Zusammenfassung
Das pantheoretische Konzept der Arbeitsallianz stellt die kollaborative Qualität der an der Therapie beteiligten Personen (i. e. zumeist der Patient und der Therapeut) in den Mittelpunkt. Die Arbeitsallianz ist die weltweit am besten untersuchte Prozessvariable in der Psychotherapie. Die vorliegende Arbeit bietet einen Überblick über den aktuellen metaanalytischen Wissensstand. Basierend auf 200 Primärstudien mit 14.000 teilnehmenden Patienten wurde der Zusammenhang zwischen Arbeitsallianz und Therapieerfolg metaanalytisch untersucht. Die Arbeitsallianz erweist sich als äußerst robuster Prädiktor, der moderate 8 % der Varianz des Therapieerfolgs erklärt. Der Zusammenhang über die verschiedenen Psychotherapietraditionen hinweg zeigte sich sowohl unter randomisierten kontrollierten, manualisierten Studienbedingungen als auch unter naturalistischen Voraussetzungen. Der Effekt fand sich zudem in den störungsspezifischen Erfolgseinschätzungen und den generelleren Erfolgsmaßen. Die moderaten Therapeuteneffekte in den Primärstudien konnten metaanalytisch bestätigt werden. Soziokulturelle Aspekte wie Substanzmissbrauch und ethnische Minoritäten moderieren den Einfluss zwischen Arbeitsallianz und Therapieerfolg. Die Nähe der Forscher zum Allianzkonzept („allegiance“) beeinflusst die Vorhersagekraft der frühen Allianz zwar statistisch bedeutsam, jedoch nicht substanziell.
Abstract
The pan-theoretical concept of the working alliance highlights the confident collaborative quality between patients and therapists. The alliance is one of the most investigated concepts in psychotherapy process research. This article presents an overview of recent meta-analyses. The relationship between the alliance and therapeutic outcomes was investigated based on 200 primary studies that included 14,000 therapies. The alliance predicts a moderate portion of the total therapy outcome (approximately 8 % explained variance). This positive relationship is robust across the various psychotherapy traditions as well as across a variety of research designs, such as randomized controlled and manualized study conditions as well as disorder-specific outcomes. Moderate therapist effects, which have been observed in primary studies, were replicated based on a meta-analytic approach. Substance use disorders and ethnic minorities are highly confounded in the investigated research samples. This suggests that sociocultural issues impact the quality of the alliance development and its relationship to outcomes. Researcher allegiance to the alliance concept was a significant but not substantial moderator of the relationship between the early alliance and outcome.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Baldwin S, Imel ZE, Wampold BE (2007) Untangling the alliance–outcome correlation: exploring the relative importance of therapist and patient variability in the alliance. J Consult Clin Psychol 75:842–852
Bassler M, Potratz B, Krauthauser H (1995) Der Helping Alliance Questionnaire (HAQ) von Luborsky. Möglichkeiten zur Evaluation von stationärer Psychotherapie. Psychotherapeut 40:23–32
Caspar F, Grosse Holtforth M, Responsiveness (2009) Eine entscheidende Prozessvariable in der Psychotherapie. Z Klin Psychol Psychoth 38(1):61–69
Constantino MJ, Ladany N, Borkovec TD (2010) Eduward S. Bordin: innovative thinker, influential investigator, and inspiring teacher. In: Castonguay LG, Muran JC, Angus L, Hayes JA, Ladany N, Anderson T (Hrsg) Bringing psychotherapy research to life: understanding change through the work of leading clinical researcher. American Psychological Association, Washington, DC, S 21–57
Crits-Christoph P, Gibbons MBC, Hamilton J, Ring-Kurtz S, Gallop R, The dependability of alliance assessments (2011) The alliance–outcome correlation is larger than you might think. J Consult Clin Psychol 79(3):267–278
Del Re AC, Flückiger C (2015) Meta analysis. In: Norcross JC, VandenBos GR, Freedheim DK (Hrsg) APA Handbook of Clinical Psychology. American Psychological Association, Washington, DC
Del Re AC, Flückiger C, Horvath AO, Symonds D, Wampold BE (2012) Therapist effects in the therapeutic alliance–outcome relationship: a restricted-maximum likelihood meta-analysis. Clin Psychol Rev 32(7):642–649
Dinger U, Strack M, Leichsenring F, Wilmers F, Schauenburg H (2008) Theraist effects on outcome and alliance in inpatient psychotherapy. J Clin Psychol 64:344–354
Flückiger C, Regli D, Zwahlen D, Hostettler S, Caspar F (2010) Der Berner Therapeuten- und Patientenstundenbogen 2000. Ein Instrument zur Erfassung von Therapieprozessen. Z Klin Psychol Psychother 39(2):71–79
Flückiger C, Del Re AC, Wampold BE, Symonds D, Horvath AO (2012) How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. J Counsel Psychol 59(1):10–17
Flückiger C, Del Re AC, Horvath AO, Symonds BD, Ackert M, Wampold BE (2013a) Substance use disorders and racial/ethnic minorities matter: a meta-analytic examination of the relation between alliance and outcome. J Counsel Psy 60:610–616
Flückiger C, Grosse Holtforth M, Znoj HJ, Caspar F, Wampold BE (2013b) Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy. Psychother Res 23:1–13
Friedlander ML, Escudero V, Heatherington L, Diamond GM (2011) The alliance in couple and family therapy. Psychotherapy 48(1):25–33
Gelso C (2014) A tripartite model of the therapeutic relationship: theory, research and practice. Psychother Res 24(2):117–131
Hartmann A, Joos A, Orlinsky DE, Zeeck A (2014) Accuracy of therapist perceptions of patientsʼ alliance: exploring the divergence. Psychother Res. doi:10.1080/10503307.2014.927601
Hatcher RL, Barends AW (2006) How a return to theory could help alliance research. Psychotherapy 64:1320–1336
Horvath AO, Bedi RP (2002) The alliance. In: Norcross JC (Hrsg) Psychotherapy relationships that work: therapist contributions and responsiveness to patients. Oxford University Press, New York, S 37–69
Horvath AO, Greenberg LS (1994) The working alliance: theory, research and practice. Wiley, New York
Horvath AO, Symonds BD (1991) Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Counsel Psychol 38(2):139–149
Horvath AO, Del Re AC, Flückiger C, Symonds D (2011a) Alliance in individual psychotherapy. In: Norcross JC (Hrsg) Psychotherapy relationships that work: therapist contributions and responsiveness to patients. Oxford University Press, New York, S 37–69
Horvath AO, Del Re AC, Flückiger C, Symonds D (2011b) Alliance in individual psychotherapy. Psychotherapy 48(1):9–16
Horvath AO, Flückiger C, Del Re AC, Jafari H, Symonds BD, Lee E (2014) The relationship between helper and client: looking beyond psychotherapy. In: 45 Congress of the Society of Psychotherapy Research. Copenhagen, Denmark. doi:10.1080/10503307.2014.927601
Mander J, Schlab A, Teufel M, Keller F, Hautzinger M, Zipfel S, Wittof A, Sammet I (2014) The individual therapy process questionanaire. Clin Psychol Psychother. doi:10.1002/cpp.1892
Martin DJ, Garske JP, Davis MK (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 68(3):438–450
Meier PS, Barrowclough C, Donmall MC (2005) The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature. Addiction 100(3):304–316
Munder T, Wilmers F, Leonhart R, Linster HW, Barth J (2010) Working alliance inventory – short revised (WAI-SR): psychometric properties in outpatients and inpatients. Clin Psychol Psychother 17(3):231–239
Norcross JC (2011) Relationships that works. American Psychological Association, Washington, DC
Rogers CR (1983) Therapeut und Klient. Grundlagen der Gesprächspsychotherapie. Fischer, Frankfurt a. M.
Shirk SR, Karver MS, Brown R (2011) The alliance in child and adolescent psychotherapy. Psychotherapy 48(1):17–24
Stiles WB (2009) Responsiveness as an obstacle for psychotherapy outcome research: it’s worse than you think. Clin Psychol-Sci Pr 16(1):86–91
Tyron GS, Blackwell SC, Hammel EF (2007) A meta-analytic examination of client-therapist perspectives of the working alliance. Psychother Res 17(6):629–642
Wampold BE, Imel ZE (2015) The great psychotherapy debate: models, methods, and findings. Taylor & Francis Group, New York
Zilcha-Mano S, McCarthy KS, Dinger U, Barber JP (2014) To what extent is alliance affected by transference? An empirical exploration. Psychotherapy 51:424–433
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
Christoph Flückiger, Adam O. Horvath, A.C. Del Re, Dianne Symonds und Corinne Holzer geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Additional information
Redaktion
Anja Hilbert, Leipzig
Alexandra Martin, Wuppertal
Rights and permissions
About this article
Cite this article
Flückiger, C., Horvath, A., Del Re, A. et al. Bedeutung der Arbeitsallianz in der Psychotherapie. Psychotherapeut 60, 187–192 (2015). https://doi.org/10.1007/s00278-015-0020-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00278-015-0020-0