audiences. Thousands of people have shared the adventure of exploring Mars and now see it as a real place through the efforts of the Mars Museum Visualization Alliance partners. The Alliance has been lauded for "providing just the right inside track for museums to do what they do best," be that webcasts, live presentations with the latest images and information, high-definition productions, planetarium shows, or hands-on educational activities. The Alliance is extending its mission component with Cassini, Genesis, Deep Impact, and Stardust. The Mars Exploration and Cassini Programs, as well as the Genesis, Deep Impact, and Stardust Projects, are managed for NASA by the Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California.

  8. Alliance: a common factor of psychotherapy modeled by structural theory.

    PubMed

    Tschacher, Wolfgang; Haken, Hermann; Kyselo, Miriam

    2015-01-01

    There is broad consensus that the therapeutic alliance constitutes a core common factor for all modalities of psychotherapy. Meta-analyses corroborated that alliance, as it emerges from therapeutic process, is a significant predictor of therapy outcome. Psychotherapy process is traditionally described and explored using two categorically different approaches, the experiential (first-person) perspective and the behavioral (third-person) perspective. We propose to add to this duality a third, structural approach. Dynamical systems theory and synergetics on the one hand and enactivist theory on the other together can provide this structural approach, which contributes in specific ways to a clarification of the alliance factor. Systems theory offers concepts and tools for the modeling of the individual self and, building on this, of alliance processes. In the enactive perspective, the self is conceived as a socially enacted autonomous system that strives to maintain identity by observing a two-fold goal: to exist as an individual self in its own right (distinction) while also being open to others (participation). Using this conceptualization, we formalized the therapeutic alliance as a phase space whose potential minima (attractors) can be shifted by the therapist to approximate therapy goals. This mathematical formalization is derived from probability theory and synergetics. We draw the conclusion that structural theory provides powerful tools for the modeling of how therapeutic change is staged by the formation, utilization, and dissolution of the therapeutic alliance. In addition, we point out novel testable hypotheses and future applications.

  9. Alliance: a common factor of psychotherapy modeled by structural theory

    PubMed Central

    Tschacher, Wolfgang; Haken, Hermann; Kyselo, Miriam

    2015-01-01

    There is broad consensus that the therapeutic alliance constitutes a core common factor for all modalities of psychotherapy. Meta-analyses corroborated that alliance, as it emerges from therapeutic process, is a significant predictor of therapy outcome. Psychotherapy process is traditionally described and explored using two categorically different approaches, the experiential (first-person) perspective and the behavioral (third-person) perspective. We propose to add to this duality a third, structural approach. Dynamical systems theory and synergetics on the one hand and enactivist theory on the other together can provide this structural approach, which contributes in specific ways to a clarification of the alliance factor. Systems theory offers concepts and tools for the modeling of the individual self and, building on this, of alliance processes. In the enactive perspective, the self is conceived as a socially enacted autonomous system that strives to maintain identity by observing a two-fold goal: to exist as an individual self in its own right (distinction) while also being open to others (participation). Using this conceptualization, we formalized the therapeutic alliance as a phase space whose potential minima (attractors) can be shifted by the therapist to approximate therapy goals. This mathematical formalization is derived from probability theory and synergetics. We draw the conclusion that structural theory provides powerful tools for the modeling of how therapeutic change is staged by the formation, utilization, and dissolution of the therapeutic alliance. In addition, we point out novel testable hypotheses and future applications. PMID:25954215

  10. Therapists' recognition of alliance ruptures as a moderator of change in alliance and symptoms.

    PubMed

    Chen, Roei; Atzil-Slonim, Dana; Bar-Kalifa, Eran; Hasson-Ohayon, Ilanit; Refaeli, Eshkol

    2016-09-07

    Therapists' awareness of ruptures in the alliance may determine whether such ruptures will prove beneficial or obstructive to the therapy process. This study investigated the associations between therapists' recognition of these ruptures, and changes in clients' alliance ratings and symptom reports, using time-series data in a naturalistic treatment setting. Eighty-four clients treated by 56 therapists completed alliance measures after each session, and the clients also completed symptom measures at the beginning of each session. Therapists' recognition of alliance rupture in non-rupture sessions was positively associated with clients' alliance ratings in the next session and this effect was significantly higher when rupture did occur. There was also a significant interaction effect for functioning ratings: Therapists' recognition of alliance ruptures abolished the negative effect of ruptures on clients' symptom ratings in the following session. These results highlight the importance of therapists' recognition of deterioration in the alliance for a repair process to take place that may eventually lead to an improved relationship and outcome.

  11. Simple rules for making alliances work.

    PubMed

    Hughes, Jonathan; Weiss, Jeff

    2007-11-01

    Corporate alliances are growing in number--by about 25% a year--and account for up to a third of revenues and value at many companies. Yet some 60% to 70% of them fail. What is going wrong? Because alliances involve interdependence between companies that may be competitors and may also have vastly different operating styles and cultures, they demand more care and handling than other business arrangements, say Hughes and Weiss, management consultants at Vantage Partners. The authors have developed five principles--based on their two decades of work with alliances -to complement the conventional advice on alliance management: (1) Focus less on defining the business plan and more on how you and your partner will work together. (2) Develop metrics pegged not only to alliance goals but also to performance in working toward them. (3) Instead of trying to eliminate differences, leverage them to create value. (4) Go beyond formal systems and structures to enable and encourage collaborative behavior. (5) Be as diligent in managing your internal stakeholders as you are in managing the relationship with your partner. Companies that have adopted these principles have radically improved their alliance success rate. Schering-Plough, for example, engages in a systematic "alliance relationship launch": four to six weeks of meetings at which the partners explore potential challenges, examine key differences and develop shared protocols for managing them, and establish mechanisms for day-to-day decision making. Blue Cross and Blue Shield of Florida measures the quality of alliance progress through regular surveys of both its own staff and its partners'. These companies have learned that the conventional advice is not so much wrong as incomplete. The five simple rules can help fill in the blanks.

  12. Automated Measurement of Noise Violations in the Therapeutic Workplace

    PubMed Central

    Sigurdsson, Sigurdur Oli; Aklin, William; Ring, Brandon M; Needham, Mick; Boscoe, James; Silverman, Kenneth

    2011-01-01

    The present analysis was conducted to validate an automated measurement system of noise violations by participants in the therapeutic workplace, which is a model workplace that offers paid employment and vocational training programs to illicit drug users. We collected data on dB levels via an electronic dB meter in a computer classroom with many different sound sources, and defined noise violations as sounds exceeding 55 dB. Human observers recorded whether staff or participants were responsible for violations, the types of events that resulted in violations, and whether these events were a result of participant behavior. Our analyses revealed that participants caused the majority of noise violations. These results suggest that the automated measurement system collects valid data on participant behavior that contributes to noise violations. Our results also suggest that these behaviors can in principle be modified to reduce the frequency of noise violations. Suggestions for replication in other settings and interventions designed to reduce behaviors leading to noise violations involving feedback and incentives are discussed. PMID:22532903

  13. NCI Alliance for Nanotechnology in Cancer - Alliance in the News

    Cancer.gov

    The NCI Alliance for Nanotechnology in Cancer is conducting cutting-edge research using nanotechnology to transform the diagnosis, prevention, treatment, and clinical outcomes for cancer patients. Read news stories and announcements below about the Alliance's multidisciplinary work.

  14. NCI Alliance for Nanotechnology in Cancer - NCI Alliance 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.

  15. 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…

  16. The role of the working alliance in treatment for alcohol problems.

    PubMed

    Cook, Sarah; Heather, Nick; McCambridge, Jim

    2015-06-01

    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 motivation to

  17. 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.

  18. 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)

  19. The Learning Alliance Inventory: Instrument Development and Initial Validation

    ERIC Educational Resources Information Center

    Rogers, Daniel T.

    2012-01-01

    Despite potential applications to educational contexts, the working alliance concept has largely been confined to psychotherapy intervention research. Some have explored theoretically related concepts (e.g., immediacy, rapport), but no measure currently exists of the working alliance between a teacher and student within an academic course. The aim…

  20. TOWARD A TENTATIVE MEASUREMENT OF THE CENTRAL THERAPEUTIC INGREDIENTS.

    ERIC Educational Resources Information Center

    TRUAX, CHARLES B.

    THESE RESEARCH SCALES PROVIDE CONCRETE SPECIFICATIONS, ALONG QUANTIFIED DIMENSIONS, OF THE THREE CENTRAL INGREDIENTS OF EFFECTIVE THERAPEUTIC ENCOUNTERS--(1) ACCURATE EMPATHY, (2) NONPOSSESSIVE WARMTH, AND (3) GENUINENESS. THE RELIABILITY OF THE SCALES WAS OBTAINED BY CORRELATING DIFFERENT RATER'S RATINGS ON THE SCALES FOR THE SAME SAMPLES OF…

  1. 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…

  2. 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.

  3. Examining Supervisor and Supervisee Agreement on Alliance: Is Shame a Factor?

    ERIC Educational Resources Information Center

    Bilodeau, Cynthia; Savard, Reginald; Lecomte, Conrad

    2010-01-01

    This study examined the agreement of 31 supervisee-supervisor pairs on perceived strength of working alliance throughout 5 supervision sessions and on whether the alliance differed significantly in relation to supervisee shame-proneness. The Supervisory Working Alliance Inventory (Trainee and Supervisor versions) was used to measure the working…

  4. Role of the Working Alliance on Treatment Outcome in Tailored Internet-Based Cognitive Behavioural Therapy for Anxiety Disorders: Randomized Controlled Pilot Trial

    PubMed Central

    Carlbring, Per; Linna, Emma; Andersson, Gerhard

    2013-01-01

    Background Internet-based cognitive behavioral therapy (ICBT) is a form of guided self-help that has been found to be effective for addressing several problems. The target for this type of therapy is usually restricted to one specific disorder. Tailoring the treatment widens the scope of ICBT in that it can address comorbid conditions directly. Objectives The working, or therapeutic, alliance has been found to predict outcome in studies of face-to-face therapy. The extent to which these findings apply to ICBT is largely unknown. We therefore decided to find out whether the working alliance could predict outcome in tailored ICBT for anxiety disorders. Methods Data were obtained from the treatment group (n=27) in a randomized controlled trial aiming to test the effects of tailored ICBT for anxiety disorders. The forthcoming study was designed to test the hypothesis that the working alliance measured both pre-treatment and early in treatment (week 3) can predict treatment outcome as measured by the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) in a heterogeneous group of patients with anxiety disorders (n=27). Results Working alliance measured at week 3 into the treatment correlated significantly with the residual gain scores on the primary outcome measure (r=-.47, P=.019, n=25), while expected working alliance pre-treatment did not (r=-.17, P=.42, n=27). Conclusions These results raise questions about the importance of working alliance in ICBT treatments, and suggest that the working alliance could be important in ICBT. PMID:23612437

  5. Alliance building and narcissistic personality disorder.

    PubMed

    Ronningstam, Elsa

    2012-08-01

    Building a therapeutic alliance with a patient with pathological narcissism or narcissistic personality disorder is a challenging process. A combined alliance building and diagnostic strategy is outlined that promotes patients' motivation and active engagement in identifying their own problems. The main focus is on identifying grandiosity, self-regulatory patterns, and behavioral fluctuations in their social and interpersonal contexts while engaging the patient in meaningful clarifications and collaborative inquiry. A definition of grandiosity as a diagnostic characterological trait is suggested, one that captures self-criticism, inferiority, and fragility in addition to superiority, assertiveness, perfectionism, high ideals, and self-enhancing and self-serving interpersonal behavior. These reformulations serve to expand the spectrum of grandiosity-promoting strivings and activities, capture their fluctuations, and help clinicians attend to narcissistic individuals' internal experiences and motivation as well as to their external presentation and interpersonal self-enhancing, self-serving, controlling, and aggressive behavior. A case example illustrates this process.

  6. A model of strategic marketing alliances for hospices: horizontal alliances.

    PubMed

    Self, D R; Starnes, B J

    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 first of two articles, this paper presents a model of horizontal alliances. The subsets include transregional, service mergers, networks, venture capital investments, trade and professional organizations, and promotional alliances. Advantages and disadvantages of each are discussed.

  7. Patient-Therapist Perspective of the Working Alliance in Psychotherapy.

    PubMed

    Andrade-González, Nelson; Lahera, Guillermo; Fernández-Liria, Alberto

    2017-09-01

    This study aimed to examine perceptions of the working alliance in a sample of Spanish patients and therapists. The alliance was measured after the third and tenth psychotherapy sessions using patient and therapist versions of the Spanish adaptation of the Working Alliance Inventory (WAI). After both sessions, correlations between the patients' and therapists' ratings, both of total alliance and of the various dimensions of the alliance, were moderate at best. Moreover, after the third psychotherapy session, patients' scores for the total alliance and the Goal and Task subscales were significantly higher than the scores from their therapists in these dimensions. Following the tenth session, patient ratings exceeded those of their therapists only on the Task subscale. Finally, in contrast to the ratings of patients, therapists' alliance ratings increased significantly between the third and tenth sessions of psychotherapy. Certain recommendations are presented to improve the study of patient and therapist perceptions of the working alliance and to increase the convergence between them with regard to this central treatment variable.

  8. Building A Middle Eastern Alliance

    DTIC Science & Technology

    2015-02-12

    implementation of NATO model to METO by reviewing NATO and suggesting some applications . Thesis This paper proposes building a Middle Eastern alliance to...ranging from terror activity and insurgency to a full- scale conventional war. The US contribution to the alliance may also include extending its...and alliance history is no different. NATO was founded to oppose a Soviet threat. The threat is long gone but NATO is still extremely relevant and

  9. Evaluation of Various Therapeutic Measures in Striae Rubra

    PubMed Central

    Karia, Umesh Karsandas; Padhiar, Bela Bhemabhai; Shah, Bela Jaswantbhai

    2016-01-01

    Background: Striae are linear atrophic depressions that form in areas of dermal damage in the skin. As on date, no consensus or protocol exists for the treatment of stria rubra. Topical retinoids, chemical peels, microdermabrasion, radiofrequency, photothermolysis, intense pulsed light and lasers are some of the modalities used. Aims and Objective: To compare the efficacy of various therapeutic modalities in striae rubra. Methods: This prospective cohort study comprised of a total of fifty patients from August-2012 to October-2013 in a tertiary care center in Western India, Gujarat having striae rubra. They were randomly divided into five groups of ten patients each. Patients were evaluated on the basis of visual assessment, both by doctor as well as the patient. Group I was given topical tretinoin (0.1% w/w) gel applied once at night, Group II-microdermabrasion (MDA) combined with trichloroacetic acid (TCA) (30%) peel, Group III-mesotherapy, Group IV-Q-switched Nd: YAG laser, and Group V-combination treatment of microdermabrasion, salicylic acid peel and retinol (yellow) peel. Patients were treated at an interval of 15 days for 2 months and then at monthly intervals. Objective assessment was done at 2nd month, 6th month, and at the end of 1st year. Results: Patients in Group I treated with topical tretinoin showed the least response with 80% (8) of them showing minimal clinical improvement (0–25%) as compared to patients in Group V in which 60% (6) patients showed moderate clinical improvement (50–75%). While majority of the patients in Group II, III, and IV showed mild clinical improvement (25–50%). Conclusions: Striae rubra is a common cause of concern for adolescent population. Combination treatment with microdermabrasion, salicylic acid and retinol yellow peel gave superior results as compared to other therapeutic options. Mild to moderate improvement was seen with Nd: YAG laser, mesotherapy and MDA + TCA whereas minimal improvement were seen with

  10. Robustness of airline alliance route networks

    NASA Astrophysics Data System (ADS)

    Lordan, Oriol; Sallan, Jose M.; Simo, Pep; Gonzalez-Prieto, David

    2015-05-01

    The aim of this study is to analyze the robustness of the three major airline alliances' (i.e., Star Alliance, oneworld and SkyTeam) route networks. Firstly, the normalization of a multi-scale measure of vulnerability is proposed in order to perform the analysis in networks with different sizes, i.e., number of nodes. An alternative node selection criterion is also proposed in order to study robustness and vulnerability of such complex networks, based on network efficiency. And lastly, a new procedure - the inverted adaptive strategy - is presented to sort the nodes in order to anticipate network breakdown. Finally, the robustness of the three alliance networks are analyzed with (1) a normalized multi-scale measure of vulnerability, (2) an adaptive strategy based on four different criteria and (3) an inverted adaptive strategy based on the efficiency criterion. The results show that Star Alliance has the most resilient route network, followed by SkyTeam and then oneworld. It was also shown that the inverted adaptive strategy based on the efficiency criterion - inverted efficiency - shows a great success in quickly breaking networks similar to that found with betweenness criterion but with even better results.

  11. 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…

  12. 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…

  13. Endpoint comparison for bone mineral density measurements in North Central Cancer Treatment Group cancer clinical trials N02C1 and N03CC (Alliance)

    PubMed Central

    Singh, J.; Atherton, P.; Liu, H.; Novotny, P.; Hines, S.; Loprinzi, C. L.; Perez, E. A.; Tan, A.; Burger, K.; Zhao, X.; Diekmann, B.; Sloan, J. A.

    2015-01-01

    Summary Bone mineral density (BMD) measurement can vary depending upon anatomical site, machine, and normative values used. This analysis compared different BMD endpoints in two clinical trials. Trial results differed across endpoints. Future clinical trials should consider inclusion of multiple endpoints in sensitivity analysis to ensure sound overall study conclusions. Introduction Methodological issues hamper efficacy assessment of osteoporosis prevention agents in cancer survivors. Osteoporosis diagnosis can vary depending upon which bone mineral density (BMD) anatomical site and machine is used and which set of normative values are applied. This analysis compared different endpoints for osteoporosis treatment efficacy assessment in two clinical studies. Methods Data from North Central Cancer Treatment Group phase III clinical trials N02C1 and N03CC (Alliance) were employed involving 774 patients each comparing two treatments for osteoporosis prevention. Endpoints for three anatomical sites included raw BMD score (RawBMD); raw machine-based, sample-standardized, and reference population-standardized T scores (RawT, TSamp, TRef); and standard normal percentile corresponding to the reference population-standardized T score (TPerc). For each, treatment arm comparison was carried out using three statistical tests using change and percentage change from baseline (CB, %CB) at 1 year. Results Baseline correlations among endpoints ranged from 0.79 to 1.00. RawBMD and TPerc produced more statistically significant results (14 and 19 each out of 36 tests) compared to RawT (11/36), TSamp (8/36), and TRef (7/36). Spine produced the most statistically significant results (26/60) relative to femoral neck (20/60) and total hip (13/60). Lastly, CB resulted in 44 statistically significant results out of 90 tests, whereas %CB resulted in only 15 significant results. Conclusions Treatment comparisons and interpretations were different across endpoints and anatomical sites

  14. [Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures].

    PubMed

    Wolfersdorf, M; Vogel, R; Vogl, R; Grebner, M; Keller, F; Purucker, M; Wurst, F M

    2016-05-01

    Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.

  15. [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.

  16. 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.

  17. 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,…

  18. Alliance for Computational Science Collaboration

    SciTech Connect

    Scheick, S. H.

    2003-04-26

    The mission of this alliance is to promote, encourage, and facilitate computational science activities at the member HBCUs and to use collaborative technologies among the alliance partners to create an environment in which students and researchers from a wide variety of applications areas can exchange ideas and share resources.

  19. The supporting alliance in child and adolescent treatment: enhancing collaboration among therapists, parents, and teachers.

    PubMed

    Feinstein, Noah R; Fielding, Krista; Udvari-Solner, Alice; Joshi, Shashank V

    2009-01-01

    Research indicates that the therapeutic alliance between therapist and pediatric patient is most effective in the context of a productive supporting alliance--an alliance encompassing the network of relationships among therapists, parents and teachers. In this essay, we develop a model of the supporting alliance, arguing that the child's primary relationships with various parties (therapists, teachers, and parents) imply a set of secondary relationships among those parties (parent-therapist, therapist-teacher, parent-teacher). We review the literature on these secondary relationships, focusing on their nature and discussing the benefits of and obstacles to establishing productive collaborations in each case. We also describe three sorts of pathology that can afflict the supporting alliance as a whole, and discuss the importance of patient autonomy and therapist-patient confidentiality relative to the supporting alliance. Finally, we identify directions for future research and highlight implications for practice.

  20. 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.

  1. MEASURING THERAPEUTIC RESPONSE IN CHRONIC GRAFT-VERSUS-HOST DISEASE

    PubMed Central

    Lee, Stephanie J.; Wolff, Daniel; Kitko, Carrie; Koreth, John; Inamoto, Yoshihiro; Jagasia, Madan; Pidala, Joseph; Olivieri, Attilio; Martin, Paul J.; Przepiorka, Donna; Pusic, Iskra; Dignan, Fiona; Mitchell, Sandra A.; Lawitschka, Anita; Jacobsohn, David; Hall, Anne M.; Flowers, Mary E.D.; Schultz, Kirk R.; Vogelsang, Georgia; Pavletic, Steven

    2016-01-01

    In 2005, the NIH Chronic GVHD Consensus Response Criteria Working Group recommended several measures to document serial evaluations of chronic GVHD organ involvement. Provisional definitions of complete response, partial response, and progression were proposed for each organ and for overall outcome. Based on publications over the last nine years, the 2014 Working Group has updated its recommendations for measures and interpretation of organ and overall responses. Major changes include elimination of several clinical parameters from the determination of response, updates to or addition of new organ scales to assess response, and the recognition that progression excludes minimal, clinically insignificant worsening that does not usually warrant a change in therapy. The response definitions have been revised to reflect these changes and are expected to enhance reliability and practical utility of these measures in clinical trials. Clarification is provided about response assessment after the addition of topical or organ-targeted treatment. Ancillary measures are strongly encouraged in clinical trials. Areas suggested for additional research include criteria to identify irreversible organ damage and validation of the modified response criteria, including in the pediatric population. PMID:25796139

  2. 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.

  3. The relationships between adult attachment, theoretical orientation, and therapist-reported alliance quality among licensed psychologists.

    PubMed

    Fleischman, Sari; Shorey, Hal S

    2016-01-01

    Attachment anxiety has been depicted as an undesirable therapist characteristic based on findings that preoccupied therapists, relative to those with other attachment styles, report more ruptures in the therapeutic alliance. What has not been considered, however, is the extent to which attachment dynamics are related to theoretical orientations and how attachment styles and theoretical orientations combine to predict therapists' perceptions of the quality of their alliances. The present surveyed 290 licensed psychologists nationally. Results revealed that even within a sample of primarily secure psychologists, higher 15 levels of attachment anxiety correlated positively with the endorsement of psychodynamic orientations, and negatively with the endorsement of cognitive-behavioral orientations and self-reported alliance quality. Endorsement of cognitive-behavioral orientations, in turn, correlated positively with therapist-reported alliance quality. The results are discussed in terms of the extent to which attachment dimensions should be considered in therapists' understandings of their therapeutic alliances.

  4. 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.

  5. Therapist-reported alliance: Is it really a predictor of outcome?

    PubMed

    Zilcha-Mano, Sigal; Solomonov, Nili; Chui, Harold; McCarthy, Kevin S; Barrett, Marna S; Barber, Jacques P

    2015-10-01

    Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient's contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients' self-reported and diagnostician-rated depressive symptoms. Overall, the findings demonstrate that the therapists' contribution to the alliance-outcome association was explained mainly by prior symptomatic levels. However, when a time lag of several sessions was introduced between alliance and symptoms, a positive association emerged between alliance at 1 time point and symptomatic distress assessed several sessions later in the treatment, controlling for previous symptomatic level. The findings were similar whether or not we controlled for the patient's perspective on the alliance. Taken together, the findings attest to the importance of improving therapists' ability to detect deterioration in the alliance.

  6. Making the alliance and taking the transference in work with suicidal patients.

    PubMed

    Plakun, E M

    2001-01-01

    This article focuses on two components of psychodynamic psychotherapy with suicidal patients. First, the value and importance of establishing and maintaining a clearly defined therapeutic alliance is noted and explored. A carefully negotiated alliance can become an edge or boundary across which the survival of the therapy, as well as the patient, can be negotiated. Attention to the vicissitudes of the alliance is hypothesized to be the central initial therapeutic action with suicidal patients. Second, the author explores the importance of "taking" rather than "refusing" the transferences offered by the suicidal patient, particularly negative and erotic transferences. Case examples are offered as illustrations.

  7. Making the Alliance and Taking the Transference in Work With Suicidal Patients

    PubMed Central

    Plakun, Eric M.

    2001-01-01

    This article focuses on two components of psychodynamic psychotherapy with suicidal patients. First, the value and importance of establishing and maintaining a clearly defined therapeutic alliance is noted and explored. A carefully negotiated alliance can become an edge or boundary across which the survival of the therapy, as well as the patient, can be negotiated. Attention to the vicissitudes of the alliance is hypothesized to be the central initial therapeutic action with suicidal patients. Second, the author explores the importance of “taking” rather than “refusing” the transferences offered by the suicidal patient, particularly negative and erotic transferences. Case examples are offered as illustrations. PMID:11696654

  8. 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

  9. The Dependability of Alliance Assessments: The Alliance–Outcome Correlation is Larger than You Might Think

    PubMed Central

    Crits-Christoph, Paul; Connolly Gibbons, Mary Beth; Hamilton, Jessica; Ring-Kurtz, Sarah; Gallop, Robert

    2011-01-01

    Objective To examine the dependability of alliance scores at the patient and therapist level, to evaluate the potential causal direction of session-to-session changes in alliance and depressive symptoms, and to investigate the impact of aggregating the alliance over progressively more sessions on the size of the alliance-outcome relationship. Method We used data from a study (N=45 patients; N=9 therapists) of psychotherapy for major depressive disorder in which the alliance was measured at every treatment session to calculate generalizability coefficients and to predict change in depressive symptoms from alliance scores. Two replication samples were also used. Results At the therapist level, a large number of patients (about 60) per therapist is needed to provide a dependable therapist-level alliance score. At the patient level, generalizability coefficients revealed that a single assessment of the alliance is only marginally acceptable. Very good (> .90) dependability at the patient level is only achieved through aggregating four or more assessments of the alliance. Session-to-session change in the alliance predicted subsequent session-to-session changes in symptoms. Evidence for reverse causation was found in later-in-treatment sessions, suggesting that only aggregates of early treatment alliance scores should be used to predict outcome. Session 3 alliance scores explained 4.7% of outcome variance but the average of sessions 3 to 9 explaining 14.7% of outcome variance. Conclusion Adequately assessing the alliance using multiple patients per therapist and at least 4 treatment sessions is crucial to fully understanding the size of the alliance-outcome relationship. PMID:21639607

  10. Pre-hospital core temperature measurement in accidental and therapeutic hypothermia.

    PubMed

    Strapazzon, Giacomo; Procter, Emily; Paal, Peter; Brugger, Hermann

    2014-06-01

    Core temperature (T core) measurement is the only diagnostic tool to accurately assess the severity of hypothermia. International recommendations for management of accidental hypothermia encourage T core measurement for triage, treatment, and transport decisions, but they also recognize that lack of equipment may be a limiting factor, particularly in the field. The aim of this nonsystematic review is to highlight the importance of field measurement of T core and to provide practical guidance for clinicians on pre-hospital temperature measurement in accidental and therapeutic hypothermia. Clinicians should recognize the difference between alternative measurement locations and available thermometers, tailoring their decision to the purpose of the measurement (i.e., intermittent vs. continual measurement), and the impact on management decisions. The importance of T core measurement in therapeutic hypothermia protocols during early cooling and monitoring of target temperature is discussed.

  11. 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

  12. A calculating alliance.

    PubMed

    Alanis, M; Sippel, S

    1999-01-01

    This article discusses the effects of the alliance between the Church and the Argentine state on women's reproductive rights. Several commentators have criticized how President Carlos Menem used the campaign against abortion for his own political interest. He issued a presidential decree on antiabortion campaign--the Day of the Unborn Child. This decree was announced on December 8, 1998, and the day of observance is March 25 of every coming year. Although the Argentine government does not have a law that explicitly regulates family planning method for the last two decades, many Argentines find the action of the president selfish. The initiation of this presidential decree was the culmination of Menem's manipulation of church and state to secure clerical support for his political regime. Even if statistics is providing him with data concerning the effects of unclear reproductive health laws, he and the church still has chosen not to focus on reproductive rights exclusively, but have concerned themselves primarily with other social and economic issues. While Menem uses the Vatican's pro-life rhetoric and his presidential power to protect fetal life, Argentines will have to contend with the existing Menem policies, which compromise the health of women and children.

  13. 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

  14. An Improved Tumour Temperature Measurement and Control Method for Superficial Tumour Ultrasound Hyperthermia Therapeutic System

    NASA Astrophysics Data System (ADS)

    Shen1, G. F.; Chen, Y. Z.; Ren, G. X.

    2006-10-01

    In tumour hyperthermia therapy, the research on measurement and control of tumour temperature is very important. Based on the hardware platform of superficial tumour ultrasound hyperthermia therapeutic system, an improved tumour temperature measurement and control method is presented in this paper. The experiment process, data and results are discussed in detail. The improved method will greatly reduce the pain and dread of the patients during the therapy period on the tumour temperature measurement and control by using the pinhead sensor.

  15. Contrasting relatedness patterns in bottlenose dolphins (Tursiops sp.) with different alliance strategies.

    PubMed

    Krützen, Michael; Sherwin, William B; Connor, Richard C; Barré, Lynne M; Van de Casteele, Tom; Mann, Janet; Brooks, Robert

    2003-03-07

    Male bottlenose dolphins (Tursiops sp.) in Shark Bay have one of the most complex male societies outside humans. Two broad mating strategies have been identified in males. In the first strategy, there are two types of alliances: stable 'first-order' pairs and trios that herd individual females in reproductive condition, and 'second-order' teams of two first-order alliances (five or six individuals) that join forces against rivals in contests for females. In the alternative strategy, a 'super-alliance' of ca. 14 individuals, males form pairs or trios to herd females, but in contrast to the stable alliances, these pairs and trios are highly labile. Here, we show that males in stable first-order alliances and the derived second-order alliances are often strongly related, so that they may gain inclusive fitness benefits from alliance membership. By contrast, members of the super-alliance are no more closely related than expected by chance. Further, the strength of the association of alliance partners within the super-alliance, as measured by an index of joint participation in consorting a female, was not correlated with their genetic relatedness. Thus, within one population and one sex, it appears that there may be simultaneous operation of more than one mode of group formation.

  16. 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, Jack R; Gorman, Bernard S; Blanchard, Mark; Barber, Jacques P

    2017-09-29

    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.

  17. Transference patterns and working alliance during the early phase of psychodynamic psychotherapy.

    PubMed

    Samardzić, Ljiljana; Nikolić, Gordana

    2014-02-01

    Working alliance, as a collaborative part of the therapeutic relationship has been proven to be one of the most powerful therapeutic factors in psychotherapy in general, regardless many technical differences between numerous psychotherapeutic modalities. On the other hand, transference is the basic concept of psychodynamic psychotherapy, and, according to the psychoanalytic theory and practice, it forms a major part of the therapeutic relationship. The aim of our paper was to determine the differences between the groups of patients with low, middle, and high working alliance scores and the dropout group in transference patterns, sociodemographic and clinical parameters, during the early phase of psychodynamic psychotherapy. Our sample consisted of 61 non-psychotic patients, randomly selected by the method of consecutive admissions and treated with psychoanalytic psychotherapy in the outpatient clinical setting. The patients were prospectively followed during 5 initial sessions of the therapeutic process. The working alliance inventory and Core conflictual relationship theme method were used for the estimation of working alliance and transference patterns, respectively. According to the Working Alliance Inventory scores, four groups of patients were formed and than compared. Our results show a significant difference between the groups of patients with low, middle, and high working alliance inventory scores and the dropout group on the variable--transference patterns in the therapeutic relationship. Disharmonious transference patterns are more frequent in patients who form poor quality working alliance in the early phase of psychotherapy, or early dropout psychotherapy. It is of great importance to recognize transference patterns of a patient at the beginning of the psychotherapeutic process, because of their potentially harmful influence on the quality of working alliance.

  18. 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

  19. 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

  20. Observer, Youth, and Therapist Perspectives on the Alliance in Cognitive Behavioral Treatment for Youth Anxiety.

    PubMed

    McLeod, Bryce D; Southam-Gerow, Michael A; Kendall, Philip C

    2017-03-06

    This study examined the score reliability and validity of observer- (Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale [TPOCS-A]; Vanderbilt Therapeutic Alliance Scale Revised, Short Form [VTAS-R-SF]), therapist- (Therapeutic Alliance Scale for Children Therapist Version [TASC-T]), and youth-rated (Therapeutic Alliance Scale for Children Child Version [TASC-C]) alliance instruments. Youths (N = 50) aged 7-15 (Mage = 10.28 years, SD = 1.84; 88.0% Caucasian; 60.0% male) diagnosed with a principal anxiety disorder received manual-based cognitive-behavioral treatment. Four independent coders, 2 using the TPOCS-A and 2 using the VTAS-R-SF, rated 2 sessions per case from early (Session 3) and late (Sessions 12) treatment. Youth and therapists completed the TASC-C and TASC-T at the end Session 3 and 12. Internal consistency of the alliance instruments was α > .80 and interrater reliability of the observer-rated instruments was ICC(2,2) > .75. The TPOCS-A, VTAS-R-SF, and TASC-T scores showed evidence of convergent validity. Conversely, the TASC-C scores failed to converge with the other instruments in a sample of children (age <11), but did converge in a sample of adolescents (age ≥11). Findings supported the predictive validity of the TASC-T and TASC-C scores. However, whereas the direction of the alliance-outcome association for both observer-rated instruments was in the expected direction for children (negative), the correlations were in the opposite direction for adolescents (positive). Overall, findings support the score reliability of observer- and therapist-report alliance instruments, but questions are raised about the score validity for the observer- and youth-report alliance instruments. (PsycINFO Database Record

  1. 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.

  2. 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.

  3. 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.

  4. 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…

  5. The Dependability of Alliance Assessments: The Alliance-Outcome Correlation Is Larger than You Might Think

    ERIC Educational Resources Information Center

    Crits-Christoph, Paul; Gibbons, Mary Beth Connolly; Hamilton, Jessica; Ring-Kurtz, Sarah; Gallop, Robert

    2011-01-01

    Objective: To examine the dependability of alliance scores at the patient and therapist level, to evaluate the potential causal direction of session-to-session changes in alliance and depressive symptoms, and to investigate the impact of aggregating the alliance over progressively more sessions on the size of the alliance-outcome relationship.…

  6. 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…

  7. Academic Consortia as Strategic Alliances.

    ERIC Educational Resources Information Center

    Cox, Charlotte

    1991-01-01

    The Association for Higher Education of North Texas is an alliance of 20 colleges and universities, 21 high-tech businesses, and civic interests in the Dallas-Fort Worth area that is modeling new ways for higher education institutions to respond to community needs. Other consortia are generally curriculum centered, service centered, or special…

  8. Complex social structure, alliance stability and mating access in a bottlenose dolphin 'super-alliance'.

    PubMed

    Connor, R C; Heithaus, M R; Barre, L M

    2001-02-07

    Large brain size in mammals has been related to the number and complexity of social relationships, particularly social alliances within groups. The largest within-group male alliance known outside of humans is found in a social network (> 400) of Indian Ocean bottlenose dolphins (Tursiops aduncus) in Shark Bay Western Australia. Members of this dolphin 'super-alliance' cooperate against other alliances over access to females. Males within the super-alliance form temporary trios and occasionally pairs in order to consort with individual females. The frequent switching of alliance partners suggests that social relationships among males within the super-alliance might be relatively simple and based on an equivalence rule', thereby allowing dolphins to form large alliances without taxing their 'social intelligence'. The equivalence model predicts that the 14 males in the super-alliance should not exhibit differences in alliance stability or partner preferences. However, data from 100 consortships do not support the equivalence hypothesis. The 14 males exhibited striking differences in alliance stability and partner preferences suggesting that the super-alliance has a complex internal structure. Further, within the super-alliance, alliance stability correlates with consortship rate, suggesting that differentiated relationships within the super-alliance are based on competition for access to females.

  9. Research on the alliance: Knowledge in search of a theory.

    PubMed

    Horvath, Adam O

    2017-09-13

    The aim of this review paper is to summarize the challenges facing research on the alliance now and going forward. The review begins with a brief overview of the development of the concept of the alliance in historical context. A summary of what has been accomplished both within the psychotherapy research community and in other professions is presented. Current challenges facing this line of research are identified, including the existence of a wide range of operational definitions that results in a diffusion of the identity of the alliance concept. It is argued that the current situation generates risks to incremental growth in several lines of research. A case is made that a lack of clarity regarding how several variables within the broader category of therapeutic relationships fit together, overlap, or complement each other is also potentially problematic. Efforts to resolve the lack of a consensual definition are reviewed, and in conclusion, it is argued that a resumption of a conversation about the relationship in the helping context in general, and the alliance in particular, should be resumed.

  10. An Offender Version of the Working Alliance Inventory-Short Revised

    ERIC Educational Resources Information Center

    Tatman, Anthony W.; Love, Keisha M.

    2010-01-01

    The series of Working Alliance Inventories remains the most extensively researched and utilized instruments to measure the working alliance. However, these instruments have not been normed and validated among individuals on probation or parole. Therefore, this study provides psychometric properties for a modified, offender version of the Working…

  11. The Role of Setting Versus Treatment Type in Alliance within Youth Therapy

    PubMed Central

    McLeod, Bryce D.; Jensen-Doss, Amanda; Tully, Carrie B.; Southam-Gerow, Michael A.; Weisz, John R.; Kendall, Philip C.

    2016-01-01

    Objective Does the strength of the youth-therapist alliance differ across treatment settings or treatment type? We examined these questions in the context of youth therapy Method 89 youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with an anxiety disorder received (a) manual-based individual cognitive-behavioral therapy (ICBT) in a research setting, (b) manual-based ICBT in practice settings, or (c) non-manualized usual care (UC) in practice settings. Coders, using the Therapy Process Observational Coding System–Alliance scale, rated 865 sessions. Youth completed the Therapeutic Alliance Scale for Children at posttreatment. Results Youth who received ICBT in a research setting had significantly higher observer-rated alliance than youth who received either therapy delivered in practice settings. In practice settings, youth who received ICBT had significantly stronger observer-rated alliance early in treatment than youth in UC, but this difference was not observed at the end of treatment. Similarly, youth-report alliance at post-treatment was significantly higher in ICBT in the research setting, and there was no difference between ICBT and UC delivered in practice settings. Alliance differences largely held when controlling for youth characteristics; however, differences early in treatment between the ICBT groups were no longer statistically significant when controlling for anxiety severity or primary anxiety diagnosis. Conclusions Our findings suggest that (a) the alliance may be stronger in research settings, and (b) treatment manuals do not undermine alliance. Future research is required to help pinpoint whether other youth, therapist, or setting factors contribute to the lower alliance seen in practice settings. PMID:26881448

  12. Simultaneous measurements of absorbed dose and linear energy transfer in therapeutic proton beams

    NASA Astrophysics Data System (ADS)

    Granville, Dal A.; Sahoo, Narayan; Sawakuchi, Gabriel O.

    2016-02-01

    The biological response resulting from proton therapy depends on both the absorbed dose in the irradiated tissue and the linear energy transfer (LET) of the beam. Currently, optimization of proton therapy treatment plans is based only on absorbed dose. However, recent advances in proton therapy delivery have made it possible to vary the LET distribution for potential therapeutic gain, leading to investigations of using LET as an additional parameter in plan optimization. Having a method to measure and verify both absorbed dose and LET as part of a quality assurance program would be ideal for the safe delivery of such plans. Here we demonstrated the potential of an optically stimulated luminescence (OSL) technique to simultaneously measure absorbed dose and LET. We calibrated the ratio of ultraviolet (UV) to blue emission intensities from Al2O3:C OSL detectors as a function of LET to facilitate LET measurements. We also calibrated the intensity of the blue OSL emission for absorbed dose measurements and introduced a technique to correct for the LET-dependent dose response of OSL detectors exposed to therapeutic proton beams. We demonstrated the potential of our OSL technique by using it to measure LET and absorbed dose under new irradiation conditions, including patient-specific proton therapy treatment plans. In the beams investigated, we found the OSL technique to measure dose-weighted LET within 7.9% of Monte Carlo-simulated values and absorbed dose within 2.5% of ionization chamber measurements.

  13. 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.

  14. 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.

  15. [Rethinking clinical significance of tear osmolarity measurement for dry eye diagnosis and therapeutic efficacy evaluation].

    PubMed

    Liang, Lingyi; Ke, Hongming; Liu, Zuguo

    2014-09-01

    Increased tear osmolarity is one of the core mechanisms of dry eye and has been considered as an important diagnostic criterion, if not"gold standard", of dry eye. However, recent studies showed the limitations of tear osmolarity measurement not only in the diagnosis, but also in the therapeutic efficacy evaluation of dry eye. The clinical significance of tear osmolarity measurement has become a hot topic of argument. Herein, we review the publications on this topic and try to find the underlying causes of such argument.

  16. Normalized Movement Quality Measures for Therapeutic Robots Strongly Correlate With Clinical Motor Impairment Measures

    PubMed Central

    Celik, Ozkan; O’Malley, Marcia K.; Boake, Corwin; Levin, Harvey S.; Yozbatiran, Nuray; Reistetter, Timothy A.

    2016-01-01

    In this paper, we analyze the correlations between four clinical measures (Fugl–Meyer upper extremity scale, Motor Activity Log, Action Research Arm Test, and Jebsen-Taylor Hand Function Test) and four robotic measures (smoothness of movement, trajectory error, average number of target hits per minute, and mean tangential speed), used to assess motor recovery. Data were gathered as part of a hybrid robotic and traditional upper extremity rehabilitation program for nine stroke patients. Smoothness of movement and trajectory error, temporally and spatially normalized measures of movement quality defined for point-to-point movements, were found to have significant moderate to strong correlations with all four of the clinical measures. The strong correlations suggest that smoothness of movement and trajectory error may be used to compare outcomes of different rehabilitation protocols and devices effectively, provide improved resolution for tracking patient progress compared to only pre-and post-treatment measurements, enable accurate adaptation of therapy based on patient progress, and deliver immediate and useful feedback to the patient and therapist. PMID:20388607

  17. Normalized movement quality measures for therapeutic robots strongly correlate with clinical motor impairment measures.

    PubMed

    Celik, Ozkan; O'Malley, Marcia K; Boake, Corwin; Levin, Harvey S; Yozbatiran, Nuray; Reistetter, Timothy A

    2010-08-01

    In this paper, we analyze the correlations between four clinical measures (Fugl-Meyer upper extremity scale, Motor Activity Log, Action Research Arm Test, and Jebsen-Taylor Hand Function Test) and four robotic measures (smoothness of movement, trajectory error, average number of target hits per minute, and mean tangential speed), used to assess motor recovery. Data were gathered as part of a hybrid robotic and traditional upper extremity rehabilitation program for nine stroke patients. Smoothness of movement and trajectory error, temporally and spatially normalized measures of movement quality defined for point-to-point movements, were found to have significant moderate to strong correlations with all four of the clinical measures. The strong correlations suggest that smoothness of movement and trajectory error may be used to compare outcomes of different rehabilitation protocols and devices effectively, provide improved resolution for tracking patient progress compared to only pre- and post-treatment measurements, enable accurate adaptation of therapy based on patient progress, and deliver immediate and useful feedback to the patient and therapist.

  18. The Working Alliance in Psychiatric Care: Agreement Communication and Trust in Action.

    PubMed

    Fuertes, Jairo N; Toporovsky, Arielle; Reyes, Mariela

    2017-01-21

    The physician-patient working alliance has been associated with improved patient satisfaction and adherence. However, up until now there has only been a patient form with which to assess the working alliance in medicine. The current study presents the provider form of the physician-patient working alliance, along with psychometric evidence and support. Participants were 106 psychiatrists (61 men and 45 women). They were selected from a database of providers in the Northeast of the U.S. and were asked to complete a mailed survey and to return it in stamped addressed envelope. We found evidence that the provider form is reliable and valid, and that the providers' ratings' of the working alliance were closely and significantly associated with their satisfaction with the treatment and with ratings of treatment outcome. The provider form of the physician-patient working alliance appears to be a reliable and valid measure of the working alliance. Providers' ratings of the working alliance can now be assessed and examined along with patients' ratings of the working alliance. Use of the measures may inform the relationship in medical treatment and advance the quality of care provided to patients.

  19. 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

    2016-11-14

    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.

  20. Objective measurement of two clinical signs in childhood atopic eczema in research and therapeutics.

    PubMed

    Hon, Kam Lun; Luk, Chi Kong David; Tsang, Yin Ching; Pong, Nga Hin; Leung, Ting Fan

    2017-02-01

    Atopic dermatitis (AD) or eczema is an inflammatory skin disease associated with significant impairment of quality of life. It is important to objectively quantify cutaneous biophysical measurements in research and therapeutics of this disease. To evaluate if skin redness (erythema) and pigmentation (melanin) correlate with disease severity and quality of life. Redness and pigmentation were measured under standardized condition at the antecubital flexure. Nottingham Eczema Severity Score (NESS) and Children's Dermatology Life Quality Index (CDLQI) were documented. Pigmentation correlated with age (r = 0.38, p = 0.02), but not with disease severity (NESS) or quality of life (CDLQI). Erythema correlated with age (r = 0.53, p = 0.001), NESS (r = 0.44, p = 0.006), pigmentation (r = 0.62, p< 0.0001), but not CDLQI (r = 0.3, trend p = 0.087). Skin erythema and pigmentation increase with age. Erythema correlates with disease severity but pigmentation correlates with neither severity nor quality-of-life score. The objective measurement of these two signs does not replace the clinical measurements of severity and quality of life, and may be of limited scope in eczema research and therapeutics.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Recalibrating Alliance Contributions: Changing Policy Environment and Military Alliances

    DTIC Science & Technology

    2005-06-01

    forces in Japan (1978-2003, current price ) 53 4.2 – Host Nation Support for U.S. forces in Japan (1978-2002, 1992 calendar year price ) 54 4.3 – Host...and Pacific area (1978-2001) 122 6.12 – Wholesale price index of durable consumer goods (final goods), Japan 125 6.13 – Size of defense...Official Development Aid (current price , 1978-2002) 237 7.10 – U.S. policy levers and conceptual models on alliance contributions 243 Chapter 8

  6. 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.

  7. Terra Nova breaks new ground for alliances

    SciTech Connect

    Ghiselin, D.

    1996-08-01

    This paper reviews the development of alliances to help develop the Terra Nova oil and gas field in the offshore Atlantic areas of Canada. Largely attributed to BP, the strategic alliance concept got its start in the North Sea and on the North Slope of Alaska. BP saw it as the best way to take advantage of economy-of-scale, mitigate risk, and achieve outsourcing goals while retaining their core competencies. This paper reviews the methods of developing the alliances, the developing of a development plan for the Terra Nova field, and how the alliance plans to maximize the profittability of the operation for all involved.

  8. The ALSFRS as an outcome measure in therapeutic trials and its relationship to symptom onset

    PubMed Central

    Proudfoot, Malcolm; Jones, Ashley; Talbot, Kevin; Al-Chalabi, Ammar; Turner, Martin R.

    2016-01-01

    Abstract The reduction in ALS Functional Rating Score (ALSFRS) from reported symptom onset to diagnosis is used to estimate rate of disease progression. ALSFRS decline may be non-linear or distorted by drop-outs in therapeutic trials, reducing the reliability of change in slope as an outcome measure. The PRO-ACT database uniquely allows such measures to be explored using historical data from negative therapeutic trials. The decline of functional scores was analysed in 18 pooled trials, comparing rates of decline based on symptom onset with rates calculated between interval assessments. Strategies to mitigate the effects of trial drop-out were considered. Results showed that progression rate calculated by symptom onset underestimated the subsequent rate of disability accumulation, although it predicted survival more accurately than four-month interval estimates of δALSFRS or δFVC. Individual ALSFRS and FVC progression within a typical trial duration were linear. No simple solution to correct for trial drop-out was identified, but imputation using δALSFRS appeared least disruptive. In conclusion, there is a trade-off between the drive to recruit trial participants soon after symptom onset, and reduced reliability of the ALSFRS-derived progression rate at enrolment. The need for objective markers of disease activity as an alternative to survival-based end-points is clear and pressing. PMID:26864085

  9. Assessment of therapeutic options for mild obstructive sleep apnea using cardiopulmonary coupling measures.

    PubMed

    Schramm, Preetam J; Thomas, Robert J

    2012-06-15

    To examine the efficacy of various therapeutic modalities for mild obstructive sleep apnea using cardiopulmonary coupling variables of sleep quality. A 67-year-old Caucasian subject's sleep was recorded at home for 10 nights using a type 3 sleep recording device that measured ECG and body position, followed by generation of the cardiopulmonary sleep spectrogram. Three baseline nights, one night with a sleep jacket containing 3 tennis balls to restrict sleep in the supine position, 2 nights with oxygen only delivered via a nasal cannula at a flow rate of 2 L/minute, 2 nights with a mandible advancing appliance (MAA) only, and 2 nights using oxygen at 2 L/minute with the MAA were compared. Baseline sleep quality estimated using the ratio of high-frequency and low-frequency coupling (1.03) was below the expected normal adult values ranging from 1.67-4.0. The sleep quality ratio was significantly higher (2.08) using the MAA alone compared to baseline, sleep position restriction (1.61), oxygen therapy (0.81), and the combination of MAA with oxygen (1.66). Sleep quality measured objectively using cardiopulmonary coupling variables differentiated the efficacy of therapeutic options for mild obstructive sleep apnea. Such an approach may have practical utility.

  10. The Alliance in Couple Therapy: Partner Influence, Early Change, and Alliance Patterns in a Naturalistic Sample

    ERIC Educational Resources Information Center

    Anker, Morten G.; Owen, Jesse; Duncan, Barry L.; Sparks, Jacqueline A.

    2010-01-01

    Objective: The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence and gender and sought to identify couple alliance patterns that predicted couple outcomes. Method:…

  11. Measuring therapeutic attitudes in the prison environment: development of the Prison Attitude to Drugs scale.

    PubMed

    Airey, Nick; Marriott, James

    2003-02-01

    To develop and test the validity of a scale measuring therapeutic attitudes among prison staff working with drug misusers. A cross-sectional postal questionnaire study using 27 statements with a five-point Likert scale. Four prisons in the south-west of England A total of 252 prison staff (response rate 70%), including 67 for test-retest (response rate 57%). The study resulted in a three-dimensional, nine-item scale: the Prison Attitude to Drugs scale (PAD). The three subscales measure confidence in skills (four items), personal rewards (three items) and job satisfaction (two items). Test-retest correlations for the questions were above 0.7, with each factor having an internal coherence (coefficient alpha) of greater than 0.7. The PAD is a reliable tool that can be used in the prison environment.

  12. Examining Patients' and Other Group Members' Agreement about Their Alliance to the Group as a Whole and Changes in Patient Symptoms Using Response Surface Analysis

    ERIC Educational Resources Information Center

    Lo Coco, Gianluca; Gullo, Salvatore; Kivlighan, Dennis M., Jr.

    2012-01-01

    There is a lack of research examining patients' and other group members' agreement about their therapeutic alliance. In the present study, the person-group (P-G) fit model was adopted to predict that the group member symptom reduction will be greater when the group member's and the other group members' perceptions of their alliance to the…

  13. Measured microdosimetric spectra and therapeutic potential of boron neutron capture enhancement of 252Cf brachytherapy.

    PubMed

    Burmeister, J; Kota, C; Maughan, R L

    2005-09-01

    Californium-252 is a neutron-emitting radioisotope used as a brachytherapy source for radioresistant tumors. Presented here are microdosimetric spectra measured as a function of simulated site diameter and distance from applicator tube 252Cf sources. These spectra were measured using miniature tissue-equivalent proportional counters (TEPCs). An investigation of the clinical potential of boron neutron capture (BNC) enhancement of 252Cf brachytherapy is also provided. The absorbed dose from the BNC reaction was measured using a boron-loaded miniature TEPC. Measured neutron, photon and BNC absorbed dose components are provided as a function of distance from the source. In general, the absorbed dose results show good agreement with results from other measurement techniques. A concomitant boost to 252Cf brachytherapy may be provided through the use of the BNC reaction. The potential magnitude of this BNC enhancement increases with increasing distance from the source and is capable of providing a therapeutic gain greater than 30% at a distance of 5 cm from the source, assuming currently achievable boron concentrations.

  14. Iowa Distance Education Alliance. Final Evaluation Report.

    ERIC Educational Resources Information Center

    Sorensen, Chris; Sweeney, Jan

    This document describes the accomplishments of the Iowa Distance Education Alliance (IDEA). The Iowa Distance Education Alliance (IDEA) is 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) fiber optic technology…

  15. Attachment and Alliance in the Treatment of Depressed, Sexually Abused Women

    PubMed Central

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

    2011-01-01

    Background 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. Method 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. Results 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. Conclusion Understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve treatments for depressed women with a history of childhood sexual abuse. PMID:22065593

  16. Using measures of disease progression to determine therapeutic effect: a sirens' song.

    PubMed

    Granger, Christopher B; McMurray, John J V

    2006-08-01

    With an increasing burden of cardiovascular disease and many promising novel treatments in development, the need for efficient systems to evaluate treatments has never been greater. To understand whether a treatment should be used in practice, we need to know whether it makes patients live longer, feel better, prevents adverse events, or does these things with better tolerability or lower cost. But therapeutic development is expensive, inefficient, and is generally focused on short-term treatment effects, rather than on prevention and on long-term impact. Could measures of disease progression, combined with trends on clinical outcomes and post-marketing surveillance to assess safety, serve as the foundation for therapeutic development? Experience and principles of clinical research tell us no. Especially in the field of heart failure, numerous treatments have appeared promising based on disease markers, yet caused harm when tested in studies that assessed clinical outcomes. The intersection of complex human disease, intended and unintended targets of therapy, and overall risk and benefit make it impossible to accurately predict the effect on clinical outcomes based on impact on a disease marker. While reliable measures of disease progression are important to guide which treatments to study in trials, clinical outcome trials must remain the basis for informing clinicians on which treatments improve clinical outcomes. Improved reliability and capacity require the development of more efficient clinical trial methods, streamlined regulatory processes, rational use of privacy protection, leveraging of electronic medical records, and recruitment of a larger proportion of the clinical community to participate in clinical trials.

  17. 3rd year final contractor report for: U.S. Department of Energy Stewardship Science Academic Alliances Program Project Title: Detailed Measurements of Rayleigh-Taylor Mixing at Large and Small Atwood Numbers

    SciTech Connect

    Malcolm J. Andrews

    2006-04-14

    This project had two major tasks: Task 1. The construction of a new air/helium facility to collect detailed measurements of Rayleigh-Taylor (RT) mixing at high Atwood number, and the distribution of these data to LLNL, LANL, and Alliance members for code validation and design purposes. Task 2. The collection of initial condition data from the new Air/Helium facility, for use with validation of RT simulation codes at LLNL and LANL. This report describes work done in the last twelve (12) months of the project, and also contains a summary of the complete work done over the three (3) life of the project. As of April 1, 2006, the air/helium facility (Task 1) is now complete and extensive testing and validation of diagnostics has been performed. Initial condition studies (Task 2) is also comp lete. Detailed experiments with air/helium with Atwood numbers up to 0.1 have been completed, and Atwood numbers of 0.25. Within the last three (3) months we have been able to successfully run the facility at Atwood numbers of 0.5. The progress matches the project plan, as does the budget. We have finished the initial condition studies using the water channel, and this work has been accepted for publication on the Journal of Fluid Mechanics (the top fluid mechanics journal). Mr. Nick Mueschke and Mr. Wayne Kraft are continuing with their studies to obtain PhDs in the same field, and will also continue their collaboration visits to LANL and LLNL. Over its three (3) year life the project has supported two(2) Ph.D.’s and three (3) MSc’s, and produced nine (9) international journal publications, twenty four (24) conference publications, and numerous other reports. The highlight of the project has been our close collaboration with LLNL (Dr. Oleg Schilling) and LANL (Drs. Dimonte, Ristorcelli, Gore, and Harlow).

  18. A Step toward Disentangling the Alliance/Improvement Cycle in Family Therapy

    ERIC Educational Resources Information Center

    Friedlander, Myrna L.; Lambert, Jessica E.; de la Pena, Cristina Muniz

    2008-01-01

    The authors focused on 2 unique aspects of the alliance in conjoint therapy: feeling safe in the therapeutic context with other family members and the family's shared sense of purpose about treatment (i.e., productive within-family collaboration). Low-income, multiproblem families were seen in a community clinic by therapists with varying…

  19. 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…

  20. Where is the Relationship in Research on the Alliance? Two Methods for Analyzing Dyadic Data

    ERIC Educational Resources Information Center

    Kivlighan, Dennis M., Jr.

    2007-01-01

    Researchers examining the therapy relationship are encouraged "to study both patients' and therapists' contribution to the relationship and the ways in which these contributions combine to impact treatment outcome" (Steering Committee, 2002, p. 443). Research on the therapeutic alliance, however, is dominated by studies that examine the individual…

  1. 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…

  2. Voice of a hidden minority: identification and countertransference in the cross-cultural working alliance.

    PubMed

    Shechter, R A

    1992-12-01

    This paper has expanded the psychoanalytical definition of the working alliance to include the influence of culture. The cross-cultural working alliance is a therapeutic dyad that incorporates a psychotherapist and a patient of dissimilar backgrounds. Each participant enters the alliance with cultural introjects--values, attitudes, and ways of behaving that stem from ethnocultural roots. These introjects influence the intrapsychic world, shape the conscious worldview, and the perception of life experience. The influence of cultural predispositions on the psychopathologies of the patients was prominent in two case examples: a black West Indian male and a Korean-American male. The therapist also brought cultural predispositions to her work. A constructive countertransference phenomenon occurred in the working alliance that had a direct connection to its cross-cultural nature. This phenomenon is called associative identification--the conscious identification of therapist with the ego experience of patient. With the use of the associative identification, the therapist uncovered parallel memories that promoted theoretical understanding and informed therapeutic technique. Just as anthropologists claim that cultures share universal institutional patterns, it is proposed that universal cultural conflicts may also be observed in the cross-cultural working alliance. The analyst and patients in this study had two culture-conflicts in common: the longing to be seen, and the pull for disidentification. It is concluded that associative identification enriched the reparative quality of treatment, and encouraged the integration of isolated, split-off parts of the self.

  3. Using Support Vector Machines to Detect Therapeutically Incorrect Measurements by the MiniMed CGMS®

    PubMed Central

    Bondia, Jorge; Tarín, Cristina; García-Gabin, Winston; Esteve, Eduardo; Fernández-Real, José Manuel; Ricart, Wifredo; Vehí, Josep

    2008-01-01

    Background Current continuous glucose monitors have limited accuracy mainly in the low range of glucose measurements. This lack of accuracy is a limiting factor in their clinical use and in the development of the so-called artificial pancreas. The ability to detect incorrect readings provided by continuous glucose monitors from raw data and other information supplied by the monitor itself is of utmost clinical importance. In this study, support vector machines (SVMs), a powerful statistical learning technique, were used to detect therapeutically incorrect measurements made by the Medtronic MiniMed CGMS®. Methods Twenty patients were monitored for three days (first day at the hospital and two days at home) using the MiniMed CGMS. After the third day, the monitor data were downloaded to the physician's computer. During the first 12 hours, the patients stayed in the hospital, and blood samples were taken every 15 minutes for two hours after meals and every 30 minutes otherwise. Plasma glucose measurements were interpolated using a cubic method for time synchronization with simultaneous MiniMed CGMS measurements every five minutes, obtaining a total of 2281 samples. A Gaussian SVM classifier trained on the monitor's electrical signal and glucose estimation was tuned and validated using multiple runs of k-fold cross-validation. The classes considered were Clarke error grid zones A+B and C+D+E. Results After ten runs of ten-fold cross-validation, an average specificity and sensitivity of 92.74% and 75.49%, respectively, were obtained (see Figure 4). The average correct rate was 91.67%. Conclusions Overall, the SVM performed well, in spite of the somewhat low sensitivity. The classifier was able to detect the time intervals when the monitor's glucose profile could not be trusted due to incorrect measurements. As a result, hypoglycemic episodes missed by the monitor were detected. PMID:19885238

  4. The International Planetary Data Alliance

    NASA Astrophysics Data System (ADS)

    Sarkissian, A.; Crichton, D. J.; Hughes, J. S.; Heather, D.; Martinez, S.; Beebe, R.; Neakrase, L. D. V.; Yamamoto, Y.; Capria, M. T.; Krishna, B. G.

    2013-09-01

    The International Planetary Data Alliance (IPDA) is an international collaboration of space agencies with a mission of providing access to scientific data returned from solar system missions archived at international data centers. In order to improve access and share scientific data, the IPDA was founded to develop data and software standards. The IPDA has focused on promoting standards that drive common methods for collecting and describing planetary science data. An initial starting point for developing such a standard has been the internationalization of NASA's Planetary Data System (PDS) standard, which has become the de-facto archival data standard. Given the demands of supporting more capable and international missions and collaborations, the Planetary Data System, in partnership with the IPDA, has embarked on developing a next generation data standard and system called PDS4. Significant progress has been made on PDS4 and early adopters are beginning to use the emerging standard on new planetary science missions.

  5. Youth Expectations about Therapeutic Alliance in a Residential Setting

    ERIC Educational Resources Information Center

    Manso, Ana; Rauktis, Mary Elizabeth; Boyd, A. Suzanne

    2008-01-01

    This exploratory study used qualitative methods to better understand how youths in a residential setting perceive their relationships with the counselors. Using focus group methodology, the study focused on how youth describe the relationship, what staff qualities the youth are able to identify as important in engaging and maintaining the…

  6. What Is the Therapeutic Alliance and Why Does It Matter?

    ERIC Educational Resources Information Center

    Manso, Ana; Rauktis, Mary Elizabeth

    2011-01-01

    The most important task of teacher-counselors in Re-ED programs is to build a trusting relationship with youth. Hobbs defined trust between child and adult as "the glue that holds teaching and learning together, the beginning point for re-education" (Hobbs, 1994, p. 22). This trusting relationship, the foundation for all other Re-ED principles,…

  7. What Is the Therapeutic Alliance and Why Does It Matter?

    ERIC Educational Resources Information Center

    Manso, Ana; Rauktis, Mary Elizabeth

    2011-01-01

    The most important task of teacher-counselors in Re-ED programs is to build a trusting relationship with youth. Hobbs defined trust between child and adult as "the glue that holds teaching and learning together, the beginning point for re-education" (Hobbs, 1994, p. 22). This trusting relationship, the foundation for all other Re-ED principles,…

  8. 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.

  9. San Diego Science Alliance Education Outreach Activities

    NASA Astrophysics Data System (ADS)

    Blue, Anne P.

    1996-11-01

    The General Atomics Science Education Outreach Activities as well as those of several other San Diego area institutions led to the formation in 1994 of the San Diego Science Alliance. The Science Alliance is a consortium of science-related industries, institutions of research and higher education, museums, medical health networks, and science competitions in support of K-12 science education. Some Alliance accomplishments include printing over 4000 resource catalogs for teachers, workshops presented by over 20 of their business members at the San Diego Science Education Conference, and hosting of 3 eight-week courses for teachers. The Alliance provides an important forum for interaction between schools and teachers and local industries and institutions. The Science Alliance maintains a World Wide Web Home Page at elvbf http://www.cerf.net/sd_science/. General Atomics' role in the San Diego Science Alliance will be presented.(Presented by Patricia S. Winter for the General Atomics Science Education Groups and San Diego Science Alliance.)

  10. 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;…

  11. 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.

  12. The Role of the Therapeutic Relationship in Psychopharmacological Treatment Outcomes: A Meta-analytic Review.

    PubMed

    Totura, Christine M Wienke; Fields, Sherecce A; Karver, Marc S

    2017-09-15

    Patient nonadherence to psychopharmacological treatment is a significant barrier to effective treatment. The therapeutic relationship is known to be a critical component of effective psychological treatment, but it has received limited study. A meta-analysis was conducted to examine the role of the therapeutic relationship in the delivery of effective psychopharmacological treatment. PubMed, PsycINFO, CINAHL, Google Scholar, Ingenta, and the Web of Science-Science Citation Index were searched, including reference lists of found articles. Meta-analytic methods were used to examine the association between the physician-patient therapeutic relationship and outcomes in psychopharmacological treatment. Eight independent studies of psychopharmacological treatment reported in nine articles met the inclusion criterion (1,065 participants) of being an empirically based study in which measures of the therapeutic relationship were administered and psychiatric treatment outcomes were assessed. The overall average weighted effect size for the association between the therapeutic relationship and treatment outcomes was z=.30 (95% confidence interval=.20-.39), demonstrating a statistically significant, moderate effect. Findings indicate that a positive therapeutic relationship or alliance between the physician and the psychiatric patient is associated with patient improvement over the course of psychopharmacological treatment. Results suggest that more attention should be paid to psychiatrist communication skills that may enhance the therapeutic alliance in psychopharmacological treatment.

  13. Therapeutic drug monitoring as a measure of proactive pharmacovigilance in child and adolescent psychiatry.

    PubMed

    Gerlach, Manfred; Egberts, Karin; Dang, Su-Yin; Plener, Paul; Taurines, Regina; Mehler-Wex, Claudia; Romanos, Marcel

    2016-11-01

    Off-label or unlicensed use of psychotropic drugs is common rather than the exception in child and adolescent psychiatry. This use exposes patients to an unknown additional risk of ineffective or even harmful treatment. In addition, treatment with psychotropic drugs during a period of life when the patient undergoes marked developmental hormonal and neurobiological changes often requires different dosing regimes in later life and may result in adverse drug reactions, which are either not seen in adults at all or not in the same frequency. Areas covered: Given these critical safety issues, efficient pharmacovigilance methods as part of routine practice are essential for the improvement of patient care. The purpose of this article is to introduce methods to increase the safety of psychotropic drug use in youngsters. In particular, therapeutic drug monitoring (TDM) as a routine measure of proactive pharmacovigilance is discussed. Expert opinion: Given the special features of psychopharmacological therapy in children and adolescents in day-to-day clinical practise, proactive surveillance by using a close standardized 'patient monitoring' and long-term follow-up with TDM is very important. This approach could minimize the risk of exposing paediatric patients to ineffective treatments of uncertain or unknown risks.

  14. Strategic alliances in health care: the challenges of cooperation.

    PubMed

    Zuckerman, H S; Kaluzny, A D

    1991-01-01

    As many industries face uncertain and changing environments, strategic alliances are rapidly emerging as a vehicle for interorganizational cooperation. Similarly in health care, alliances represent a mechanism for organizations to seek collaborative solutions to common problems. Drawing on a general typology, alliances in health care are categorized as service, opportunistic, or stakeholder alliances. Existing health care alliances serve to illustrate and characterize the purpose, structure, and operation of each of the three types. Strategic alliances offer significant challenges in managing the inherently fragile relationships within these emerging organizational forms. These challenges center around issues of commitment (v. control) as the underlying managerial philosophy; expectations for alliance performance; managing relationships, communication, and operations; member participation in alliance programs and activities; and stability of alliances over time. Alliances require new ways of thinking about organizations. Sensitivity to their unique characteristics and understanding the factors that can lead to their success are essential to managing them effectively.

  15. 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.

  16. 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

  17. Alliance for the Prudent Use of Antibiotics

    MedlinePlus

    ... can mean donations to APUA The Faces of Antibiotic Resistance (FOAR) Project The Alliance for the Prudent Use ... the Center for Adaptation Genetics and Drug Resistance . Antibiotic Resistance in the News Tweets by @APUANews WHO Worldwide ...

  18. Popular Participation, Research and New Alliances.

    ERIC Educational Resources Information Center

    MacCall, Brian

    1981-01-01

    Suggests the need for more emphasis upon popular participation as a means of rural development. Proposes alliances between governments and people's organizations to cooperate in research, education and training, and mobilization. Describes contributions of international organizations toward this goal. (SK)

  19. 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 biologically-informed approach, Alliance investigators focus their efforts on specific classes of glycan markers that are likely to play important roles in oncogenesis. |

  20. The teaching alliance: a perspective on the good teacher and effective learning.

    PubMed

    Ursano, Amy M; Kartheiser, Paul H; Ursano, Robert J

    2007-01-01

    Teaching is a part of nearly every professional's activities and, for some, it is a career. At its core, psychotherapy itself is a teaching activity and its therapeutic alliance can provide a useful concept from which to consider the teacher student relationship. From this perspective, the teaching alliance is the fundamental relationship between teacher and student. Here, the teacher establishes a learning context, communicates with a particular student, and develops an educational diagnosis. The reactions of teacher and student to each other and to the learning context can become barriers to the development of the teaching alliance. For the "good teacher", teaching is not a display of knowledge. Rather it is a process which includes identifying an area for learning and deciding on the interventions that will foster learning.

  1. Clients' secret keeping and the working alliance in adult outpatient therapy.

    PubMed

    Kelly, Anita E; Yuan, Ke-Hai

    2009-06-01

    This research investigated the relations among clients' keeping relevant secrets in therapy, the working alliance, and symptom change. Clients (N = 83) in outpatient therapy and their therapists (N = 22) at a mental health hospital completed confidential surveys after a session of ongoing therapy. The clients who reported keeping a relevant secret (27.7%) scored significantly lower on the Working Alliance Inventory (WAI) than did clients who said that they were not, even when the analyses controlled for clients' social desirability scores and for therapist effects. Therapists of these clients also reported a weaker working alliance, even though the therapists typically did not know that the clients were keeping a relevant secret. However, keeping a relevant secret was not related to symptom change. The findings support the long-standing belief that secret keeping in therapy either hurts the therapeutic relationship or happens when the relationship is relatively weak. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  2. Southern Impact Testing Alliance (SITA)

    NASA Technical Reports Server (NTRS)

    Hubbs, Whitney; Roebuck, Brian; Zwiener, Mark; Wells, Brian

    2009-01-01

    Efforts to form this Alliance began in 2008 to showcase the impact testing capabilities within the southern United States. Impact testing customers can utilize SITA partner capabilities to provide supporting data during all program phases-materials/component/ flight hardware design, development, and qualification. This approach would allow programs to reduce risk by providing low cost testing during early development to flush out possible problems before moving on to larger scale1 higher cost testing. Various SITA partners would participate in impact testing depending on program phase-materials characterization, component/subsystem characterization, full-scale system testing for qualification. SITA partners would collaborate with the customer to develop an integrated test approach during early program phases. Modeling and analysis validation can start with small-scale testing to ensure a level of confidence for the next step large or full-scale conclusive test shots. Impact Testing Facility (ITF) was established and began its research in spacecraft debris shielding in the early 1960's and played a malor role in the International Space Station debris shield development. As a result of return to flight testing after the loss of STS-107 (Columbia) MSFC ITF realized the need to expand their capabilities beyond meteoroid and space debris impact testing. MSFC partnered with the Department of Defense and academic institutions as collaborative efforts to gain and share knowledge that would benefit the Space Agency as well as the DoD. MSFC ITF current capabilities include: Hypervelocity impact testing, ballistic impact testing, and environmental impact testing.

  3. Improving quality measurement for anticoagulation: adding international normalized ratio variability to percent time in therapeutic range.

    PubMed

    Razouki, Zayd; Ozonoff, Al; Zhao, Shibei; Jasuja, Guneet K; Rose, Adam J

    2014-09-01

    Among patients receiving warfarin, percent time in therapeutic range (TTR) and international normalized ratio (INR) variability predict adverse events individually. Here, we examined what is added to the prediction of adverse events by using both measures together. We included 40 404 patients anticoagulated for atrial fibrillation, aged 65+, within the Veterans Health Administration. TTR and log-transformed INR variability were calculated for each patient. Our study outcomes were ischemic stroke and major bleeding, defined using International Classification of Diseases-9 codes. We estimated the hazard ratios (HRs) for the study outcomes using 3 nested Cox regression models, including (1) TTR or log INR variability separately; (2) TTR and log INR variability together; and (3) both predictors together plus an interaction term. We divided TTR into 3 categories (high, >70%; moderate, 50% to 70%; low, <50%) and log INR variability into 2 categories (stable and unstable). The reference groups high TTR and stable anticoagulation each denote good control. Higher log INR variability (ie, unstable control) predicted ischemic stroke (HR=1.45, P<0.001) and major bleeding (HR=1.57, P<0.001) independently, regardless of TTR levels. Our model with interaction terms showed that High log INR variability predicted a significantly higher risk for ischemic stroke and major bleeding compared with low log INR variability, at moderate TTR levels (HR= 1.27 and HR=1.29, respectively) and at high TTR levels (HR=1.55 and HR=1.56, respectively), but not at low TTR levels. Unstable anticoagulation predicts warfarin adverse effects independent of TTR. Moreover, knowledge about anticoagulation stability further stratifies the risk for adverse events at given levels of TTR. © 2014 American Heart Association, Inc.

  4. 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…

  5. 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…

  6. 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…

  7. 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…

  8. Remote Sensing and Earth System Dynamics: The Helmholtz Alliance

    NASA Astrophysics Data System (ADS)

    Hajnsek, I.; Eineder, M.; Walter, T. R.; Friedrich, A. M.; Bieber, P.; Huth, A.; Papathanassiou, K.; Montzka, C.; Wollschläger, U.; Thies, B.; Humbert, A.; Braun, M.; Krieger, G.; Moreira, A.

    2014-12-01

    The main objective of the five year funded German Helmholtz Alliance "Remote Sensing and Earth System Dynamics" is the development and evaluation of novel bio/geo-physical information products derived from data acquired by a new generation of remote sensing satellites; and their integration in Earth system models for improving understanding and modelling the ability of global environmental processes and ecosystem change. The Alliance is organized in 4 research topics, each one dedicated to a specific Earth sphere with a specific scientific goal: Biosphere: Global forest structure and biomass dynamics are evaluated for forest and biodiversity monitoring and the quantification of the global carbon cycle; Geosphere: The ability to measure topographic variations with millimeter accuracy is explored for improving the understanding of earthquake and volcano activities; Hydrosphere: The quantification of soil moisture and its variations at high spatial resolution is assessed with respect to hydrological models and the global water cycle; Cryosphere: The estimation of melting processes in snow, ice and permafrost regions is addressed in terms of global climate change. The Alliance has been founded in June 2012 and comprises around 120 scientists with a financial support for 50 PhDs and Postdocs having different backgrounds and nationalities. 18 national research centers and universities are participating which represent a unique opportunity to exploit and widen the expertise of all participating centers and to maximize their role and contribution in the international environmental change science. In this talk the objectives of the Alliance and research highlights will be presented which were obtained in the first 2.5 years of its research activities.

  9. 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.

  10. Alliances and reproductive success in Camargue stallions.

    PubMed

    Feh

    1999-03-01

    A study of a herd of Camargue horses Equus caballus, showed that while the majority of high-ranking stallions held single-male harems, some sons of low-ranking mares, being low ranking themselves, formed alliances that could last a lifetime. The two stallions were each other's closest associate and preferential grooming partner. Alliances were based on coalitions in which either both partners confronted an intruder synchronously or the dominant of the pair tended the female(s) while the subordinate simultaneously displayed towards the rival. Alliance partners were of similar age but were not more closely related to each other than to other stallions in the herd. Long-term paternity data revealed that subordinates sired close to a quarter of the foals born into the alliance group, and significantly more foals than low-ranking stallions in the herd adopting a 'sneak'-mating strategy. The dominant appeared to benefit from the presence of his subordinate partner. Fights occurred all year round, and the subordinate stallion of each alliance pair fought outside competitors more than twice as often as the dominant. Forming short-term alliances before defending mares on their own may enhance long-term reproductive success for both partners. Other benefits to both partners include higher survivorship of their foals and increased access to proven reproductive mares. These results suggest that the relationship between alliance partners is based on mutualism, but several conditions for reciprocity seem to be fulfilled: the benefit to the dominant (assistance in fights), and the benefit to the subordinate (access to reproduction), are both costly to the other partner and delayed in time. Copyright 1999 The Association for the Study of Animal Behaviour.

  11. Working alliance and treatment fidelity as predictors of externalizing problem behaviors in parent management training.

    PubMed

    Hukkelberg, Silje S; Ogden, Terje

    2013-12-01

    The study investigated treatment fidelity and working alliance in the Parent Management Training-Oregon model (PMTO) and investigated how these relate to children's externalizing problem behaviors, as reported by parents and teachers. Participants were 331 Norwegian parents who rated the client-therapist working alliance at 3 time points (Sessions 3, 12, and 20). Competent adherence to the PMTO treatment protocol was assessed by PMTO specialists from evaluations of videotaped therapy sessions using the Fidelity of Implementation (FIMP) system (Knutson, Forgatch, & Rains, 2003). Parents and teachers reported children's problem behaviors at baseline and at the end of therapy. Structural equation modeling was used to analyze the repeated measures data. Parents reported high and stable levels of alliance and fidelity from Time 1 to Time 3, with no correlational or direct relations between the 2. Treatment fidelity predicted reductions in parent-reported externalizing behavior, whereas working alliance was related to less change in problem behavior. Alliance and fidelity were unrelated to teacher-reported behavior problems. The findings point to treatment fidelity as an active ingredient in PMTO and working alliance as a negative predictor of postassessment parent-reported externalizing behavior. More research is needed to investigate whether these findings can be replicated and extended beyond PMTO.

  12. 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

  13. 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

  14. Japanese contributions to International Planetary Data Alliance

    NASA Astrophysics Data System (ADS)

    Yamamoto, Yukio; Kasaba, Yasumasa; Hirata, Naru; Shinohara, Iku

    2012-07-01

    In this presentation, we will introduce Japanese contributions to the data archives for international collaborations. In Japan, the importance of planetary data archive was not recognized enough until early in 2000's. While NASA and ESA started their collaborations to their archives: PDS and PSA, and tried to make the new standard, JAXA was looking for the way of contributions because Japan did not have own data and archiving policy. The activities of NASA and ESA extended to the international collaborations, and International Planetary Data Alliance was established. JAXA had an opportunity to join the IPDA as an agency member. One of the contributions, the IPDA chairman was undertaken by Japanese member. The projects in IPDA were managed and were proceeded successfully during the term. For the technical part, JAXA is making several pilot systems to share planetary data. Planetary Data Access Protocol, PDAP, developed by IPDA, is implemented in JAXA's system, and provides a search system for Hayabusa and Kaguya (SELENE) data. Not only for Japanese data, but also Apollo's seismic data archives are prepared for scientific communities. The seismic data on the moon has not been measured for a long time, and Apollo's data are still precious and should be archived together with much information. The contributions to planetary data archives has just started and continues as a member of IPDA.

  15. Therapeutic Misconception in Research Subjects: Development and Validation of a Measure

    PubMed Central

    Appelbaum, Paul S.; Anatchkova, Milena; Albert, Karen; Dunn, Laura B.; Lidz, Charles W.

    2013-01-01

    Background Therapeutic misconception (TM), which occurs when research subjects fail to appreciate the distinction between the imperatives of clinical research and ordinary treatment, may undercut the process of obtaining meaningful consent to clinical research participation. Previous studies have found TM is widespread, but progress in addressing TM has been stymied by the absence of a validated method for assessing its presence. Purpose The goal of this study was to develop and validate a theoretically grounded measure of TM, assess its diagnostic accuracy, and test previous findings regarding its prevalence. Methods 220 participants were recruited from clinical trials at 4 academic medical centers in the U.S. Participants completed a 28-item Likert-type questionnaire to assess the presence of beliefs associated with TM, and a semi-structured TM interview designed to elicit their perceptions of the nature of the clinical trial in which they were participating. Data from the questionnaires were subjected to factor analysis and items with poor factor loadings were excluded. This resulted in a 10-item scale, with 3 strongly correlated factors and excellent internal consistency; the fit indices of the model across 10 training sets were consistent with the original results, suggesting a stable factor solution. Results The scale was validated against the TM interview, with significantly higher scores among subjects coded as displaying evidence of TM. ROC analysis based on a 10-fold internal cross-validation yielded AUC=.682 for any evidence of TM. When sensitivity (0.72) and specificity (0.61) were both optimized, Positive Predictive Value was 0.65 and Negative Predictive Value was 0.68, with a Positive Likelihood Ratio of 1.89, and a Negative Likelihood Ratio of 0.47. 50.5% (n=101) of participants manifested evidence of TM on the TM interview, a somewhat lower rate than in most previous studies. Limitations The predictive value of the scale compared with the

  16. 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.

  17. 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.

  18. Strategic alliances fit pattern of industry innovation

    SciTech Connect

    Crump, J.G.

    1997-03-31

    The strategic alliance, vitally important as an isolated practice in the oil and gas business, also fits a broad pattern of innovation by which the industry is redefining itself for prosperity in a new energy age. The industry is experiencing a renaissance in almost every aspect, from technological breakthroughs to innovative business practices to new products and markets. An inevitable outgrowth of such rapid and fundamental change is an evolution in business relationships. The strategic alliance is at the forefront of this trend. Development of new relationships capitalizes on, and partly results from, enormous advances in technology and finance. The paper discusses new relationships, the outsourcing rage, integrating work flows, and technological advances.

  19. Client outcomes and the working alliance in the client-case manager relationship: a causal analysis.

    PubMed

    Cunningham, Jennifer; Calsyn, Robert J; Burger, Gary K; Morse, Gary A; Klinkenberg, W Dean

    2007-01-01

    This study investigated the causal relationship between the working alliance and client outcomes in the client-case manager relationship. All 162 study participants received services fiom a case manager who worked as a member of an assertive community treatment team. All participants had both a substance use disorder and a diagnosis of severe mental illness and were homeless at baseline. A brief form of the Working Alliance Inventory (WAI) was used to measure the working alliance after 3 and 15 months of treatment. The Brief Psychiatric Rating Scale was used to measure psychiatric symptoms at baseline, 9, and 18 months. Days per month that clients used alcohol or illegal drugs was also assessed at baseline, 9, and 18 months. The data were analyzed using structural equation modeling (SEM). The correlations between the working alliance and the outcome measures were lower than similar correlations obtained in studies investigating the psychotherapy relationship. The SEM analyses revealed little or no causal relationship between the working alliance and client outcome in this sample.

  20. 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.

  1. Earth System Science Education Alliance

    NASA Astrophysics Data System (ADS)

    Myers, R.; Schwerin, T.

    2006-12-01

    The Earth System Science Education Alliance (ESSEA) professional development program is providing in- depth geoscience content and teaching methods to pre- and in-service teachers. The program is building and expanding on NASA's successful ESSEA program that was funded from 2000-2005. Beginning in 2006 NSF funding will enable ESSEA will expand to 40 institutions of higher learning that are committed to teacher education in Earth system science. The program will support participating institutions with funding, training, and standards-aligned courses and resources for pre- and in-service teachers. As a result, teachers will be prepared to teach Earth system science using inquiry-based classroom methods, geoscience data and tools. From 1999-2005, the NASA funded ESSEA Program delivered online Earth system science professional development for K-12 teachers through a network of 20 colleges and universities. The program was led by the Institute for Global Environmental Strategies (IGES) and based on a trio of 16-week online courses (for elementary, middle, and high school teachers) that had been developed and piloted by NASA's Classroom of the Future at Wheeling Jesuit University. The ESSEA program's mission was to: 1) support universities, colleges, and science education organizations delivering the K-12 online graduate courses; 2) strengthen teachers' understanding of Earth system science; 3) demonstrate the ability to deliver exceptional professional development to a national audience; and 4) create a solid infrastructure to sustain the program. As of spring 2006, the courses had been used by 40 faculty at 20 institutions educating over 1,700 k-12 teachers in Earth system science. Although NASA funding ended in late 2005, the courses continue to be offered by 17 of the original 20 institutions. Through NSF funding beginning in late 2006, IGES will enhance and build upon the ESSEA foundation by: 1.Using the ESSEA courses as a model to introduce newly upgraded Earth

  2. Earth System Science Education Alliance

    NASA Astrophysics Data System (ADS)

    Myers, R.; Schwerin, T.

    2007-12-01

    The Earth System Science Education Alliance (ESSEA) professional development program is providing in-depth geoscience content and teaching methods to pre- and in-service teachers. The program is building and expanding on NASA's successful ESSEA program that was funded from 2000-2005. Now sponsored by NSF, the network has expanded to nearly 40 institutions of higher learning committed to teacher Earth system science education. The program supports participating institutions with funding, training, and standards-aligned courses and resources for pre- and in-service teachers. As a result, teachers are prepared to teach Earth system science using inquiry-based classroom methods, geoscience data and tools. From 1999-2005, the NASA funded ESSEA Program delivered online Earth system science professional development for K-12 teachers through a network of 20 colleges and universities. The program was led by the Institute for Global Environmental Strategies (IGES) and based on a trio of 16-week online courses (for elementary, middle, and high school teachers) that had been developed and piloted by NASA's Classroom of the Future at Wheeling Jesuit University. The ESSEA program's mission was to: 1) support universities, colleges, and science education organizations delivering the K-12 online graduate courses; 2) strengthen teachers' understanding of Earth system science; 3) demonstrate the ability to deliver exceptional professional development to a national audience; and 4) create a solid infrastructure to sustain the program. As of spring 2006, the courses had been used by 40 faculty at 20 institutions educating over 1,700 K-12 teachers in Earth system science. Through NSF funding beginning in late 2006, IGES is enhancing and building on the ESSEA foundation by: 1. Introducing extensive use of data, models and existing Earth system educational materials to support the courses; 2. Implementing a rigorous evaluation program designed to demonstrate growth in teachers' Earth

  3. Chapter 12. Therapists' narratives of therapeutic relationships in the treatment of drug-dependent patients.

    PubMed

    von Braun, Therese

    2013-11-01

    The article explores and analyzes therapists' narratives, using selected stories, and their strategies for achieving a positive therapeutic relationship and a therapeutic alliance with their patients as a critical dimension to enable effective treatment with patients manifesting dependency problems. Although the therapists are applying different treatment and dependency theories and methods they all emphasize the importance of the therapeutic alliance in order to be successful in the treatment process.

  4. 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.

  5. 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.

  6. 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…

  7. 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…

  8. 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…

  9. Contractor Alliances and the New World of Work.

    ERIC Educational Resources Information Center

    Owen, C.; Bound, H.

    A study investigated knowledge, skills, and attitudes required to operate in new working arrangements where people operate in alliance with others. Six strategic alliances were selected across three states and different industries. Participants in contractor alliances and stakeholders in the study were interviewed. Findings indicated that all…

  10. 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…

  11. Prevalence of Counselling Alliance Type Preferences across Two Samples

    ERIC Educational Resources Information Center

    Bedi, Robinder P.; Duff, Carlton T.

    2009-01-01

    A cross-sectional survey was conducted across two samples of counselling clients to estimate the prevalence of two sets of counselling alliance type preferences: (a) nurturant, insight-oriented, or collaborative alliance; and (b) personal or professional alliance. Results indicated that participants generally preferred an insight-oriented alliance…

  12. 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…

  13. Ideas of cure as a predictor of premature termination, early alliance and outcome in psychoanalytic psychotherapy.

    PubMed

    Philips, Björn; Wennberg, Peter; Werbart, Andrzej

    2007-06-01

    This study examines how young adult patients' ideas of cure prior to psychoanalytic psychotherapy are associated with premature termination, early alliance and therapy outcome. The hypotheses were that ideas about approaching one's problems would be related to fewer premature terminations, higher early alliance and better outcome, than would ideas about distancing oneself from one's problems. Young adult patients (N=46) were interviewed prior to therapy regarding their ideas of cure. Outcome measures were administered pre- and post-therapy. Alliance measures were administered early in treatment. A typology of the patients based on their ideas of cure was performed using ideal type analysis. Clusters of patients were then rank ordered in accordance to the theoretical dimension 'approaching-distancing'. The relation between rank ordered ideas of cure and premature termination was analysed using Mann-Whitney's U-test. These ideas' associations with early alliance and therapy outcome were analysed using Spearman's rho. Patients who terminated therapy prematurely were significantly closer to the 'distancing' pole regarding ideas of cure, while the therapy completers were more often found near the 'approaching' pole. No associations were found between ideas of cure and early alliance or therapy outcome. In addition, patients with attrition due to failure to participate in interviews and complete interviews were significantly closer to the 'distancing' pole than those who had completed their research commitments. The positive finding regarding premature termination indicates the importance of negotiating ideas of cure as a part of the initial assessment process. Possible explanations for the negative findings are discussed.

  14. 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…

  15. 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.…

  16. 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.

  17. 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…

  18. 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.

  19. 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)

  20. 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;…

  1. 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)

  2. Family Story Curriculum Project. Refugee Women's Alliance.

    ERIC Educational Resources Information Center

    de Barros, Judy; And Others

    A Family Story Curriculum Project was implemented in three English-as-a-Second-Language (ESL) classes at the Refugee Women's Alliance (ReWA) center in Seattle, Washington. This project followed a successful storytelling project in which students remembered and told folktales from their native countries. The purposes of the Family Story curriculum…

  3. A Study on the PRC-DPRK Alliance: Focusing on Historical Development of Alliance

    DTIC Science & Technology

    2015-06-12

    other governmental agency. (References to this study should include the foregoing statement.) iv ABSTRACT A STUDY ON THE PRC-DPRK ALLIANCE...is the firm strategic policy of the CCP and the Chinese government to steadily consolidate and develop PRC-DPRK friendly and cooperative relations...referring the treaty’s effectiveness to the two governments , the treaty appears to be a firmly effective alliance by the obligation bond. However, in

  4. 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

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

    PubMed

    Preschl, Barbara; Maercker, Andreas; Wagner, Birgit

    2011-12-06

    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. 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. 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. 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. ACTRN12611000563965. © 2011 Preschl et al; licensee BioMed Central Ltd.

  6. Humor: A Therapeutic Intervention for Child Counseling

    ERIC Educational Resources Information Center

    Berg, Rachelle G.; Parr, Gerald; Bradley, Loretta J.; Berry, Jeremy J.

    2009-01-01

    Counselors utilize many strategies, techniques, and tools when building a therapeutic alliance or addressing children's issues. Due to the serious nature of discussing problems or perhaps because of the fear of seeming insensitive, counselors often overlook humor as a means to enhance therapy. Whether deliberate or spontaneous, humor can add…

  7. Humor: A Therapeutic Intervention for Child Counseling

    ERIC Educational Resources Information Center

    Berg, Rachelle G.; Parr, Gerald; Bradley, Loretta J.; Berry, Jeremy J.

    2009-01-01

    Counselors utilize many strategies, techniques, and tools when building a therapeutic alliance or addressing children's issues. Due to the serious nature of discussing problems or perhaps because of the fear of seeming insensitive, counselors often overlook humor as a means to enhance therapy. Whether deliberate or spontaneous, humor can add…

  8. 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.

  9. Barriers and strategies to align stakeholders in healthcare alliances.

    PubMed

    Herald, Larry R; Alexander, Jeffrey A; Beich, Jeff; Mittler, Jessica N; O'Hora, Jennifer L

    2012-09-01

    To identify barriers to stakeholder alignment and strategies used by 14 multi-stakeholder alliances participating in the Aligning Forces for Quality initiative to overcome these barriers. The study used a mixed method, comparative case study design. Alliances were categorized as more or less highly aligned based on an alignment index constructed from survey responses. Six alliances (top and bottom quartile) were selected for more in-depth qualitative analysis. Semi-structured interviews of key informants were used to identify factors that distinguished more highly aligned alliances from less highly aligned alliances. Market context was one of the most important factors differentiating alliances. More highly aligned alliances had more extensive histories of collaboration, established more credibility in the local community, and were more effective at balancing collaborative initiatives against competitive interests. More highly aligned alliances also took more active approaches to build consensus among stakeholders regarding alliance initiatives, and were able to successfully utilize small decision-making bodies to foster this consensus. In contrast, leadership credibility, leadership stability, and trust were important facilitators of alignment for all alliances, regardless of the level of alignment. These factors intersect and overlap in a multitude of ways to influence stakeholder alignment. Alignment in an alliance context is critical for leveraging the unique knowledge, skills, and abilities of stakeholders in ways that can build capacity to improve the health of the community in ways that cannot be achieved independently by stakeholders. The findings highlight the need for multifaceted approaches to promote stakeholder alignment.

  10. The Relationship Between U.S. Military Spending and the Cohesion of the Rok-U.S. Alliance

    DTIC Science & Technology

    2016-12-01

    of information is estimated to average 1 hour per response , including the time for reviewing instruction, searching existing data sources, gathering...RESEARCH QUESTION China’s power in Asia has risen dramatically since 2002. In response , U.S. policy has emphasized a Pivot to Asia (or Rebalancing...alliance cohesion as the extent of the security policy corporation within the countries of an alliance.46 To measure the cohesion, he suggested

  11. 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.

  12. Accuracy of intraocular pressure measurements in dogs using two different tonometers and plano therapeutic soft contact lenses.

    PubMed

    Ahn, Jeong-Taek; Jeong, Man-Bok; Park, Young-Woo; Kim, Se-Eun; Ahn, Jae-Sang; Lee, Yes-Ran; Lee, Eui-Ri; Seo, Kangmoon

    2012-03-01

    To compare and evaluate the accuracy of intraocular pressure (IOP) measured through a therapeutic contact lens, using applanation (TonoPen XL(®)) and rebound (TonoVet(®)) tonometers in enucleated dog eyes. A total of 30 enucleated eyes from 15 beagle dogs. To measure accurate IOP, the anterior chamber of each enucleated eye was cannulated with two 26-gauge needles and two polyethylene tubes were connected vertically to an adjustable reservoir bag of normal saline and a pressure transducer. IOP was measured by the TonoPen XL(®) followed by the TonoVet(®) without a contact lens. After a contact lens was applied to the cornea, IOP was re-measured in the same order. Three consecutive IOP measurements were performed using both tonometers. Without the contact lens, the IOP values obtained by both tonometers correlated well according to the regression analysis (TonoVet(®): γ(2) = 0.98, TonoPen XL(®): γ(2) = 0.97, P < 0.001). The TonoPen XL(®) consistently underestimated values as transducer IOP increased; however, IOP values measured with the TonoPen XL(®) were in close agreement and were less variable than those determined with the TonoVet(®) when a contact lens was applied to the cornea. Bland-Altman analysis was used to determine the lower and upper limits of agreement (TonoVet(®): -29.7 and +21.1 mmHg, TonoPen XL(®): -3.9 and +3.6 mmHg) between the two devices. This study suggests that the TonoPen XL(®) is a useful tonometer for dogs wearing therapeutic contact lenses, and importantly, contact lenses would not need to be removed prior to IOP measurement. © 2012 American College of Veterinary Ophthalmologists.

  13. The accuracy of PiCCO® in measuring cardiac output in patients under therapeutic hypothermia - Comparison with transthoracic echocardiography.

    PubMed

    Souto Moura, T; Aguiar Rosa, S; Germano, N; Cavaco, R; Sequeira, T; Alves, M; Papoila, A L; Bento, L

    2017-05-25

    Invasive cardiac monitoring using thermodilution methods such as PiCCO® is widely used in critically ill patients and provides a wide range of hemodynamic variables, including cardiac output (CO). However, in post-cardiac arrest patients subjected to therapeutic hypothermia, the low body temperature possibly could interfere with the technique. Transthoracic Doppler echocardiography (ECHO) has long proved its accuracy in estimating CO, and is not influenced by temperature changes. To assess the accuracy of PiCCO® in measuring CO in patients under therapeutic hypothermia, compared with ECHO. Thirty paired COECHO/COPiCCO measurements were analyzed in 15 patients subjected to hypothermia after cardiac arrest. Eighteen paired measurements were obtained at under 36°C and 12 at ≥36°C. A value of 0.5l/min was considered the maximum accepted difference between the COECHO and COPiCCO values. Under conditions of normothermia (≥36°C), the mean difference between COECHO and COPiCCO was 0.030 l/min, with limits of agreement (-0.22, 0.28) - all of the measurements differing by less than 0.5 l/min. In situations of hypothermia (<36°C), the mean difference in CO measurements was -0.426 l/min, with limits of agreement (-1.60, 0.75), and only 44% (8/18) of the paired measurements fell within the interval (-0.5, 0.5). The calculated temperature cut-off point maximizing specificity was 35.95°C: above this temperature, specificity was 100%, with a false-positive rate of 0%. The results clearly show clinically relevant discordance between COECHO and COPiCCO at temperatures of <36°C, demonstrating the inaccuracy of PiCCO® for cardiac output measurements in hypothermic patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  14. 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.

  15. Measuring changes in client-level treatment process in the therapeutic community (TC) with the Dimensions of Change Instrument (DCI).

    PubMed

    Paddock, Susan M; Edelen, Maria O; Wenzel, Suzanne L; Ebener, Patricia; Mandell, Wallace; Dahl, James

    2007-01-01

    The Dimensions of Change Instrument (DCI) measures treatment process in residential therapeutic community (TC) settings. It summarizes eight factors of treatment process from a client perspective. We present evidence of the reliability of the DCI for assessing both adult (N = 519) and adolescent (N = 474) client perceptions of treatment process. The DCI factors significantly increase over time, with increases consistently seen across all DCI factors for adults. We highlight areas for future DCI modifications to broaden its applicability to adolescents. Our findings show that clinicians can use the DCI to evaluate adult client progress and target areas for improving quality of care.

  16. Data Collection Strategies and Measurement Tools for Assessing Academic and Therapeutic Outcomes in Recovery Schools

    PubMed Central

    Botzet, Andria M.; McIlvaine, Patrick W.; Winters, Ken C.; Fahnhorst, Tamara; Dittel, Christine

    2014-01-01

    Accurate evaluation and documentation of the efficacy of recovery schools can be vital to the continuation and expansion of these beneficial resources. A very limited data set currently exists that examines the value of specific schools established to support adolescents and young adults in recovery; additional research is necessary. The following article outlines the methodology utilized in a current quasi-experimental study evaluating both academic and therapeutic outcomes of adolescents attending recovery high schools as compared to traditional (non-recovery-based) high schools. The developmental considerations in assessing adolescents in recovery and their parents is delineated in this article, which underscores the need for extensive knowledge of adolescent substance abuse and other mental health issues. In addition, sensitivity around privacy among adolescents, parents, schools, and health providers is highlighted, as well as the validity of assessment. Key assessment strategies, including protocol of recruitment and interviewing techniques, are also presented along with a list of parent and adolescent assessment instruments and their corresponding interpretive variables. Protocol recommendations for future research are also outlined. PMID:25018573

  17. [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.

  18. Direct oral anticoagulants and digestive bleeding: therapeutic management and preventive measures.

    PubMed

    Deutsch, David; Boustière, Christian; Ferrari, Emile; Albaladejo, Pierre; Morange, Pierre-Emmanuel; Benamouzig, Robert

    2017-06-01

    The use of direct oral anticoagulants (DOACs) was an important step forward in the management of atrial fibrillation and venous thromboembolism (VTE). The DOACs, anti-IIa for dabigatran and anti-Xa for rivaroxaban, apixaban and edoxaban, all have a rapid onset of action and a short half life. There is no need for routine hemostasis testing for treatment monitoring of a DOAC. Compared with vitamin K antagonists (VKAs), DOACs may increase the risk of gastrointestinal bleeding (relative risk 1.25). Withholding the DOAC treatment, evaluating the time of the last intake and estimating the patient's renal function are the first steps in the management of gastrointestinal bleeding. For patients without impaired renal function, achieving low coagulation takes around 24 h after the last intake of a DOAC. The use of DOAC antagonists will be helpful in controlling bleeding in the most severe and urgent situations. Idarucizumab is available for clinical use for dabigatran and andexanet is currently being reviewed by drug agencies for rivaroxaban, apixaban and edoxaban. It is important to assess the bleeding risk associated with the planned procedure, and the patient's renal function before withholding DOAC therapy for a scheduled intervention. It is mandatory to strengthen the local hemostasis strategies in DOAC-treated patients undergoing a therapeutic endoscopic procedure. Resuming or not resuming anticoagulation with a DOAC after bleeding or a risky procedure depends on the thrombotic and bleeding risk as well as the procedure involved. This discussion should always involve the cardiologist and decisions should be taken by a pluridisciplinary team.

  19. Physiological measurements corroborate symptomatic improvement after therapeutic leukapheresis in a pregnant woman with chronic myelogenous leukemia.

    PubMed

    Galera, Pallavi; Haynes, Stefanie; Sulmasy, Paula; Bailey, Jeffrey A; Greene, Mindy; Vauthrin, Michelle; Brettler, Doreen; Liebmann, James; Mark Madison, J; Weinstein, Robert

    2016-08-01

    Therapeutic leukapheresis can control the white blood cell count (WBC) of pregnant women with chronic myelogenous leukemia (CML) who have hyperleukocytosis without leukostasis. The medical justification for this treatment has not been objectively documented. We report a 27-year-old woman, diagnosed with CML at 10-week gestation, who developed severe dyspnea on exertion. A workup that included chest CT and echocardiography with a bubble study detected no cardiopulmonary pathology to explain her symptoms, and thus she was referred for leukapheresis. Prior to her first leukapheresis, which lowered her WBC from 154 × 10(3) /μL to 133 × 10(3) /μL, her oxygen saturation (SpO2 ) on room air decreased from 98 to 93% during 100 feet of slow ambulation and she was dyspneic. Just after the leukapheresis, her dyspnea on exertion was much improved and her SpO2 remained at 98% with repeat ambulation. Spirometry and lung volume studies obtained before and after her first leukapheresis demonstrated 32 and 31% improvements in forced vital capacity and forced expiratory volume in 1 s respectively, a 25% increase in functional residual capacity, and a 142% improvement in expiratory reserve volume. Residual volume decreased by almost 20%. Three times in a week, leukapheresis was continued until her WBC was controlled with interferon α-2b approximately 4 weeks later. Her dyspnea had completely resolved. She gave birth by elective caesarean section to a healthy boy at 32 weeks. Corroboration of symptom relief by leukapheresis with physiological data may justify such treatment in pregnant patients with CML. J. Clin. Apheresis 31:393-397, 2016. © 2015 Wiley Periodicals, Inc.

  20. 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.

  1. 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.

  2. 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.

  3. The NPARC Alliance Verification and Validation Archive

    NASA Technical Reports Server (NTRS)

    Slater, John W.; Dudek, Julianne C.; Tatum, Kenneth E.

    2000-01-01

    The NPARC Alliance (National Project for Applications oriented Research in CFD) maintains a publicly-available, web-based verification and validation archive as part of the development and support of the WIND CFD code. The verification and validation methods used for the cases attempt to follow the policies and guidelines of the ASME and AIAA. The emphasis is on air-breathing propulsion flow fields with Mach numbers ranging from low-subsonic to hypersonic.

  4. Measuring intranodal pressure and lymph viscosity to elucidate mechanisms of arthritic flare and therapeutic outcomes.

    PubMed

    Bouta, Echoe M; Wood, Ronald W; Perry, Seth W; Brown, Edward B; Ritchlin, Christopher T; Xing, Lianping; Schwarz, Edward M

    2011-12-01

    Rheumatoid arthritis (RA) is a chronic autoimmune disease with episodic flares in affected joints; the etiology of RA is largely unknown. Recent studies in mice demonstrated that alterations in lymphatics from affected joints precede flares. Thus, we aimed to develop novel methods for measuring lymph node pressure and lymph viscosity in limbs of mice. Pressure measurements were performed by inserting a glass micropipette connected to a pressure transducer into popliteal lymph nodes (PLN) or axillary lymph nodes (ALN) of mice; subsequently, we determined that the lymphatic pressures of water were 9 and 12 cm, respectively. We are also developing methods for measuring lymph viscosity in lymphatic vessels afferent to PLN, which can be measured by multiphoton fluorescence recovery after photobleaching (MP-FRAP) of fluorescein isothiocyanate-labeled bovine serum albumin (FITC-BSA) injected into the hind footpad. These results demonstrate the potential of lymph node pressure and lymph viscosity measurements, and future studies to test these outcomes as biomarkers of arthritic flare are warranted.

  5. 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.

  6. Therapeutic Consequences of Variation in Intraarterial Pressure Measurements After Iliac Angioplasty

    SciTech Connect

    Tetteroo, Eric; Haaring, Cees; Engelen, Andries D. van; Graaf, Yolanda van der; Mali, Willem P.T.M.

    1997-11-15

    Purpose: To assess the accuracy of intraarterial measurement of transstenotic pressure gradients for the detection of hemodynamically suboptimal iliac angioplasty. Methods: In 14 patients, referred for diagnostic angiography, mean pressure gradients in the aorta and iliac artery were obtained twice, using a double-sensor pressure catheter. Additional iliac measurements were performed during pharmacologically induced flow augmentation. Repeatability was assessed by calculation of the mean difference plus standard deviation (MD {+-} SD) and repeatability coefficient (2 x SD). These results were extrapolated to 137 iliac angioplasty procedures with secondary stenting where there was a residual pressure gradient > 10 mmHg. Results: MD {+-} SD for repeated measurements at rest and during flow augmentation were 0 {+-} 2 mmHg and 1 {+-} 3 mmHg, respectively. Repeatability coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty were 8 {+-} 7 mmHg at rest and 17 {+-} 5 mmHg following vasodilatation. Inaccurate pressure recordings may have led to inappropriate stent placement in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions. Conclusion: Variability of intraarterial pressure measurements has little consequence in the detection of hemodynamically significant stenosis after angioplasty.

  7. Measurement of therapeutic photon beams-induced Cerenkov radiation generated in PMMA- and PS-based plastic optical fibers

    NASA Astrophysics Data System (ADS)

    Lee, Bongsoo; Shin, Sang Hun; Yoo, Wook Jae; Jang, Kyoung Won

    2016-10-01

    In this study, we characterized Cerenkov radiation generated in polystyrene (PS)- and polymethyl methacrylate (PMMA)-based plastic optical fibers (POFs) to select an adequate optical fiber for producing Cerenkov radiation. To determine the relationship between the absorbed dose and the intensity of Cerenkov radiation, we calculated the energy depositions of photon beams and fluxes of electrons inducing Cerenkov radiation using the Monte Carlo N-Particle eXtended code. Also, intensities of Cerenkov radiation generated in PS- and PMMA-based POFs were measured as functions of dose rate and monitor unit. At last, therapeutic photon beams-induced Cerenkov radiation in PS- and PMMA-based POFs was measured according to depths of solid water phantom.

  8. Recent advances from the National Cancer Institute Alliance for Nanotechnology in Cancer.

    PubMed

    Farrell, Dorothy; Alper, Joe; Ptak, Krzystof; Panaro, Nicholas J; Grodzinski, Piotr; Barker, Anna D

    2010-02-23

    Nanotechnology will have great impact on how cancer is diagnosed and treated in the future. New technologies to detect and image cancerous changes and materials that enable new methods of cancer treatment will radically alter patient outcomes. The National Cancer Institute (NCI) Alliance for Nanotechnology in Cancer sponsors research in cancer prevention, diagnosis, and therapy and promotes translation of basic science discoveries into clinical practice. The Fourth Annual NCI Alliance Principal Investigator Meeting was held in Manhattan Beach, California October 20-22, 2009. Presented here are highlights from the research presentations at the meeting, in the areas of in vitro diagnostics, targeted delivery of anticancer and contrast enhancement agents, and nanotherapeutics and therapeutic monitoring.

  9. Modelling of experimentally created partial-thickness human skin burns and subsequent therapeutic cooling: a new measure for cooling effectiveness.

    PubMed

    Van de Sompel, Dominique; Kong, Tze Yean; Ventikos, Yiannis

    2009-07-01

    Rapid post-injury cooling of a skin burn has been shown to have both symptomatic and therapeutic benefits. However, the latter cannot be explained by temperature reduction alone, and must thus be secondary to an altered biological response. In this study, we construct a computational model to calculate the heat transfer and damage accumulation in human skin during and after a burn. This enables us to assess the effectiveness of various cooling protocols (involving both free and forced convection to air and water respectively) in terms of their reduction in Arrhenius tissue damage. In this process, we propose an extension of the Arrhenius damage model in the form of a new measure xi, which estimates the relevance of post-burn accrued damage. It was found that the reduction in Arrhenius damage integrals near the skin surface was too small to be physiologically relevant. Hence our results confirm that while the reduction in tissue temperatures is indeed quicker, the therapeutic benefit of cooling cannot be explained by thermal arguments (i.e. based on Arrhenius damage models) alone. We plan to validate this hypothesis by conducting future microarray analyses of differential gene expression in cooled and non-cooled burn lesions. Our computational model will support such experiments by calculating the necessary conditions to produce a burn of specified severity for a given experimental setup.

  10. Child Involvement, Alliance, and Therapist Flexibility: Process Variables in Cognitive-Behavioural Therapy for Anxiety Disorders in Childhood

    PubMed Central

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

    2013-01-01

    Background This study examined the relations between treatment process variables and child anxiety outcomes. Method 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-behavioral 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. Results 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. Conclusion 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. PMID:24246476

  11. Psychological and behavioral disease during developmental age: the importance of the alliance with parents

    PubMed Central

    Gatta, Michela; Ramaglioni, Elisabetta; Lai, Jessica; Svanellini, Lorenza; Toldo, Irene; Del Col, Lara; Salviato, Cinzia; Spoto, Andrea; Antonio, Battistella Pier

    2009-01-01

    The aim of the study is to analyze the clinician’s alliance with parents during the diagnostic process in relation to therapeutic compliance and clinical evolution of individuals aged 0–11 years. The sample was formed by 84 individuals aged 0 to 11 years (18 < 6 years, 66 aged 6 to 11 years; 62 males and 22 females) who came to the Neuropsychiatric Unit for Children and Adolescents for a consultation regarding psychorelational and behavioral problems. Neuropsychiatric consultation took place in five diagnostic interviews with child and parents, separately. The last session was devoted to communication of psychiatric diagnosis (according to ICD 10) and therapeutic suggestions, if any. The clinician’s relationship with parents and patients’ participation were evaluated in terms of collaboration and quality of interaction, on the basis of pre-established criteria. Data about patients’ therapeutic compliance and clinical outcome were collected during a follow-up visit eight months after the last session. Results suggest that the better the alliance between parents and clinician, the higher the therapeutic compliance and the likelihood of a positive outcome for patients. Our data suggest that good communication with parents benefits child patients, both in terms of response to the parents’ need to report their children’s worrying behavior and as a response to the discomfort expressed by children when they come in for consultation. PMID:19898668

  12. Forming, managing and sustaining alliances for health promotion.

    PubMed

    Baldwin, Louise; Abernethy, Peter; Roberts, Lyn; Egan, Helen

    2005-08-01

    To create consistency among the health promotion alliances in which it engages, the National Heart Foundation of Australia (NHFA) undertook to develop guidelines for the formation, management and sustainability of alliances for cardiovascular health. A condensed review of the key themes in the literature and survey of staff who were involved in health promotion alliances were conducted to guide the development of a checklist and template Memorandum of Understanding (MOU) for use by staff when engaging in health promotion alliances. The essential factors for forming, managing and sustaining alliances are explored extensively throughout the literature. Here we provide a condensed overview of the key themes relating to the advantages and barriers of health promotion alliances, plus a useful set of principles for forming, managing and, where applicable, sustaining health promotion alliances. Alliances are a crucial part of the cardiovascular health work of the NHFA and, indeed, broader approaches to promote health. These alliances may involve simply sharing knowledge and creating networks, or they may involve complex arrangements to address broad health issues.

  13. Objective measurement of activation of rigidity: diagnostic, pathogenetic and therapeutic implications in parkinsonism

    PubMed Central

    KIROLLOS, C.; CHARLETT, A.; O'NEILL, C. J. A.; KOSIK, R.; MOZOL, K.; PURKISS, A. G.; BOWES, S. G.; NICHOLSON, P. W.; HUNT, W. B.; WELLER, C.; DOBBS, S. M.; DOBBS, R. J.

    1996-01-01

    1Quantification of the effect on rigidity of its ‘activation’, by isometric grip, of standardized pressure, of the contralateral hand, was explored. Torque required to move the forearm through a fixed angle of 40°, at a controlled rate of 0.5 Hz, in a horizontal plane about a pivotal axis aligned to the elbow joint, was recorded before (12 ‘baseline’ recordings), during (10), and after (≥8) activation. Work required per unit displacement was calculated. 2Specificity: Pilot serial daytime measurements gave an overall mean ratio, work required on activation over baseline, of 2.94 (95% CI 2.53, 3.42) in two elderly untreated parkinsonians, and 3.19 (2.75, 3.71) in two elderly subjects with isolated, clinically activation phenomenon, compared with 1.90 (1.64, 2.21) in two elderly without (P<0.001), whilst two young adults did not activate, 0.98 (0.85, 1.14). In elderly subjects, work required under activation decreased during the day in health (−10 (−5, −14)% h−1, P=0.0002), showed no significant change in those with clinical activation (4 (−1, 9)% h−1), and increased in parkinsonians (6 (0, 12)% h−1, P=0.05): there appeared to be a transitionary state. 3Validation of methodology: Quantifying the same work ratio on a single occasion in 20 aged parkinsonians (P), their spouses (Ps), 20 index controls (C) without parkinsonism, matched to (P), and their spouses (Cs) gave corroborative evidence of a pre-clinical state, defined by other measurements, in the spouses of sufferers. Values for C, Cs and Ps, 1.89 (1.42, 2.52), 2.38 (1.79, 3.17) and 2.93 (2.20, 3.90) respectively, were in consecutive positions, from health to (P, 2.96 (2.22, 3.95)) disease (P=0.001 for Ps c.f. C; P=0.1 for Ps c.f. Cs). Data on change over the day may enhance discrimination. 4Sensitivity to medicines was illustrated, in two parkinsonians, by randomised, placebo balanced and controlled challenges: 1 and 2 tablets, Sinemet CR (Du Pont Pharmaceuticals, each levodopa

  14. Measurement of Free Versus Total Therapeutic Monoclonal Antibody in Pharmacokinetic Assessment is Modulated by Affinity, Incubation Time, and Bioanalytical Platform.

    PubMed

    Talbot, Jeffrey J; Calamba, Dominador; Pai, Melody; Ma, Mark; Thway, Theingi M

    2015-11-01

    Decisions about efficacy and safety of therapeutic proteins (TP) designed to target soluble ligands are made in part by their ex vivo quantification. Ligand binding assays (LBAs) are critical tools in measuring serum TP levels in pharmacokinetic, toxicokinetic, and pharmacodynamic studies. This study evaluated the impact of reagent antibody affinities, assay incubation times, and analytical platform on free or total TP quantitation. An ELISA-based LBA that measures monoclonal anti-sclerostin antibody (TPx) was used as the model system. To determine whether the method measures free or total TPx, the effects of K on, K off, and K D were determined. An 8:1 molar ratio of sclerostin (Scl) to TPx compared to a 1:1 molar ratio produced by rabbit polyclonal antibodies to TPx was required to achieve IC50, a measure of TPx interference effectiveness, making it unclear whether the ELISA truly measured free TPx. Kinetic analysis revealed that Scl had a rapid dissociation rate (K off) from TPx and that capture and detection antibodies had significantly higher binding affinities (K D) to TPx. These kinetic limitations along with long ELISA incubation times lead to the higher molar ratios (8:1) required for achieving 50% inhibition of TPx. However, a microfluidic platform with the same reagent pairs required shorter incubations to achieve a lower Scl IC50 molar ratio (1:1). The findings from this study provide the bioanalytical community with a deeper understanding of how reagent and platform selection for LBAs can affect what a particular method measures, either free or total TP concentrations.

  15. 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.

  16. Measuring oxygen tension modulation, induced by a new pre-radiotherapy therapeutic, in a mammary window chamber mouse model

    NASA Astrophysics Data System (ADS)

    Schafer, Rachel; Gmitro, Arthur F.

    2015-03-01

    Tumor regions under hypoxic or low oxygen conditions respond less effectively to many treatment strategies, including radiation therapy. A novel investigational therapeutic, NVX-108 (NuvOx Pharma), has been developed to increase delivery of oxygen through the use of a nano-emulsion of dodecofluoropentane. By raising pO2 levels prior to delivering radiation, treatment efficacy may be improved. To aid in evaluating the novel drug, oxygen tension was quantitatively measured, spatially and temporally, to record the effect of administrating NVX-108 in an orthotopic mammary window chamber mouse model of breast cancer. The oxygen tension was measured through the use of an oxygen-sensitive coating, comprised of phosphorescent platinum porphyrin dye embedded in a polystyrene matrix. The coating, applied to the surface of the coverslip of the window chamber through spin coating, is placed in contact with the mammary fat pad to record the oxygenation status of the surface tissue layer. Prior to implantation of the window chamber, a tumor is grown in the SCID mouse model by injection of MCF-7 cells into the mammary fat pad. Two-dimensional spatial distributions of the pO2 levels were obtained through conversion of measured maps of phosphorescent lifetime. The resulting information on the spatial and temporal variation of the induced oxygen modulation could provide valuable insight into the optimal timing between administration of NVX-108 and radiation treatment to provide the most effective treatment outcome.

  17. Therapeutic Nanodevices

    NASA Astrophysics Data System (ADS)

    Lee, Stephen C.; Ruegsegger, Mark; Barnes, Philip D.; Smith, Bryan R.; Ferrari, Mauro

    Therapeutic nanotechnology offers minimally invasive therapies with high densities of function concentrated in small volumes, features that may reduce patient morbidity and mortality. Unlike other areas of nanotechnology, novel physical properties associated with nanoscale dimensionality are not the raison d'etre of therapeutic nanotechnology, whereas the aggregation of multiple biochemical (or comparably precise) functions into controlled nanoarchitectures is. Multifunctionality is a hallmark of emerging nanotherapeutic devices, and multifunctionality can allow nanotherapeutic devices to perform multi-step work processes, with each functional component contributing to one or more nanodevice subroutine such that, in aggregate, subroutines sum to a cogent work process. Cannonical nanotherapeutic subroutines include tethering (targeting) to sites of disease, dispensing measured doses of drug (or bioactive compound), detection of residual disease after therapy and communication with an external clinician/operator. Emerging nanotherapeutics thus blur the boundaries between medical devices and traditional pharmaceuticals. Assembly of therapeutic nanodevices generally exploits either (bio)material self assembly properties or chemoselective bioconjugation techniques, or both. Given the complexity, composition, and the necessity for their tight chemical and structural definition inherent in the nature of nanotherapeutics, their cost of goods (COGs) might exceed that of (already expensive) biologics. Early therapeutic nanodevices will likely be applied to disease states which exhibit significant unmet patient need (cancer and cardiovascular disease), while application to other disease states well-served by conventional therapy may await perfection of nanotherapeutic design and assembly protocols.

  18. Therapeutic Nanodevices

    NASA Astrophysics Data System (ADS)

    Lee, Stephen; Ruegsegger, Mark; Barnes, Philip; Smith, Bryan; Ferrari, Mauro

    Therapeutic nanotechnology offers minimally invasive therapies with high densities of function concentrated in small volumes, features that may reduce patient morbidity and mortality. Unlike other areas of nanotechnology, novel physical properties associated with nanoscale dimensionality are not the raison d'être of therapeutic nanotechnology, whereas the aggregation of multiple biochemical (or comparably precise) functions into controlled nanoarchitectures is. Multifunctionality is a hallmark of emerging nanotherapeutic devices, and multifunctionality can allow nanotherapeutic devices to perform multistep work processes, with each functional component contributing to one or more nanodevice subroutine such that, in aggregate, subroutines sum to a cogent work process. Cannonical nanotherapeutic subroutines include tethering (targeting) to sites of disease, dispensing measured doses of drug (or bioactive compound), detection of residual disease after therapy and communication with an external clinician/operator. Emerging nanotherapeutics thus blur the boundaries between medical devices and traditional pharmaceuticals. Assembly of therapeutic nanodevices generally exploits either (bio)material self-assembly properties or chemoselective bioconjugation techniques, or both. Given the complexity, composition, and the necessity for their tight chemical and structural definition inherent in the nature of nanotherapeutics, their cost of goods (COGs) might exceed that of (already expensive) biologics. Early therapeutic nanodevices will likely be applied to disease states which exhibit significant unmet patient need (cancer and cardiovascular disease), while application to other disease states well-served by conventional therapy may await perfection of nanotherapeutic design and assembly protocols.

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

    PubMed Central

    2012-01-01

    Summary 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. PMID:22958542

  20. The Alliance for Cellular Signaling Plasmid Collection

    PubMed Central

    Zavzavadjian, Joelle R.; Couture, Sam; Park, Wei Sun; Whalen, James; Lyon, Stephen; Lee, Genie; Fung, Eileen; Mi, Qingli; Liu, Jamie; Wall, Estelle; Santat, Leah; Dhandapani, Kavitha; Kivork, Christine; Driver, Adrienne; Zhu, Xiaocui; Chang, Mi Sook; Randhawa, Baljinder; Gehrig, Elizabeth; Bryan, Heather; Verghese, Mary; Maer, Andreia; Saunders, Brian; Ning, Yuhong; Subramaniam, Shankar; Meyer, Tobias; Simon, Melvin I.; O’Rourke, Nancy; Chandy, Grischa; Fraser, Iain D. C.

    2012-01-01

    Cellular responses to inputs that vary both temporally and spatially are determined by complex relationships between the components of cell signaling networks. Analysis of these relationships requires access to a wide range of experimental reagents and techniques, including the ability to express the protein components of the model cells in a variety of contexts. As part of the Alliance for Cellular Signaling, we developed a robust method for cloning large numbers of signaling ORFs into Gateway® entry vectors, and we created a wide range of compatible expression platforms for proteomics applications. To date, we have generated over 3000 plasmids that are available to the scientific community via the American Type Culture Collection. We have established a website at www.signaling-gateway.org/data/plasmid/ that allows users to browse, search, and blast Alliance for Cellular Signaling plasmids. The collection primarily contains murine signaling ORFs with an emphasis on kinases and G protein signaling genes. Here we describe the cloning, databasing, and application of this proteomics resource for large scale subcellular localization screens in mammalian cell lines. PMID:17192258

  1. Relationships among patient hostility, anger expression, depression, and the working alliance in a work hardening program.

    PubMed

    Burns, J W; Higdon, L J; Mullen, J T; Lansky, D; Wei, J M

    1999-01-01

    Hostility, anger expression, and depression may adversely affect the response of chronic pain patients to pain or functional restoration programs by hampering the development of good working alliances between patients and physical or occupational therapists. Measures of hostility, anger expression, and depression and the Working Alliance Inventory (WAI) were completed by 71 patients with chronic pain (stemming from work-related injuries) prior to starting a "work hardening" program. The physical or occupational therapist acting as any given patient's "program manager" completed the WAI, as well. Hostility and anger expression were correlated negatively only with patient ratings of the working alliance. Therapist ratings were predicted by the interaction of patient anger expression and depression, such that therapists reported their poorest alliances with patients who were both depressed and expressed anger. Results imply that hostility and the propensity to express anger may diminish a pain patient's capacity to foster a collaborative relationship with physical or occupational therapists, while therapists may readily become alienated from depressed and irritable patients.

  2. 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

  3. 78 FR 35747 - Airworthiness Directives; Engine Alliance Turbofan Engines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-14

    ... Turbofan Engines AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final rule. SUMMARY: We are adopting a new airworthiness directive (AD) for certain Engine Alliance GP7270 and GP7277 turbofan engines...) Applicability This AD applies to Engine Alliance GP7270 and GP7277 turbofan engines with a high-pressure...

  4. Care and Control: Working Alliance among Adolescents in Authoritarian Settings

    ERIC Educational Resources Information Center

    Magrinelli Orsi, Mylene; Lafortune, Denis; Brochu, Serge

    2010-01-01

    This article reviews the literature published in the last 20 years on working alliance in adolescents involuntarily enrolled in intervention programs. Firstly, Bordin's adaptation of the concept of working alliance to adolescent populations is discussed. This is followed by an analysis of the main results of empirical studies on helping…

  5. 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,…

  6. 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,…

  7. Care and Control: Working Alliance among Adolescents in Authoritarian Settings

    ERIC Educational Resources Information Center

    Magrinelli Orsi, Mylene; Lafortune, Denis; Brochu, Serge

    2010-01-01

    This article reviews the literature published in the last 20 years on working alliance in adolescents involuntarily enrolled in intervention programs. Firstly, Bordin's adaptation of the concept of working alliance to adolescent populations is discussed. This is followed by an analysis of the main results of empirical studies on helping…

  8. 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,…

  9. Service company alliance reduces tight sands frac costs

    SciTech Connect

    Hunter, J.L. ); Stuchly, S.G. )

    1994-08-15

    Smaller, multiple-stage fracture treatments, worked out by an alliance between a producing and a service company, were a significant element in reducing costs for fracturing Carthage Cotton Valley infill wells in Panola County, Texas. Pennzoil's infill drilling program takes advantage of the Texas Railroad Commission's (RRC) ruling that allows optional 80-acre well spacing in this tight gas-sand reservoir. Pennzoil spudded 29 wells between September 1992 and December 1993 and expects to spud 20 more in 1994. The Pennzoil-Halliburton alliance began in September 1992 for the purpose of drilling and completing Cotton Valley infill wells through 1993. The two companies share the cost of new technology development, with Pennzoil providing the rig times to test Halliburton technology. To date, the alliance has experimented with an elastic strain relaxation, a six-arm extensometer, and a water-recovery surfactant. Some of the features of the alliance are: Halliburton guarantees the availability of crews and equipment to meet Pennzoil's drilling and completion schedule; Halliburton technical advisor studies existing wells to find candidates for workover or refracture; the technical advisor analyzes, plants, and evaluates the ongoing program; and the alliance is not rigidly structured, and other service companies perform part of the work. Both parties have benefited financially from the alliance and well performance has met or exceeded expectations. The alliance has enabled Pennzoil to stay on a rigid and aggressive drilling schedule and through efforts of the alliance, fracture orientation has been confirmed.

  10. 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,…

  11. The Global Research Alliance on agricultural greenhouse gases

    USDA-ARS?s Scientific Manuscript database

    The Global Research Alliance on Agricultural Greenhouse Gases was proposed by New Zealand at the United Nations Framework Convention on Climate Change Conference of the Parties (COP) in Copenhagen in 2009 and developed in partnership with the United States. This alliance now includes 32 member count...

  12. Roles and Alliances within Mexican-American and Anglo Families.

    ERIC Educational Resources Information Center

    Jaramillo, Patricio T.; Zapata, Jesse T.

    1987-01-01

    Examined Mexican-American and White children's perceptions of roles (of siblings and parents) and alliances (between parents and siblings) within their families. Tested whether assignment to roles and alliances was based on birth order and/or sex. Found birth-order and sex differences when treating Mexican-American and White samples separately.…

  13. Clients' Pretreatment Counseling Expectations as Predictors of the Working Alliance

    ERIC Educational Resources Information Center

    Patterson, Candace L.; Uhlin, Brian; Anderson, Timothy

    2008-01-01

    Because research suggests that counseling expectations are malleable and that alliance ratings predict clinical outcomes, the relationship between this pretreatment client characteristic (expectations) and the quality of the alliance early in treatment deserves further attention. This study examined the relationships between 57 clients'…

  14. Therapist stress, coping, career sustaining behavior and the working alliance.

    PubMed

    Briggs, Denise Broholm; Munley, Patrick H

    2008-10-01

    Relations were examined among therapist stress, coping styles, career sustaining behaviors and therapist working alliance. 160 therapists completed a demographic questionnaire, a rating of stress experienced in work as a psychotherapist, a rating of stress experienced in work with an individual client, the Perceived Stress Scale, the Career Sustaining Behavior Questionnaire, the COPE, and the Working Alliance Inventory. After controlling for demographic and therapists' stress variables, and alternating entry of Career Sustaining Behavior and COPE scores in the regression model, Career Sustaining Behavior contributed significant variance to predicting working alliance, and COPE scores accounted for significant variance in working alliance with active coping a significant predictor. Career Sustaining Behavior and COPE scores entered together accounted for significant unique variance in Working Alliance with career sustaining behavior and avoidant coping identified as significant predictors.

  15. Library Services Alliance of New Mexico. 1994 Annual report

    SciTech Connect

    1995-09-01

    The Library Services Alliance is a unique multi-type library consortium committed to resource sharing. As a voluntary association of university and governmental laboratory libraries supporting scientific research, the Alliance has become a leader in New Mexico in using cooperative ventures to cost-effectively expand resources supporting their scientific and technical communities. During 1994, the alliance continued to expand on their strategic planning foundation to enhance access to research information for the scientific and technical communities. Significant progress was made in facilitating easy access to the on-line catalogs of member libraries via connections through the Internet. Access to Alliance resources is now available via the World Wide Web and Gopher, as well as links to other databases and electronic information. This report highlights the accomplishments of the Alliance during calendar year 1994.

  16. Geoscience Alliance--A National Alliance for Broadening Participation of Native Americans in the Geosciences

    NASA Astrophysics Data System (ADS)

    Dalbotten, D. M.; Pellerin, H.; Greensky, L.; Burger, A.

    2009-12-01

    The continuing underrepresentation of Native Americans in the geosciences can only mean that native voices go unheard in setting research agendas and priorities. This is particularly significant where issues such as global climate change impact the land and livelihood of Native American communities. This talk will outline progress towards a Geoscience Alliance, with participation by faculty from tribal colleges, universities, and research centers; native elders and community members; students (K12, undergraduate, and graduate); formal and informal educators; and other interested individuals. Our focus will be on defining goals for this alliance, i.e., new research in Geoscience education, defining best practices, inclusion of Native voices in Geoscience research, the potential for new collaborations, and promotion of opportunities for Native students and communities.

  17. The international Planetary Data Alliance: overview

    NASA Astrophysics Data System (ADS)

    Sarkissian, Alain; Crichton, Daniel J.; Gopala Krishna, B.

    The IPDA's main emphasis is to ease discovery, access and use of planetary data by world-wide scientists regardless of which agency is collecting and distributing the data. Ensuring proper capture, accessibility and availability of the data is the task of the individual space agencies. The IPDA is focusing on developing an international standard which allows the following capabilities: query, access and usage of data across international planetary data archive systems. While, trends in other areas of space science are concentrating on the sharing of science data from diverse standards and collection methods, the IPDA shall concentrate on promoting standards which drive common methods for collecting and describing planetary science data across the international community. Such an approach will better support the long term goal of easing data sharing across system and agency boundaries. An initial starting point for developing such a standard will be internationalization of NASA's Planetary Data System standards. We will present here the current activities of the Alliance.

  18. Science and Engineering Alliance: A new resource for the nation

    SciTech Connect

    1998-04-01

    The Lawrence Livermore National Laboratory and four major Historically Black Colleges and Universities with strong research and development capabilities in science, engineering and computer technology have formed the Science and Engineering Alliance. Located in California, Alabama, Mississippi, Louisiana and Texas, each brings to the Alliance a tradition of research and development and educational excellence. This unique consortium is now available to perform research development and training to meet the needs of the public and private sectors. The Alliance was formed to help assure an adequate supply of top-quality minority scientists in the next century, while simultaneously meeting the research and development needs of the public and private sectors.

  19. Research on Efficiency of Knowledge Transfer in Technical Innovation Alliances

    NASA Astrophysics Data System (ADS)

    Zhang-sheng, Jiang

    The knowledge transfer efficiency (KTE) is closely relative to the success or failure of technology innovation in strategic alliances. This paper takes the KTE as the essential variable to establish the benefit function model of technology innovations to explore the KTE's influences on partners' innovative decisions under two different modes: independent innovations and alliance innovations. It is found that the higher the KTE, the greater the reducing extent of production costs is. The results could provide some theoretical supports for selections of the optimal competitive-ooperative relationship and managerial flexibility in technical innovation alliances.

  20. Noninvasive Measures of Ventricular-Arterial Coupling and Circumferential Strain Predict Cancer Therapeutics-Related Cardiac Dysfunction.

    PubMed

    Narayan, Hari K; French, Benjamin; Khan, Abigail M; Plappert, Theodore; Hyman, David; Bajulaiye, Akinyemi; Domchek, Susan; DeMichele, Angela; Clark, Amy; Matro, Jennifer; Bradbury, Angela; Fox, Kevin; Carver, Joseph R; Ky, Bonnie

    2016-10-01

    This study sought to determine the relationships between echocardiography-derived measures of myocardial mechanics and cancer therapeutics-related cardiac dysfunction (CTRCD). Doxorubicin and trastuzumab are highly effective breast cancer therapies, but have a substantial risk of CTRCD. There is a critical need for the early detection of patients at increased risk of toxicity. We performed a prospective, longitudinal cohort study of breast cancer participants undergoing doxorubicin and/or trastuzumab therapy. Echocardiography was performed prior to therapy initiation (baseline) and at standardized follow-up intervals during and after completion of therapy. Ejection fraction (EF), strain, strain rate, and ventricular-arterial coupling (effective arterial elastance [Ea]/end-systolic elastance [Eessb]) were quantitated. CTRCD was defined as a ≥10% reduction in EF from baseline to <50%. Multivariable logistic regression models were used to determine the associations between baseline levels and changes from baseline in echocardiographic measures and CTRCD. Receiver-operating characteristic curves were used to evaluate the predictive ability of these measures. In total, 135 participants contributed 517 echocardiograms to the analysis. Over a median follow-up time of 1.9 years (interquartile range: 0.9 to 2.4 years), 21 participants (15%) developed CTRCD. In adjusted models, baseline levels and changes in Ea/Eessb, circumferential strain, and circumferential strain rate were associated with 21% to 38% increased odds of CTRCD (p < 0.001). Changes in longitudinal strain (p = 0.037), radial strain (p = 0.015), and radial strain rate (p = 0.006) were also associated with CTRCD. Ea/Eessb (area under the curve: 0.703; 95% confidence interval: 0.583 to 0.807) and circumferential strain (area under the curve: 0.655; 95% confidence interval: 0.517 to 0.767) demonstrated the greatest predictive utility. Sensitivity analyses using an alternative CTRCD definition did not

  1. The "educational alliance" as a framework for reconceptualizing feedback in medical education.

    PubMed

    Telio, Summer; Ajjawi, Rola; Regehr, Glenn

    2015-05-01

    Feedback has long been considered a vital component of training in the health professions. Nonetheless, it remains difficult to enact the feedback process effectively. In part, this may be because, historically, feedback has been framed in the medical education literature as a unidirectional content-delivery process with a focus on ensuring the learner's acceptance of the content. Thus, proposed solutions have been organized around mechanistic, educator-driven, and behavior-based best practices. Recently, some authors have begun to highlight the role of context and relationship in the feedback process, but no theoretical frameworks have yet been suggested for understanding or exploring this relational construction of feedback in medical education. The psychotherapeutic concept of the "therapeutic alliance" may be valuable in this regard.In this article, the authors propose that by reorganizing constructions of feedback around an "educational alliance" framework, medical educators may be able to develop a more meaningful understanding of the context-and, in particular, the relationship-in which feedback functions. Use of this framework may also help to reorient discussions of the feedback process from effective delivery and acceptance to negotiation in the environment of a supportive educational relationship.To explore and elaborate these issues and ideas, the authors review the medical education literature to excavate historical and evolving constructions of feedback in the field, review the origins of the therapeutic alliance and its demonstrated utility for psychotherapy practice, and consider implications regarding learners' perceptions of the supervisory relationship as a significant influence on feedback acceptance in medical education settings.

  2. 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…

  3. 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…

  4. 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

    ... COMMISSION Order of Suspension of Trading; In The Matter of Crown Alliance Capital Limited October 22, 2013... information concerning the securities of Crown Alliance Capital Limited (``Crown Alliance''), quoted under the ticker symbol CACL, because of questions regarding the accuracy of assertions in Crown Alliance's...

  5. 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.

  6. Parental alliance and family functioning in pediatric obesity from both parents' perspectives.

    PubMed

    Mazzeschi, Claudia; Pazzagli, Chiara; Laghezza, Loredana; De Giorgi, Giovanni; Reboldi, Gianpaolo; De Feo, Pierpaolo

    2013-10-01

    The aim of the present study was to investigate the maternal and paternal specific contributions on the associations between family socioeconomic status, parental anthropometric factors, parental alliance, and family functioning. These were assessed separately for mothers and fathers, by means of a case-control study with families of Italian youths with and without overweight/obesity. Ninety families with children aged 11 to 16 years (mean = 13.27 years; SD = 1.5) participated in the study. Half of the families included children with overweight/obesity (n = 45). The body mass indices (BMIs) of youths and parents were measured and the former transformed in BMI z-scores. The parents completed the Parenting Alliance Measure and the Family Assessment Measure Version III, General Scale. Higher levels of dysfunction in parental alliance and family functioning of the mothers and fathers of the overweight/obese group were found. Socioeconomic status did not contribute significantly to the prediction of overweight and obesity in youth. Both maternal and paternal BMIs were positively associated with youth overweight/obesity. The degrees of parental alliance perceived by both mothers (odds ratio [OR], 81; 95% confidence interval [CI], 0.72-0.90) and fathers (OR, 89; 95% CI, 0.81-0.98) predicted child's weight status. The perception of poor parental and familial functioning by both parents contributed to the prediction of overweight and obesity in youth (mother: OR, 1.06; 95% CI, 1.02-1.10; father: OR, 1.06; 95% CI, 1.01-1.11). The results support a strong effect of parental and family functioning on a youth's overweight/obesity also from the father's perspective. The importance of considering the father's perspective is discussed.

  7. National Alliance of Clean Energy Incubator Activities - Final Technical Report

    SciTech Connect

    Chris Downing, P.E.

    2004-12-14

    Summary of activity related to development of the Alliance of Clean Energy Business Incubators and incubation services provided to the clean energy sector by the Advanced Technology Development Center at the Georgia Institute of Technology.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Reliability Generalization of Working Alliance Inventory Scale Scores.

    ERIC Educational Resources Information Center

    Hanson, William E.; Curry, Kyle T.; Bandalos, Deborah L.

    2002-01-01

    Used reliability generalization to study five versions of the Working Alliance Inventory (A. Horvath, 1981; WAI), analyzing 67 internal consistency estimates, 6 interrater reliability estimates, and 4 study characteristics. In general WAI scale scores appear to be robust. (SLD)

  13. 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

  14. 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

  15. Technological Innovation, Corporate R&D Alliances and Organizational Learning

    DTIC Science & Technology

    1995-01-01

    end of the cold war, which has seen the transformation of national security policies based on relative military might to those designed to maintain...and economic benefits from alliance participation, particularly international R&D alliances. To 1 Organizational learning encompasses both the design ...open new markets, and therefore new consumer and customer sources of innovation. Antitrust efforts designed to enforce the General Agreement on

  16. NCI Alliance for Nanotechnology in Cancer - Tutorials and Seminar Series

    Cancer.gov

    View details about tutorials and seminars hosted by Alliance members and members of the cancer research community. These events provide a forum for sharing innovative perspectives on research and development efforts in the field of nanotechnology and their application to cancer diagnosis, treatment, and prevention. Also visit the Event Listing section to find scientific meetings and events where NCI Alliance for Nanotechnology in Cancer leaders and members are participating.

  17. The Helping Alliance Questionnaire: psychometric properties in patients with substance dependence.

    PubMed

    De Weert-Van Oene, G H; De Jong, C A; Jörg, F; Schrijvers, G J

    1999-09-01

    Psychometric properties of the Helping Alliance Questionnaire (HAQ) are analyzed in a population of 340 substance-dependent patients of an addiction clinic in the Netherlands. Factor analysis yields a two-factor structure: Cooperation and Helpfulness. The scales show fair correlations with three out of seven scales from the Barrett-Lennard Relationship Inventory. Length of Stay in Detox is predicted by scores on the Helpfulness scale and noncompliance by scores on the Cooperation scale. Besides this, intermediate outcome measures are correlated with HAQ scores. The HAQ seems to be a "quick scan" instrument to give a quick and global impression of the patients' perception of the quality of the working alliance with the therapist.

  18. 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.

  19. Alliance for Sequestration Training, Outreach, Research & Education

    SciTech Connect

    Olson, Hilary

    2013-09-01

    The Sequestration Training, Outreach, Research and Education (STORE) Alliance at The University of Texas at Austin completed its activity under Department of Energy Funding (DE- FE0002254) on September 1, 2013. The program began as a partnership between the Institute for Geophysics, the Bureau of Economic Geology and the Petroleum and Geosystems Engineering Department at UT. The initial vision of the program was to promote better understanding of CO2 utilization and storage science and engineering technology through programs and opportunities centered on training, outreach, research and technology transfer, and education. With over 8,000 hrs of formal training and education (and almost 4,500 of those hours awarded as continuing education credits) to almost 1,100 people, STORE programs and activities have provided benefits to the Carbon Storage Program of the Department of Energy by helping to build a skilled workforce for the future CCS and larger energy industry, and fostering scientific public literacy needed to continue the U.S. leadership position in climate change mitigation and energy technologies and application. Now in sustaining mode, the program is housed at the Center for Petroleum and Geosystems Engineering, and benefits from partnerships with the Gulf Coast Carbon Center, TOPCORP and other programs at the university receiving industry funding.

  20. Wind Alliance for the Sustainable Development

    SciTech Connect

    Camacho, Damarys Gonzalez

    2012-09-30

    The Puerto Rico Energy Affairs Administration (PREAA) is actively engaged in the implementation of existing public policy for the conservation of energy and promotion of renewable energy to reduce consumer’s costs and reduce environmental impact. Puerto Rico is an island in where no own reserves of gas, oil or coal exists. This severe dependence in on foreign oil is reflected in the higher cost of electricity in Puerto Rico, which is significantly higher than most of the United States. Therefore, public energy policy of Puerto Rico places emphasis on diversification of energy sources and the use of renewable energy technologies. The Wind energy Alliance for the Sustainable Development project focused on the formation of a wind energy working group to educate and promote wind energy technologies; at the same time the evaluating the viability of wind energy in Puerto Rico. The educational outreach was performed through a series of wind energy workshops where interested parties such as, installers, sellers, engineers, general public even opposing groups participate from the activities.

  1. Heat pump associations, alliances, and allies

    SciTech Connect

    Not Available

    1992-09-01

    Associations, Alliances, and Allies, a seminar and workshop sponsored by the Electric Power Research Institute, was held in Memphis, Tennessee, April 10--11, 1991. The focus of the meeting was relationships forged between electric utilities and trade allies that sell residential heat pumps. one hundred and seven representatives of electric utilities, dealer/contractors, manufacturers, and consultants attended. Electric utility trade ally programs run the gamut from coop advertising to heat pump association to elaborate technician training programs. All utility participants recognize the important programs, since it is the trade ally who sells, installs, and services heat pumps, while it is the electric utility who gets blamed if the heat pumps fail to operate properly or are inefficient. Heat pumps are efficient and effective, but their efficiency and effectiveness depends critically upon the quality of installation and maintenance. A utility can thus help to ensure satisfied customers and can also help to achieve its own load shape objectives by working closely with its trade allies, the dealers, contractors, manufacturers, and distributors. Attendees spent the morning sessions of the two day meeting in plenary sessions, hearing about utility and dealer heat pump programs and issues. Afternoon roundtable discussions provided structured forums to discuss: Advertising; Heat pump association startup and operation; Rebates and incentives; Technician training school and centers; Installation inspection and dealer qualification; and Heat pump association training. These proceedings report on the papers presented in the morning plenary sessions and summarize the main points discussed in the afternoon workshops.

  2. Confirmatory Factor Analysis of the Patient Version of the Working Alliance Inventory--Short Form Revised.

    PubMed

    Falkenström, Fredrik; Hatcher, Robert L; Holmqvist, Rolf

    2015-10-01

    The working alliance concerns the quality of collaboration between patient and therapist in psychotherapy. One of the most widely used scales for measuring the working alliance is the Working Alliance Inventory (WAI). For the patient-rated version, the short form developed by Hatcher and Gillaspy (WAI-SR) has shown the best psychometric properties. In two confirmatory factor analyses of the WAI-SR, approximate fit indices were within commonly accepted norms, but the likelihood ratio chi-square test showed significant ill-fit. The present study used Bayesian structural equations modeling with zero mean and small variance priors to test the factor structure of the WAI-SR in three different samples (one American and two Swedish; N = 235, 634, and 234). Results indicated that maximum likelihood confirmatory factor analysis showed poor model fit because of the assumption of exactly zero residual correlations. When residual correlations were estimated using small variance priors, model fit was excellent. A two-factor model had the best psychometric properties. Strong measurement invariance was shown between the two Swedish samples and weak factorial invariance between the Swedish and American samples. The most important limitation concerns the limited knowledge on when the assumption of residual correlations being small enough to be considered trivial is violated.

  3. Le public de l'Ecole Internationale de l'Alliance francaise de Paris (The Student Population of the International School of the Alliance Francaise in Paris).

    ERIC Educational Resources Information Center

    Gibert, Pierre

    1979-01-01

    Discusses the results of a survey of characteristics of adult students of French attending courses at the Alliance Francaise in Paris. Also examines some of the social services provided by the Alliance, including housing, employment, and meal services. (AM)

  4. 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

  5. The Relationship of Client Stages of Change to Working Alliance and Outcome in Short-Term Counseling

    ERIC Educational Resources Information Center

    Rochlen, Aaron B.; Rude, Stephanie S.; Baron, Augustine

    2005-01-01

    This study evaluated the relationship of J. O. Prochaska's (1984; J. O. Prochaska & C. C. DiClemente, 1992) transtheoretical model of change with the process and outcome of short-term counseling in college help seekers. Participants completed measures of readiness to change, psychological symptoms, and working alliance. Clients in the…

  6. 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.

  7. Pilot Study Measuring the Effects of Therapeutic Horseback Riding on School-Age Children and Adolescents with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Gabriels, Robin L.; Agnew, John A.; Holt, Katherine D.; Shoffner, Amy; Zhaoxing, Pan; Ruzzano, Selga; Clayton, Gerald H.; Mesibov, Gary

    2012-01-01

    This preliminary study examined the effects of 10 weekly lessons of therapeutic horseback riding (THR) on 42 participants diagnosed with an autism spectrum disorder (ages 6-16 years) compared to a subset (n=16) of the total study population who were first evaluated before and after a 10-week waitlist control condition. All participants received…

  8. A model measuring therapeutic inertia and the associated factors among diabetes patients: A nationwide population-based study in Taiwan.

    PubMed

    Huang, Li-Ying; Shau, Wen-Yi; Yeh, Hseng-Long; Chen, Tsung-Tai; Hsieh, Jun Yi; Su, Syi; Lai, Mei-Shu

    2015-01-01

    This article presents an analysis conducted on the patterns related to therapeutic inertia with the aim of uncovering how variables at the patient level and the healthcare provider level influence the intensification of therapy when it is clinically indicated. A cohort study was conducted on 899,135 HbA1c results from 168,876 adult diabetes patients with poorly controlled HbA1c levels. HbA1c results were used to identify variations in the prescription of hypoglycemic drugs. Logistic regression and hierarchical linear models (HLMs) were used to determine how differences among healthcare providers and patient characteristics influence therapeutic inertia. We estimated that 38.5% of the patients in this study were subject to therapeutic inertia. The odds ratio of cardiologists choosing to intensify therapy was 0.708 times that of endocrinologists. Furthermore, patients in medical centers were shown to be 1.077 times more likely to be prescribed intensified treatment than patients in primary clinics. The HLMs presented results similar to those of the logistic model. Overall, we determined that 88.92% of the variation in the application of intensified treatment was at the within-physician level. Reducing therapeutic inertia will likely require educational initiatives aimed at ensuring adherence to clinical practice guidelines in the care of diabetes patients. © 2014, The American College of Clinical Pharmacology.

  9. Pilot Study Measuring the Effects of Therapeutic Horseback Riding on School-Age Children and Adolescents with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Gabriels, Robin L.; Agnew, John A.; Holt, Katherine D.; Shoffner, Amy; Zhaoxing, Pan; Ruzzano, Selga; Clayton, Gerald H.; Mesibov, Gary

    2012-01-01

    This preliminary study examined the effects of 10 weekly lessons of therapeutic horseback riding (THR) on 42 participants diagnosed with an autism spectrum disorder (ages 6-16 years) compared to a subset (n=16) of the total study population who were first evaluated before and after a 10-week waitlist control condition. All participants received…

  10. 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.

  11. 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

  12. What Do Chinese and Foreign Universities Value about Their Strategic Alliances? Exploring a Dimension of Higher Education Alliances in a Cross Cultural Context

    ERIC Educational Resources Information Center

    Willis, Mike

    2003-01-01

    There are now over 5,000 alliances between Chinese and foreign universities but there is little research on how managers from the two sides value the various aspects of their educational alliances. This research finds that both sides valued a range of alliance levels, types, activities, sizes and structures but there were significant differences.…

  13. The International Planetary Data Alliance (IPDA)

    NASA Astrophysics Data System (ADS)

    Stein, Thomas; Gopala Krishna, Barla; Crichton, Daniel J.

    2016-07-01

    The International Planetary Data Alliance (IPDA) is a close association of partners with the aim of improving the quality of planetary science data and services to the end users of space based instrumentation. The specific mission of the IPDA is to facilitate global access to, and exchange of, high quality scientific data products managed across international boundaries. Ensuring proper capture, accessibility and availability of the data is the task of the individual member space agencies. The IPDA is focused on developing an international standard that allows discovery, query, access, and usage of such data across international planetary data archive systems. While trends in other areas of space science are concentrating on the sharing of science data from diverse standards and collection methods, the IPDA concentrates on promoting governing data standards that drive common methods for collecting and describing planetary science data across the international community. This approach better supports the long term goal of easing data sharing across system and agency boundaries. An initial starting point for developing such a standard will be internationalization of NASA's Planetary Data System's (PDS) PDS4 standard. The IPDA was formed in 2006 with the purpose of adopting standards and developing collaborations across agencies to ensure data is captured in common formats. It has grown to a dozen member agencies represented by a number of different groups through the IPDA Steering Committee. Member agencies include: Armenian Astronomical Society, China National Space Agency (CNSA), European Space Agency (ESA), German Aerospace Center (DLR), Indian Space Research Organization (ISRO), Italian Space Agency (ASI), Japanese Aerospace Exploration Agency (JAXA), National Air and Space Administration (NASA), National Centre for Space Studies (CNES), Space Research Institute (IKI), UAE Space Agency, and UK Space Agency. The IPDA Steering Committee oversees the execution of

  14. Final report : PATTON Alliance gazetteer evaluation project.

    SciTech Connect

    Bleakly, Denise Rae

    2007-08-01

    In 2005 the National Ground Intelligence Center (NGIC) proposed that the PATTON Alliance provide assistance in evaluating and obtaining the Integrated Gazetteer Database (IGDB), developed for the Naval Space Warfare Command Research group (SPAWAR) under Advance Research and Development Activity (ARDA) funds by MITRE Inc., fielded to the text-based search tool GeoLocator, currently in use by NGIC. We met with the developers of GeoLocator and identified their requirements for a better gazetteer. We then validated those requirements by reviewing the technical literature, meeting with other members of the intelligence community (IC), and talking with both the United States Geologic Survey (USGS) and the National Geospatial Intelligence Agency (NGA), the authoritative sources for official geographic name information. We thus identified 12 high-level requirements from users and the broader intelligence community. The IGDB satisfies many of these requirements. We identified gaps and proposed ways of closing these gaps. Three important needs have not been addressed but are critical future needs for the broader intelligence community. These needs include standardization of gazetteer data, a web feature service for gazetteer information that is maintained by NGA and USGS but accessible to users, and a common forum that brings together IC stakeholders and federal agency representatives to provide input to these activities over the next several years. Establishing a robust gazetteer web feature service that is available to all IC users may go a long way toward resolving the gazetteer needs within the IC. Without a common forum to provide input and feedback, community adoption may take significantly longer than anticipated with resulting risks to the war fighter.

  15. Tc-99m-ECD SPECT as the measure for therapeutic response in patients with cobalamin deficiency: Two case reports.

    PubMed

    Tu, Min-Chien; Lo, Chung-Ping; Chen, Ching-Yuan

    2016-09-01

    Cobalamin (Cbl) is an essential vitamin for human health. While an increasing body of evidence supports the negative impact of Cbl deficiency on cognition, the causality has yet to be determined, and the reported therapeutic responses after Cbl supplement therapy have been inconsistent. Besides, few reports have described neuroimaging characteristics associated with the therapeutic response. To describe and compare technetium-99m ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT) findings in 2 patients with Cbl deficiency with distinct therapeutic responses. Case 1 scored 12/30 in the mini-mental state examination (MMSE) and 34/100 in the cognitive abilities screening instrument (CASI). Profound deficits in mental manipulation, drawing, short-term/long-term memory, and verbal fluency were noted. Case 2 scored 24/30 in the MMSE and 78/100 in the CASI, mainly due to impaired mental manipulation, abstract thinking, and borderline performance in short-term memory and verbal fluency. While both cases showed widespread hypoperfusion within bilateral frontotemporal regions and thalamus on Tc-99m-ECD SPECT, Case 2 demonstrated relatively preserved radio-uptake in the frontal regions, especially the anterior cingulate cortex (ACC) and prefrontal cortex (PFC), consistent with the better therapeutic response (Case 1: 12/30 to 11/30 in the MMSE; Case 2: 24/30 to 28/30 in the MMSE). Given that the ACC integrates the limbic system and frontosubcortical circuits and the PFC governs executive function, the extent and severity of hypofrontality may be responsible for the worse prognosis. Our Tc-99m-ECD SPECT observations revealed that the negative impact on cerebral metabolic tone is relevant to the severity of Cbl deficiency, and the functional integrity of the ACC and PFC is highly associated with the preservation of global cognitive function in our cases with Cbl deficiency.

  16. Tc-99m-ECD SPECT as the measure for therapeutic response in patients with cobalamin deficiency

    PubMed Central

    Tu, Min-Chien; Lo, Chung-Ping; Chen, Ching-Yuan

    2016-01-01

    Abstract Background: Cobalamin (Cbl) is an essential vitamin for human health. While an increasing body of evidence supports the negative impact of Cbl deficiency on cognition, the causality has yet to be determined, and the reported therapeutic responses after Cbl supplement therapy have been inconsistent. Besides, few reports have described neuroimaging characteristics associated with the therapeutic response. Methods: To describe and compare technetium-99m ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT) findings in 2 patients with Cbl deficiency with distinct therapeutic responses. Results: Case 1 scored 12/30 in the mini-mental state examination (MMSE) and 34/100 in the cognitive abilities screening instrument (CASI). Profound deficits in mental manipulation, drawing, short-term/long-term memory, and verbal fluency were noted. Case 2 scored 24/30 in the MMSE and 78/100 in the CASI, mainly due to impaired mental manipulation, abstract thinking, and borderline performance in short-term memory and verbal fluency. While both cases showed widespread hypoperfusion within bilateral frontotemporal regions and thalamus on Tc-99m-ECD SPECT, Case 2 demonstrated relatively preserved radio-uptake in the frontal regions, especially the anterior cingulate cortex (ACC) and prefrontal cortex (PFC), consistent with the better therapeutic response (Case 1: 12/30 to 11/30 in the MMSE; Case 2: 24/30 to 28/30 in the MMSE). Conclusion: Given that the ACC integrates the limbic system and frontosubcortical circuits and the PFC governs executive function, the extent and severity of hypofrontality may be responsible for the worse prognosis. Our Tc-99m-ECD SPECT observations revealed that the negative impact on cerebral metabolic tone is relevant to the severity of Cbl deficiency, and the functional integrity of the ACC and PFC is highly associated with the preservation of global cognitive function in our cases with Cbl deficiency. PMID:27684816

  17. 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

  18. 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.

  19. Establishing the heparin therapeutic range using aPTT and anti-Xa measurements for monitoring unfractionated heparin therapy

    PubMed Central

    Byun, Jung-Hyun; Jang, In-Seok; Kim, Jong Woo

    2016-01-01

    Background Unfractionated heparin (UFH) has unstable pharmacokinetics and requires close monitoring. The activated partial thromboplastin time (aPTT) test has been used to monitor UFH therapy for decades in Korea, but its results can be affected by numerous variables. We established an aPTT heparin therapeutic range (HTR) corresponding to therapeutic anti-Xa levels for continuous intravenous UFH administration, and used appropriate monitoring to determine if an adequate dose of UFH was applied. Methods A total of 134 ex vivo samples were obtained from 71 patients with a variety of thromboembolisms. All patients received intravenous UFH therapy and were enrolled from June to September 2015 at Gyeongsang National University Hospital. All laboratory protocols were in accordance with the Clinical and Laboratory Standards Institute guidelines and the College of American Pathologist requirements for aPTT HTR. Results An aPTT range of 87.1 sec to 128.7 sec corresponded to anti-Xa levels of 0.3 IU/mL to 0.7 IU/mL for HTR under our laboratory conditions. Based on their anti-Xa levels, blood specimen distribution were as follows: less than 0.3 IU/mL, 65.7%; 0.3–0.7 IU/mL (therapeutic range), 33.6%; and more than 0.7 IU/mL, 0.7%. No evidence of recurring thromboembolism was observed. Conclusion Using the conventional aPTT target range may lead to inappropriate dosing of UFH. Transitioning from the aPTT test to the anti-Xa assay is required to avoid the laborious validation of the aPTT HTR test, even though the anti-Xa assay is more expensive. PMID:27722127

  20. A Hypothesis on Biological Protection from Space Radiation Through the Use of New Therapeutic Gases as Medical Counter Measures

    NASA Technical Reports Server (NTRS)

    Schoenfeld, Michael P.; Ansari, Rafat R.; Nakao, Atsunori; Wink, David

    2011-01-01

    Exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. As biological damage from exposure is associated with increased oxidative stress, it would be enabling to mitigate and/or prevent stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as both chemical radioprotectors for radical scavenging and biological promoters for management of the body s response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it is concluded that this approach may have great therapeutic potential for exposure. Furthermore, it also appears to have potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion injury, acute respiratory distress syndrome, Parkinson s and Alzheimer s disease, cataracts, and aging.

  1. A Hypothesis on Biological Protection from Space Radiation Through the Use of New Therapeutic Gases as Medical Counter Measures

    NASA Technical Reports Server (NTRS)

    Schoenfeld, Michael P.; Ansari, Rafat R.; Nakao, Atsunori; Wink, David

    2012-01-01

    Radiation exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. The concern regarding exposure to cosmic radiation is the biological damage it induces. As damage is associated with increased oxidative stress, it is important and would be enabling to mitigate and/or prevent oxidative stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as both chemical radioprotectors for radical scavenging and biological signaling molecules for management of the body s response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it is concluded that this approach may have great therapeutic potential for radiation exposure. Furthermore, it also appears to have similar potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion injury, acute respiratory distress syndrome, Parkinson s and Alzheimer s disease, cataracts, and aging.

  2. A hypothesis on biological protection from space radiation through the use of new therapeutic gases as medical counter measures.

    PubMed

    Schoenfeld, Michael P; Ansari, Rafat R; Nakao, Atsunori; Wink, David

    2012-04-04

    Radiation exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. The concern regarding exposure to cosmic radiation is biological damage that is associated with increased oxidative stress. It is therefore important and would be enabling to mitigate and/or prevent oxidative stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as chemical radioprotectors for radical scavenging and as biological signaling molecules for management of the body's response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it can be concluded that this approach may have therapeutic potential for radiation exposure. Furthermore, it also appears to have similar potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion (IR) injury, acute respiratory distress syndrome, Parkinson's and Alzheimer's disease, cataracts, and aging. We envision applying these therapies through inhalation of gas mixtures or ingestion of water with dissolved gases.

  3. A hypothesis on biological protection from space radiation through the use of new therapeutic gases as medical counter measures

    PubMed Central

    2012-01-01

    Radiation exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. The concern regarding exposure to cosmic radiation is biological damage that is associated with increased oxidative stress. It is therefore important and would be enabling to mitigate and/or prevent oxidative stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as chemical radioprotectors for radical scavenging and as biological signaling molecules for management of the body's response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it can be concluded that this approach may have therapeutic potential for radiation exposure. Furthermore, it also appears to have similar potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion (IR) injury, acute respiratory distress syndrome, Parkinson's and Alzheimer's disease, cataracts, and aging. We envision applying these therapies through inhalation of gas mixtures or ingestion of water with dissolved gases. PMID:22475015

  4. Sesquiterpenoids Isolated from Two Species of the Asteriscus Alliance.

    PubMed

    Triana, Jorge; Eiroa, José Luis; Morales, Manuel; Perez, Francisco J; Brouard, Ignacio; Quintana, José; Ruiz-Estévez, Mercedes; Estévez, Francisco; León, Francisco

    2016-05-27

    Investigation of the aerial parts of two Spanish members of the Asteriscus alliance, Asteriscus graveolens subsp. stenophyllus and Asteriscus schultzii, afforded four new sesquiterpene lactones containing a humulene skeleton (1-4) and one new sesquiterpene lactone of the asteriscanolide type (5). Their chemical structures were determined on the basis of the HRMS and from 1D and 2D NMR spectroscopic studies. Both species showed different profiles of sesquiterpenoid constituents. A. schultzii did not show humulene or asteriscane sesquiterpenes, suggesting a resemblance to the genus Pallenis, another member of the Asteriscus alliance. A literature review on chemical isolates from the Asteriscus alliance supported the placement of A. schultzii in the genus Pallenis. The isolated components (1-5) were assessed for cytotoxicity against the HL-60 and MOLT-3 leukemia cell lines, with compound 1 showing activity in both biological assays (IC50 value range 4.1-5.4 μM).

  5. 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.

  6. Wind-US 1.0 Released by NPARC Alliance

    NASA Technical Reports Server (NTRS)

    Towne, Charles E.

    2005-01-01

    The NPARC (National Project for Application-oriented Research in CFD) Alliance has released Version 1.0 of Wind-US, the latest in its line of general-purpose, multizone, compressible-flow Navier-Stokes solvers. The NPARC Alliance is a formal partnership between the NASA Glenn Research Center and the Air Force Arnold Engineering Development Center, with additional significant involvement by the Boeing Company s Phantom Works Group, whose mission is to provide an applications-oriented computational fluid dynamics (CFD) system primarily for aerospace flow simulation. The alliance is committed to the long-range maintenance and improvement of this capability, with teams focused on user support, code development, and validation.

  7. "Co-constructing" stigma and the therapist-parent alliance.

    PubMed

    Fox, Judith E

    2012-03-01

    Just as many relationships are susceptible to the distorting and distancing effects of stigmatization, so are therapist-parent relationships, particularly in instances where children/youth present with significant mental illness. Therapist awareness and attunement to the dynamics of stigma are critical to the development of engaged therapist-parent alliances, and therapist-parent alliances are key to successful child/youth psychotherapy. Intersubjectivity theory offers a useful lens by which to understand stigma dynamics as mutually reinforced, "co-constructed" experiences between therapists and parents. Applying this perspective provides direction for therapists to work in ways that recognize and reduce the negative impact of stigma dynamics on this important alliance. PsycINFO Database Record (c) 2012 APA, all rights reserved

  8. Annual report 1994 - Science and Engineering Alliance, Inc.

    SciTech Connect

    1998-04-01

    The Science and Engineering Alliance (SEA) was formed in 1990. The goal of the SEA is to foster and encourage collaborative research among the Alliance members. Collaborative research enhances the production of well-qualified scientists and engineers graduating from the SEA member institutions. These students will become contributing participants in the United States technical workforce now and into the next century. The SEA consist of four historically black colleges and universities (HBCUs) and a national laboratory. The SEA is a non-profit consortium. The SEA collaborates on research projects with government agencies, national laboratories, private foundations, industry, and other universities in a broad range of scientific and technical areas.

  9. Research on suppliers selection for e-commerce alliance

    NASA Astrophysics Data System (ADS)

    Ju, Chunhua; Sun, Bin; Liu, Dongsheng

    2009-07-01

    First, the characteristics of suppliers in the e-Commerce alliances of certain industries will be analyzed in this paper and the initial model to select suppliers is built. Then, the history performances of providers in the initial model and the ability to cooperate with others are recorded and analyzed. Based on the analysis above and considering the restriction of supply, the number of re-sellers and the price of products, an improved model to select suppliers in the e-Commerce alliance of certain industries called "the mix-integers model" is built. Finally, a mathematical example is used to describe how the mix-integers model to work.

  10. Alliance for NanoHealth Competitive Research Program

    DTIC Science & Technology

    2008-10-01

    AWARD NUMBER: W81XWH-06-2-0067 PROJECT TITLE: Alliance for NanoHealth Competitive Research Program PRINCIPAL INVESTIGATOR: Jodie L. Conyers, PhD...Sep 2007-28 Sep 2008 4. TITLE AND SUBTITLE Alliance for NanoHealth Competitive Research Program 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-06-2...Networks for the Controlled Growth and Differentiation of Dental Stem Cells Jeffrey Hartgerink, PhD (Rice University) Rena D’Souza, DDS, PhD (UT

  11. Building global alliances for public health nutrition training.

    PubMed

    Lawrence, Mark A; Galal, Osman; Margetts, Barrie M; Yngve, Agneta

    2009-05-01

    The purpose of this paper is to present a review of opportunities and challenges for future progress in building intercountry, regional, and global alliances for public health nutrition training. Drawing on experiences from developing, implementing, and evaluating public health nutrition training in Australasia, Europe, and the Middle East, suggestions are provided for building a network of global training activities. Opportunities are described in areas such as standardization of course competencies and registration schemes, resource sharing, student and trainer exchange programs, and professional development. Challenges are identified and options presented for building global alliances in public health nutrition training into the future.

  12. 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.

  13. Two levels of alliance formation among male bottlenose dolphins (Tursiops sp.).

    PubMed

    Connor, R C; Smolker, R A; Richards, A F

    1992-02-01

    In Shark Bay, Western Australia, male bottlenose dolphins (Tursiops sp.) cooperate in pairs and triplets to sequester and control the movements of females. We refer to this behavior as "herding" and to the male pairs and triplets as alliances. During a 25-month study (1987-1989) on the social relationships of males, we documented herding in 10 alliances. Males preferentially herded nonpregnant females likely to be in estrus. Alliance members associated with one another consistently when not herding females. Each alliance associated preferentially with one or two other alliances. Occasionally, two alliances combined and took females from another alliance or defended females against such efforts. This study documents multiple-level male alliances within a social group outside of humans.

  14. Measuring T-cell responses against LCV and CMV in cynomolgus macaques using ELISPOT: potential application to non-clinical testing of immunomodulatory therapeutics.

    PubMed

    Kamperschroer, Cris; O'Donnell, Lynn M; Schneider, Patricia A; Li, Dingzhou; Roy, Marc; Coskran, Timothy M; Kawabata, Thomas T

    2014-01-01

    A number of immunomodulatory therapeutics increase the risk of disease associated with latent herpesviruses such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV), a member of the lymphocryptovirus (LCV) family that infects humans. The diseases associated with loss of immunity to these viruses can have major impacts on patients as well as on the commercial viability of the immunomodulatory therapeutics. In an effort to develop non-clinical methods for measuring effects on anti-viral immunity, we have developed an interferon (IFN)-γ enzyme-linked immunosorbent spot (ELISPOT) assay to quantify the number of CMV or LCV-reactive T-cells in peripheral blood of cynomolgus macaques. After optimization of various parameters, the IFN-γ ELISPOT assay was characterized for specificity, intra-assay, monkey-to-monkey, and longitudinal variability and sensitivity to immunosuppression. The results show that nearly all animals have detectable responses against both CMV and LCV and responses were derived from T-cells specific to the virus of interest. Analyses of variability show assay reproducibility (≤23% CV), and that variability over time in anti-viral responses in individual animals (larger for LCV than for CMV) was ∼2-fold in most animals over a 3-month time period, which is predicted to allow for detection of drug-induced changes when using group sizes typical of non-clinical studies. In addition, the IFN-γ ELISPOT assay was capable of detecting decreases in the numbers of CMV and LCV reactive T-cells induced by immunosuppressive drugs in vitro. This assay may allow for non-clinical assessment of the effects of immunomodulatory therapeutics on anti-viral T-cell immunity in monkeys, and may help determine if therapeutics increase the risk of reactivating latent viral infections.

  15. 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…

  16. Patient's and Therapist's Views of Early Alliance Building in Dynamic Psychotherapy: Patterns and Relation to Outcome

    ERIC Educational Resources Information Center

    Kramer, Ueli; de Roten, Yves; Beretta, Veronique; Michel, Luc; Despland, Jean-Nicolas

    2008-01-01

    Patients and therapists have somewhat divergent perspectives of alliance. Usually in psychotherapy research, the focus is on the patient's view of alliance, predicting parts of outcome. This study questions this hypothesis by applying the shape-of-change procedure to patient's and therapist's view of alliance-building processes in dynamic…

  17. Strategic Alliances between Chinese and Foreign Universities: Was a Staggered Form of Entry Used?

    ERIC Educational Resources Information Center

    Willis, Mike

    2001-01-01

    Explored whether foreign universities moved through levels of alliance with China as a form of staggered market entry. Found almost no movement between levels of alliance, and that high levels of commitment were required at all levels to make an alliance successful. This indicates that foreign universities should be careful to establish alliances…

  18. Counseling Supervisors' Assessment of Race, Racial Identity, and Working Alliance in Supervisory Dyads

    ERIC Educational Resources Information Center

    Bhat, Christine Suniti; Davis, Thomas E.

    2007-01-01

    The authors investigated the role of race, racial identity attitudes and working alliance in counseling supervision using data obtained from supervisors in supervisory dyads. Results revealed the strongest working alliance for supervisor-supervisee pairs with high racial identity development and the weakest working alliance for pairs with low…

  19. 75 FR 70363 - Alliance Bancorp, Inc. of Pennsylvania, Broomall, PA; Approval of Conversion Application

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Office of Thrift Supervision Alliance Bancorp, Inc. of Pennsylvania, Broomall, PA; Approval of Conversion... application of Alliance Mutual Holding Company and Greater Delaware Valley Savings Bank, dba Alliance...

  20. Patient's and Therapist's Views of Early Alliance Building in Dynamic Psychotherapy: Patterns and Relation to Outcome

    ERIC Educational Resources Information Center

    Kramer, Ueli; de Roten, Yves; Beretta, Veronique; Michel, Luc; Despland, Jean-Nicolas

    2008-01-01

    Patients and therapists have somewhat divergent perspectives of alliance. Usually in psychotherapy research, the focus is on the patient's view of alliance, predicting parts of outcome. This study questions this hypothesis by applying the shape-of-change procedure to patient's and therapist's view of alliance-building processes in dynamic…