DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

Finally, there was preliminary evidence of an interaction effect such that those patients
who remained in treatment longer and rated the alliance relatively high early in treatment
had better outcomes. This appears to be consistent with findings across the therapeutic
alliance research.
Upon review, it appears that there is a scarcity of literature that considers the therapeutic
alliance with specific client groups. Lingiardi, Fillipucci & Baiocco (2005), supported the
finding that early alliance leads to more positive results i.e. less dropout (e.g. Horvath et
al, 1994). Furthermore, they found that DSM-IV ‘cluster A’ patients had difficulty
establishing working alliances. This was not surprising as these individuals are
considered the most disturbed, characterised by withdrawal, detachment, refusal of
relationships and beliefs that others are hostile or threatening. The therapists were found
to evaluate the alliance with ‘cluster B’ patients negatively. These individuals (with
antisocial, borderline, histrionic, narcissistic personality disorders) are impaired in basic
trust and interpersonal relationships. Again it was found that the therapists’ evaluations
were always lower than the patients’ evaluations.
Therapy alliance and older adults
The therapeutic alliance does not appear to have been widely discussed in relation to
older adults, however the trends in understanding the therapeutic alliance in general
suggest that this construct also has value with older clients. First, the therapeutic alliance
is largely formed in the first sessions of therapy (Saunders, 2000). Thereafter, the
therapeutic alliance is associated with different patterns of therapeutic activity, emotions
and verbal content, with high and low-alliance bonds showing distinct developmental
paths during the early, middle and late course of brief therapy (Saunders, 2000).
Monitoring of the therapeutic alliance and negotiating ruptures in the alliance is
considered to be as important in older adults as in younger adults as it is more likely that
older adults may drop out of therapy (Hyer el al 2004). As in younger adulthood the
clients with better quality object relations are better able to withstand a weaker
therapeutic alliance than those with poorer object relations, (Saunders, 2000).
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