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findings. Researchers discovered that therapists increased their adherence to specific interventions in cognitive behavioral therapy during alliance strains and that this, in turn, contributed to deteriorations in the alliance and outcome (Castonguay, Goldfried, Wiser, & Raue, & Hayes, 1996). These findings suggest that therapists' strict adherence to treatment manuals during ruptures may be detrimental to outcome; however, whether therapists' strict adherence to these specific interventions or whether the specific interventions themselves are implicated in poor outcome has not been determined. Based on the studies so far, it can be inferred that therapists' rigid adherence contributes to problems in the alliance. Another interpretation for the findings, however, is that certain interventions (e.g., dynamic and cognitive behavioral interventions) are not effective during ruptures. According to this line of reasoning, the degree of therapist adherence is not the source of the problem; rather it is the interventions to which therapists adhere. Thus, on the basis of theories on rupture resolution and research findings demonstrating the benefits of therapists' use of relational interventions during ruptures, it can be inferred that therapists' adherence to relational interventions during ruptures would contribute to good outcome, regardless of the degree of therapist adherence. Additional research is necessary in order to clarify the relationship between therapists' adherence to relational, cognitive behavioral and dynamic interventions and outcome during ruptures. The present study is a step in that direction.
This study will investigate therapists' technical behavior during ruptures. Therapists in two treatment groups (relational therapy and cognitive behavioral therapy) will be investigated. Therapists' utilization of relational, cognitive behavioral, and dynamic interventions, will be correlated with outcome. The literature review, which follows, begins with a historical outline of the theoretical conceptualization of the therapeutic alliance. Empirical findings on the therapeutic alliance are reviewed. Theoretical and empirical research on ruptures is presented, with a particular focus on writings on rupture resolution. An outline of the historical development of treatment manuals is provided; features of treatment manuals as well as their advantages and disadvantages are highlighted. Furthermore, research on therapist adherence to treatment manuals in the context of ruptures is reviewed. The literature review concludes with a statement of purpose and a list of the research hypotheses generated by this dissertation. The Therapeutic Alliance The therapeutic alliance, which is also referred to as the therapeutic relationship or the working alliance, has taken a predominant place in psychotherapy research in the last two decades; however, the concept of the alliance was developed more than 70 years ago. This will be discussed below, followed by a review of the empirical research. Conceptualizations of the therapeutic alliance. The therapeutic alliance originated in early psychoanalytic literature. Sigmund Freud (1912) acknowledged the value of the 4
Page 1 and 2: Therapists' Adherence To Manualized
Page 3 and 4: Abstract The overall goal of this s
Page 5 and 6: Table of Contents List of Tables v
Page 7 and 8: List of Tables Table 1. ICC Means,
Page 9 and 10: APPENDIX A. APPENDIX B. APPENDIX C.
Page 11: For example, research in contempora
Page 15 and 16: Greenson (1967) extended the ego ps
Page 17 and 18: The conceptualization of the allian
Page 19 and 20: Rhodes, Hill, Thompson, and Elliott
Page 21 and 22: Researchers have demonstrated that
Page 23 and 24: characteristic of stages that commo
Page 25 and 26: treatment manuals; methodological a
Page 27 and 28: set of propositions that therapists
Page 29 and 30: most therapists do not administer t
Page 31 and 32: Research on the Effects of Therapis
Page 33 and 34: higher 'toxic-dose' of disaffiliate
Page 35 and 36: interpretations may not be helpful.
Page 37 and 38: during ruptures, and to assess the
Page 39 and 40: For the purposes of this study, dat
Page 41 and 42: immediacy achieved by using phenome
Page 43 and 44: In the CBT treatment condition, fou
Page 45 and 46: Selection Procedure of Ruptures In
Page 47 and 48: adequate internal consistency, inte
Page 49 and 50: BAP techniques. The BAP (BAP; Polla
Page 51 and 52: prescribed treatment. In this study
Page 53 and 54: Interrater Reliability Reliability
Page 55 and 56: BAP). The between-treatment factor
Page 57 and 58: Table 3 Analysis of Variance for Tr
Page 59 and 60: Table 4 Differences Between Adheren
Page 61 and 62: Figure 1 Means for Adherence Scores
Page 63 and 64:
Table 5 Intercorrelations Between M
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Table 6 Intercorrelations Between M
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Discussion The overall goal of this
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predictive abilities of the therape
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Another limitation is that this stu
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References Addis, M. E. (1997). Eva
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Derogatis, L. R., Rickels, K., & Ro
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Greenson, R. R. (1971). The 'real'
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Kivlighan, M. D., Jr., & Schmitz, J
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Najavits, M. L., Weiss, D. R., Shaw
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Safran, D. J. (1984a). Assessing th
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Shaw, B. F. (1984). Specification o
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Waltz, J., Addis E. M, Koerner K.,
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Appendix A SCL—90—R® HOW MUCH
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14. socialize with other people. 15
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Appendix C BRIEF PSYCHOTHERAPY RESE
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PART D The following items reflect
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PART E Please rate how well each of
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Appendix D BETH ISRAEL ADHERENCE SC
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15. Therapist involvement. How invo
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31. Engages in didactic persuasion.
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Appendix E Definitions of the Treat
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BRIEF ADAPTIVE PSYCHOTHERAPY 13. In
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COGNITIVE-BEHAVIORAL THERAPY 25. Pr
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NON-SPECIFICS 37. Therapist's commu
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Global Items Frequent & Pervasive (
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BETH ISRAEL MEDICAL CENTER FIRST AV
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