Skip to main content

Therapeutic Alliance and Common Factors in Treatment

  • Chapter
  • First Online:

Part of the book series: Series in Anxiety and Related Disorders ((SARD))

Abstract

Changes in therapy can result from variables unique to a particular treatment package (i.e., specific factors), as a function of variables common to a variety of treatments (i.e., nonspecific/common factors), or a combination of both specific and nonspecific ingredients (Kazdin,1979). Nonspecific (or common) treatment factors include variables that are common across different treatment modalities, which are thought to influence outcomes in therapy but are often not well linked to a mechanism of change. Due to differences in what is posited to be important to the change process by any one treatment theory, specific factors that are deemed crucial for one theoretical approach might be considered a common factor for another approach (Kazdin,1979; Wilkins,1979).

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Arnkoff, D. B., Glass, C. R., & Shapiro, S. J. (2002). Expectations and preferences. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 335–356). New York: Oxford University Press.

    Google Scholar 

  • Basoglu, M., Lax, T., Kasvikis, Y., & Marks, I. M. (1988). Predictors of improvement in obsessive-compulsive disorder. Journal of Anxiety Disorders, 2(4), 299–317.

    Article  Google Scholar 

  • Basoglu, M., Marks, I. M., Kilic, C., Brewin, C. R., & Swinson, R. P. (1994). Alprazolam and exposure for panic disorder with agoraphobia: Attribution of improvement to medication predicts subsequent relapse. British Journal of Psychiatry, 164, 652–659.

    Article  PubMed  Google Scholar 

  • Biondi, M., & Picardi, A. (2003). Increased probability of remaining in remission from panic disorder with agoraphobia after drug treatment in patients who received concurrent cognitive-behavioural therapy: A follow-up study. Psychotherapy and Psychosomatics, 72(1), 34–42.

    Article  PubMed  Google Scholar 

  • Bonner, B. L., & Everett, F. L. (1982). Influence of client preparation and therapist prognostic expectations on children’s attitudes and expectations of psychotherapy. Journal of Clinical Child Psychology, 11(3), 202–208.

    Article  Google Scholar 

  • Bonner, B. L., & Everett, F. L. (1986). Influence of client preparation and problem severity on attitudes and expectations in child psychotherapy. Professional Psychology: Research and Practice, 17(3), 223–229.

    Article  Google Scholar 

  • Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.

    Article  Google Scholar 

  • Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61(4), 611–619.

    Article  PubMed  Google Scholar 

  • Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26(1), 25–30.

    Article  PubMed  Google Scholar 

  • Brewin, C., & Antaki, C. (1982). The role of attributions in psychological treatment. In C. Antaki & C. Brewin (Eds.), Attributions and psychological change: Applications of attributional theories to clinical and educational practice (pp. 23–31). London: Academic Press.

    Google Scholar 

  • Briere, J. (1988). The long-term clinical correlates of childhood sexual victimization. Annals of the New York Academy of Sciences, 528, 327–334.

    Article  PubMed  Google Scholar 

  • Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71(5), 843–861.

    Article  PubMed  Google Scholar 

  • Chambless, D. L., & Gracely, E. J. (1989). Fear of fear and the anxiety disorders. Cognitive Therapy and Research, 13(1), 9–20.

    Article  Google Scholar 

  • Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18.

    Article  PubMed  Google Scholar 

  • Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716.

    Article  PubMed  Google Scholar 

  • Chambless, D. L., Tran, G. Q., & Glass, C. R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11(3), 221–240.

    Article  PubMed  Google Scholar 

  • Chemtob, C. M., Novaco, R. W., Hamada, R. S., & Gross, D. M. (1997). Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 65(1), 184–189.

    Article  PubMed  Google Scholar 

  • Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067–1074.

    Article  PubMed  Google Scholar 

  • Cloitre, M., Stovall-McClough, K. C., Miranda, R., & Chemtob, C. M. (2004). Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 72(3), 411–416.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Cole, P. M., & Putnam, F. W. (1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of Consulting and Clinical Psychology, 60(2), 174–184.

    Article  PubMed  Google Scholar 

  • Conoley, C. W., Padula, M. A., Payton, D. S., & Daniels, J. A. (1994). Predictors of client implementation of counselor recommendations: Match with problem, difficulty level, and building on client strengths. Journal of Counseling Psychology, 41(1), 3–7.

    Article  Google Scholar 

  • Constantino, M. J., Castonguay, L. G., & Schut, A. J. (2002). The working alliance: A flagship for the “scientist–practitioner” model in psychotherapy. In G. S. Tryon (Ed.), Counseling based on process research: Applying what we know (pp. 81–131). Boston, MA: Allyn & Bacon.

    Google Scholar 

  • Davison, G. C., Tsujimoto, R. N., & Glaros, A. G. (1973). Attribution and the maintenance of behavior change in falling asleep. Journal of Abnormal Psychology, 82(1), 124–133.

    Article  PubMed  Google Scholar 

  • Day, L., & Reznikoff, M. (1980). Preparation of children and parents for treatment at a children’s psychiatric clinic through videotaped modeling. Journal of Consulting and Clinical Psychology, 48(2), 303–304.

    Article  PubMed  Google Scholar 

  • Delsignore, A., & Schnyder, U. (2007). Control expectancies as predictors of psychotherapy outcome: A systematic review. British Journal of Clinical Psychology, 46(4), 467–483.

    Article  PubMed  Google Scholar 

  • Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73–86.

    Article  PubMed  Google Scholar 

  • Dew, S. E., & Bickman, L. (2005). Client expectancies about therapy. Mental Health Services Research, 7(1), 21–33.

    Article  PubMed  Google Scholar 

  • Dozois, D. J. A., & Westra, H. A. (2005). Development of the anxiety change expectancy scale (ACES) and validation in college, community, and clinical samples. Behaviour Research and Therapy, 43(12), 1655–1672.

    Article  PubMed  Google Scholar 

  • Ehlers, A., Mayou, R. A., & Bryant, B. (1998). Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Journal of Abnormal Psychology, 107(3), 508–519.

    Article  PubMed  Google Scholar 

  • Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Franklin, M. E., & Foa, E. B. (1998). Cognitive-behavioral treatments for obsessive-compulsive disorder. In P. E. Nathan & J. M. Gorman (Eds.), A guide to treatments that work (pp. 339–357). New York: Oxford University Press.

    Google Scholar 

  • Freud, S. (1958). On beginning the treatment: Further recommendations on the technique of psychoanalysis. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (pp. 122–144). London: Hogarth Press. (Original work published 1913)

    Google Scholar 

  • Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.) , Handbook of psychotherapy and behavior change (4th ed., pp. 190–228). Oxford: John Wiley & Sons.

    Google Scholar 

  • Goossens, M. E. J. B., Vlaeyen, J. W. S., Hidding, A., MKole-Snijders, A. M., & Evers, S. M. A. A. (2005). Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain. Clinical Journal of Pain, 21(1), 18–26.

    Article  PubMed  Google Scholar 

  • Greenberg, R. P., Constantino, M. J., & Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26(6), 657–678.

    Article  PubMed  Google Scholar 

  • Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621–632.

    Article  PubMed  Google Scholar 

  • Hogue, A., Henderson, C. E., Dauber, S., Barajas, P. C., Fried, A., & Liddle, H. A. (2008). Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 76(4), 544–555.

    Article  PubMed  Google Scholar 

  • Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36(2), 223–233.

    Article  Google Scholar 

  • Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139–149.

    Article  Google Scholar 

  • Huppert, J. D., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2006). The interaction of motivation and therapist adherence predicts outcome in cognitive behavioral therapy for panic disorder: Preliminary findings. Cognitive and Behavioral Practice, 13(3), 198–204.

    Article  Google Scholar 

  • Jeffrey, D. B. (1974). A comparison of the effects of external control and self-control on the modification and maintenance of weight. Journal of Abnormal Psychology, 83(4), 404–410.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (1979). Nonspecific treatment factors in psychology outcome research. Journal of Consulting and Clinical Psychology, 47(5), 846–851.

    Article  PubMed  Google Scholar 

  • Klein, D. N., Schwartz, J. E., Santiago, N. J., Vivian, D., Vocisano, C., Castonguay, L. G., et al. (2003). Therapeutic alliance in depression treatment: Controlling for prior change and patient characteristics. Journal of Consulting and Clinical Psychology, 71(6), 997–1006.

    Article  PubMed  Google Scholar 

  • Lazarus, A. A. (2003). Some reactions to Robert Kohlenberg’s article. The Behavior Therapist, 26(7), 380–381.

    Google Scholar 

  • Linehan, M. M., Cochran, B. N., Mar, C. M., Levensky, E. R., & Comtios, K. A. (2000). Therapeutic burnout among borderline personality disordered clients and their therapists: Development and evaluation of two adaptations of the Maslach Burnout Inventory. Cognitive and Behavioral Practice, 7(3), 329–337.

    Article  Google Scholar 

  • Livanou, M., Basoglu, M., Marks, I. M., De Sliva, P., Noshirvani, H., Lovell, K., et al. (2002). Beliefs, sense of control and treatment outcome in post-traumatic stress disorder. Psychological Medicine, 32(1), 157–165.

    Article  PubMed  Google Scholar 

  • Loeb, K. L., Wilson, G. T., Labouvie, E., Pratt, E. M., Hayaki, J., Walsh, B. T., et al. (2005). Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: A study of process and outcome. Journal of Consulting and Clinical Psychology, 73(6), 1097–1107.

    Article  PubMed  Google Scholar 

  • Maltby, N., & Tolin, D. F. (2005). A brief motivational intervention for treatment-refusing OCD patients. Cognitive Behaviour Therapy, 34(3), 176–184.

    Article  PubMed  Google Scholar 

  • Marmar, C. R., Weiss, D. S., & Gaston, L. (1989). Toward the validation of the California therapeutic alliance rating system. Journal of Consulting and Clinical Psychology, 1(1), 46–52.

    Article  Google Scholar 

  • Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.

    Article  PubMed  Google Scholar 

  • Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147–172.

    Article  Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change addictive behavior. New York: The Guilford Press.

    Google Scholar 

  • Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10(2), 155–180.

    Article  Google Scholar 

  • Norcross, J. C. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.

    Google Scholar 

  • Otto, M. W., & Hofmann, S. G. (Eds.). (2009). Avoiding treatment failures in the anxiety disorders. New York: Springer.

    Google Scholar 

  • Powers, M. B., Smits, J. A. J., Whitley, D., Bystritsky, A., & Telch, M. J. (2008). The effect of attributional processes concerning medication taking on return of fear. Journal of Consulting and Clinical Psychology, 76(3), 478–490.

    Article  PubMed  Google Scholar 

  • Raue, P. J., Goldfried, M. R., & Barkham, M. (1997). The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 65(4), 582–587.

    Article  PubMed  Google Scholar 

  • Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.

    Article  PubMed  Google Scholar 

  • Rubak, S., Sandboek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. The British Journal of General Practice, 55, 305–311.

    PubMed  Google Scholar 

  • Safran, J. D. (1990). Towards a refinement of cognitive therapy in light of interpersonal theory: I. Theory. Clinical Psychology Review, 10(1), 87–105.

    Article  Google Scholar 

  • Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71(3), 452–464.

    Article  PubMed  Google Scholar 

  • Shuman, A. L., & Shapiro, J. P. (2002). The effects of preparing parents for child psychotherapy on accuracy of expectations and treatment attendance. Community Mental Health Journal, 38(1), 3–16.

    Article  PubMed  Google Scholar 

  • Slagle, D. M., & Gray, M. J. (2007). The utility of motivational interviewing as an adjunct to exposure therapy in the treatment of anxiety disorders. Professional Psychology: Research and Practice, 38(4), 329–337.

    Article  Google Scholar 

  • Smits, J. A. J., Reese, H. E., Powers, M. B., & Otto, M. W. (2009). Combined treatment strategies: Current efficacy and future directions. In M. W. Otto & S. G. Hofmann (Eds.), Avoiding treatment failures in the anxiety disorders (pp. 67–81). New York: Springer.

    Google Scholar 

  • Snyder, C. R., Ilardi, S., Michael, S. T., & Cheavens, J. (2000). Hope theory: Updating a common process for psychological change. In C. R. Snyder, & R. E. Ingram (Eds.), Handbook of psychological change: Psychotherapy processes and practices for the 21st century (pp. 128–153). New York: Wiley.

    Google Scholar 

  • Snyder, C. R., Michael, S., & Cheavens, J. (1999). Hope as a psychotherapeutic foundation of common factors, placebos, and expectancies. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 179–200). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Sonne, J., & Janoff, D. (1979). The effect of treatment attributions on the maintenance of weight reduction: A replication and extension. Cognitive Therapy and Research, 3(4), 389–397.

    Article  Google Scholar 

  • Spinhoven, P., Giesen-Bloo, J., van Dyck, R., & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 75(1), 104–115.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B., Gibbon, M., & First, M. B. (1990). User’s guide for the structured clinical interview for DSM-III-R – Personality Disorders (SCID-II). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Strauss, J. L., Hayes, A. M., Johnson, S. L., Newman, C. F., Brown, G. K., Barber, J. P., et al. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2), 337–345.

    Article  PubMed  Google Scholar 

  • Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67(6), 894–904.

    Article  PubMed  Google Scholar 

  • Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620–630.

    Article  PubMed  Google Scholar 

  • Westra, H. A., & Dozois, D. J. A. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30(4), 481–498.

    Article  Google Scholar 

  • Westra, H. A., Dozois, D. J. A., & Marcus, M. (2007). Expectancy, homework compliance, and initial change in cognitive-behavioral therapy for anxiety. Journal of Consulting and Clinical Psychology, 75(3), 363–373.

    Article  PubMed  Google Scholar 

  • Wilkins, W. (1979). Expectancies in therapy research: Discriminating among heterogeneous nonspecifics. Journal of Consulting and Clinical Psychology, 47(5), 837–845.

    Article  PubMed  Google Scholar 

  • Wolfe, B. E., & Goldfried, M. R. (1988). Research on psychotherapy integration: Recommendations and conclusions from an NIMH workshop. Journal of Consulting and Clinical Psychology, 56(3), 448–451

    Article  PubMed  Google Scholar 

  • Woods, C. M., Chambless, D. L., & Steketee, G. (2002). Homework compliance and behavior therapy outcome for panic with agoraphobia and obsessive compulsive disorder. Cognitive Behaviour Therapy, 31(2), 88–95.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniella M. Halperin .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Halperin, D.M., Weitzman, M.L., Otto, M.W. (2010). Therapeutic Alliance and Common Factors in Treatment. In: Otto, M., Hofmann, S. (eds) Avoiding Treatment Failures in the Anxiety Disorders. Series in Anxiety and Related Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0612-0_4

Download citation

Publish with us

Policies and ethics