Alliance in individual psychotherapy.
Meta-analýza
Typy studií podle spolehlivosti
Od nejspolehlivějšího po nejméně spolehlivý.
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Souhrn více studií (meta-analýza, systematický přehled) ← tahle studie
nejspolehlivější obraz, jaký dnes máme. -
Randomizovaný pokus (RCT)
lidé byli rozděleni náhodně, takže rozdíl lze přičíst zásahu. -
Porovnání skupin
skupiny se porovnaly, ale bez náhodného rozdělení; naznačuje účinek. -
Pozorování nebo rozhovory
popisuje, co se děje a co spolu souvisí; příčinu to neukáže. -
Názor odborníků, teorie nebo jeden případ
nic se neměřilo na skupině lidí, jde o zkušenost a výklad.
Typ studie říká, jak byla udělaná, ne jak velký byl účinek.
Klasika
Jak nová je studie
Podle roku vydání; klasika stojí stranou.
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Nový výzkum
vyšla letos nebo loni. -
Zavedené
vyšla předloni nebo dřív. -
Klasika ← tahle studie
práce, na které obor staví.
Stáří neříká, jak je studie spolehlivá. To říká typ studie.
Ve zkratce
The therapeutic alliance has a small to moderate link with how well individual therapy goes. This meta-analysis pooled 190 independent data sources and over 14,000 treatments. The link is consistent, but the studies differ a lot from each other.
Celý souhrn studie Context · Findings · Implications · Co nepřeceňovat
Context
The alliance is the working bond between a client and a therapist. It includes agreement on goals and tasks, plus an emotional bond. Therapists often ask whether this bond actually helps clients change. The authors combined research on individual psychotherapy to answer that question. They looked at studies of real treatment, not analogue or laboratory versions. Each study had to include at least five adult clients. The authors counted a variable as alliance only when researchers used terms like "therapeutic alliance" or "working alliance." More than 200 research reports met the criteria, drawn from 190 independent data sources. The alliance is one of the most studied ideas in psychotherapy research. Researchers have long debated how much it matters compared with specific techniques. The question matters in practice because therapists can influence the alliance directly.
Findings
The overall link between alliance and outcome was r = .275. The 95% confidence interval ran from .25 to .30. The probability of this result arising by chance was p < .0001. In plain terms, the association is small to moderate. It accounts for roughly 8% of the variation in client outcomes. The authors adjusted this figure for sample size and for repeated outcome measures. They used a random model, which assumes studies estimate somewhat different true effects. The data were heterogeneous, meaning the studies did not agree closely with each other. The estimate rests on 190 independent data sources, so it is not a single study result. The authors explored several possible explanations for the variation. These included who rated the alliance: the client, the therapist, or an outside observer. They also looked at the publication source, the assessment method, and when the alliance was measured. The available summary does not say which of these factors changed the size of the link.
Implications
A small to moderate association still matters across a whole caseload. It does not tell you what will happen with the client in front of you. The alliance is not the only active ingredient in therapy. These studies cannot prove that a stronger alliance causes better outcomes. Clients who rate the alliance well may already be improving for other reasons. The evidence does not settle whether strengthening the alliance improves outcomes. It also does not settle which rater's view predicts change best. A client who feels unheard may show it in the alliance before it shows in symptoms. Treat the alliance as one useful signal among several. Use alliance ratings alongside symptom measures, not instead of them. Keep monitoring the alliance, and treat a drop as information worth discussing.
Co nepřeceňovat
Do not tell clients the alliance is proven to cause change. The r = .275 link is small to moderate and correlational. Do not promise that a strong bond guarantees a good outcome. Do not assume your own rating matches the client's rating.
Zdroje
- Horvath, Adam O., Del Re, A. C., Flückiger, Christoph, Symonds, Dianne (2011). Alliance in individual psychotherapy. Psychotherapy. https://doi.org/10.1037/a0022186