Investigating the Relationship Between the Therapeutic Alliance and Treatment Outcome in Violent Offender Treatment

<p>The role of the therapeutic alliance (TA) has largely been ignored in the field of high-risk violent offender treatment. The focus on effective manualised treatment that reduces recidivism has led to improvements in treatment programme delivery, but at the cost of examining the therapy process. Considering previous research has consistently linked levels of alliance with treatment outcome in clinical and community treatment settings, it is imperative to investigate the role of the TA within high-risk violent offender treatment, because of the particularly challenging group that they represent. The aim of this thesis was to examine the relationship between the TA and treatment outcome, and the various factors that influence this relationship, within a violence prevention setting. To achieve this aim, a longitudinal study was conducted at the Rimutaka Violence Prevention Unit (RVPU) in Wellington, New Zealand, with a cohort of 70 men in treatment and their therapists, examining the TA, treatment outcome and associated variables over four time points throughout the eight month treatment programme. The results of this research are reported as four related studies. Study One explored the structure and patterns of the Working Alliance Inventory (WAI). Study One Part A was a Confirmatory Factor Analysis of the WAI, which tested the competing models of the factor structure of the WAI and explored whether rater perspective (client, therapist, observer) had an effect on the structure. It was found that a two-factor structure was the best fit for the WAI, and that all rater perspectives shared this structure. Study One Part B explored the pattern of the WAI over the four time periods of this study in order 8 to understand how the WAI changes over time, and whether this pattern differed by rater perspective. The results confirmed that changes in all rater perspectives showed a linearly increasing pattern of alliance over time. Study Two explored the client factors that affect the initial formation of the TA and examined whether these factors were specific to an "offender" or "general" client profile informed by previous research. Two client factors specific to an offender profile - motivation to change and criminal attitudes - were found to be significantly associated with the initial formation of the TA. Study Three examined the relationship between the TA and treatment outcome, and explored whether there were any factors that co-varied with or moderated this relationship. A small but significant association between alliance and outcome was found; however no significant co-varying or moderating factors were discovered. Lastly, Study Four drew together the data from Study Two and Study Three and tested whether these results fit the Revised Theory of the Therapeutic Alliance (RTTA) model (Ross, Polaschek, & Ward, 2008), or other models previously reported in the literature. Several significant models were found that partly supported the RTTA. The best of these models incorporated client motivation to change, TA and treatment outcome as measured by change in risk of violent reoffending. Overall, the results of this study support the importance of the TA and client motivation to change in violent offender treatment. The implications for these results and the clinical applications are discussed, limitations are outlined, and directions for future research are suggested.</p>

Investigating the Relationship Between the Therapeutic Alliance and Treatment Outcome in Violent Offender Treatment

<p>The role of the therapeutic alliance (TA) has largely been ignored in the field of high-risk violent offender treatment. The focus on effective manualised treatment that reduces recidivism has led to improvements in treatment programme delivery, but at the cost of examining the therapy process. Considering previous research has consistently linked levels of alliance with treatment outcome in clinical and community treatment settings, it is imperative to investigate the role of the TA within high-risk violent offender treatment, because of the particularly challenging group that they represent. The aim of this thesis was to examine the relationship between the TA and treatment outcome, and the various factors that influence this relationship, within a violence prevention setting. To achieve this aim, a longitudinal study was conducted at the Rimutaka Violence Prevention Unit (RVPU) in Wellington, New Zealand, with a cohort of 70 men in treatment and their therapists, examining the TA, treatment outcome and associated variables over four time points throughout the eight month treatment programme. The results of this research are reported as four related studies. Study One explored the structure and patterns of the Working Alliance Inventory (WAI). Study One Part A was a Confirmatory Factor Analysis of the WAI, which tested the competing models of the factor structure of the WAI and explored whether rater perspective (client, therapist, observer) had an effect on the structure. It was found that a two-factor structure was the best fit for the WAI, and that all rater perspectives shared this structure. Study One Part B explored the pattern of the WAI over the four time periods of this study in order 8 to understand how the WAI changes over time, and whether this pattern differed by rater perspective. The results confirmed that changes in all rater perspectives showed a linearly increasing pattern of alliance over time. Study Two explored the client factors that affect the initial formation of the TA and examined whether these factors were specific to an "offender" or "general" client profile informed by previous research. Two client factors specific to an offender profile - motivation to change and criminal attitudes - were found to be significantly associated with the initial formation of the TA. Study Three examined the relationship between the TA and treatment outcome, and explored whether there were any factors that co-varied with or moderated this relationship. A small but significant association between alliance and outcome was found; however no significant co-varying or moderating factors were discovered. Lastly, Study Four drew together the data from Study Two and Study Three and tested whether these results fit the Revised Theory of the Therapeutic Alliance (RTTA) model (Ross, Polaschek, & Ward, 2008), or other models previously reported in the literature. Several significant models were found that partly supported the RTTA. The best of these models incorporated client motivation to change, TA and treatment outcome as measured by change in risk of violent reoffending. Overall, the results of this study support the importance of the TA and client motivation to change in violent offender treatment. The implications for these results and the clinical applications are discussed, limitations are outlined, and directions for future research are suggested.</p>

The Value of Adapting Counseling to Client’s Spirituality and Religion: Evidence-Based Relationship Factors

There is a strong tradition of attention to relationship factors in the field of counseling. The research on the importance of the relationship and adapting to client factors continues to grow, supporting the importance of professional multicultural competence. The field of counseling, specifically within the United States context, has focused on Multicultural Counseling Competencies with more recent emphasis on social justice through the Multicultural and Social Justice Counseling Competencies. Within these competencies, spirituality and religion are mentioned as multicultural components to consider as potentially salient to clients. Yet, there has been less emphasis on ways to adapt counseling to a client’s spirituality and religion compared to other multicultural components of one’s identity, such as race, gender, and culture. Historically, a lack of training, fear of causing offense, or concerns about influencing clients, resulted in clients’ spirituality and religion being overlooked far too often in counseling. Despite this tendency, recent clinical evidence on relational responsiveness identifies the adaptation of counseling to a client’s spirituality and religion as highly effective. In this article, the authors discuss how adapting counseling to a client’s spirituality and religion, in relation to all multicultural factors salient to the client, enhances relational responsiveness and treatment effectiveness. The authors also discuss the implications for training, supervision, and practice.

Speech-Language Pathologists' Practice Patterns When Designing Home Practice Programs for Persons With Aphasia: A Survey

Purpose We aimed to describe the current practices of speech-language pathologists regarding the creation and implementation of home practice programs for persons with poststroke aphasia. Method Survey participants were American Speech-Language-Hearing Association–certified speech-language pathologists, had 30% of their caseload include persons with aphasia, and had recently created at least two home programs for persons with aphasia. Respondents completed a web-based survey on home program creation, training, technology, and methods for tracking adherence with closed and open-ended questions. Results We analyzed 80 complete surveys. Most of the participants ( n = 56) created home programs for greater than 75% of their caseload. Common interventions in home programs addressed functional practice and spoken expression. Participants describe instructional techniques including building skill practice in daily routines and guided practice. Applications of technology and formal mechanisms to monitor adherence were less frequently reported. Various factors were identified as facilitators and barriers to home program creation with environmental support from others and client factors (i.e., motivation, impairments) most evident. Conclusions This study provides insight into speech-language pathologists' home program creation and implementation. Results can be used to consider mechanisms to improve use of and adherence to home programs to further support recovery. Supplemental Material https://doi.org/10.23641/asha.16840204

Therapeutic alliance in vocational rehabilitation counseling: assessing client factors and functioning

BACKGROUND: The therapeutic relationship is often acknowledged as one of the most significant factors in clinical process that influences client outcomes. OBJECTIVE: While considerable research has been conducted on the therapeutic relationship in psychotherapy, there is a paucity of research on the impact of the therapeutic relationship in vocational rehabilitation counseling settings. METHODS: This study explored the relationship between areas of client functioning (individual, interpersonal, social, and overall) and the therapeutic alliance among clients who receive services from the State vocational rehabilitation agency. RESULTS: In this study, younger clients (ages between 16 to 29) reported stronger therapeutic alliance. CONCLUSION: The findings of this study suggest that clients’ perceived individual, interpersonal and overall functioning have a significant positive relationship with the task and bond components of therapeutic relationship.

Fostering Change Through Occupation-Based Intervention: An International Joint Group Concept Mapping Study

Further consolidation and clarity regarding occupation as a means to foster change in interventions are needed. The study aimed to utilize the knowledge of occupational scholars to systematically determine what is required to use occupation as means to foster change within occupation-based interventions and to generate a conceptual model from those results. Group Concept Mapping involved the following: preparation, generation of ideas, structuring of statements, data analysis, interpretation of maps, and development of conceptual model. Fifty-two international occupational scholars brainstormed 125 ideas. A cluster rating map with nine clusters posed the foundation for a conceptual model with seven themes, namely, artful use of occupation, evidence-based use of occupation, collaboration to promote occupation, coordinating intervention fit, client factors, sociocultural context, and structural influences. The conceptual model, capturing dimensions and dynamics required for using occupation to foster change, may guide future research into occupation-based interventions.

Virtual Hearing Aid Care – Clinical Practice Guidance Document

This document was informed by literature reviews conducted in accordance with the Joanna Briggs Institute’s guide to evidence synthesis (Aromataris & Munn, 2017; https://joannabriggs.org) and includes evidence related to client candidacy, delivery models, modalities of delivery, and outcomes of virtual hearing aid fitting and management. This document provides clinical practice guidance for virtual hearing aid fitting and management processes and technological requirements in the delivery of such services (herein referred to as virtual hearing aid care). Virtual hearing aid care can include services delivered directly to a client by a provider or using facilitator-supported services and specialized equipment, depending on client factors, type of care, and the timepoint in the care process (e.g., initial versus follow-up appointments). This document will address virtual care including the following types of hearing aid care: o Programming o Verification o Validation o Management (counselling and education) Currently, virtual hearing aid care is better suited to follow-up appointments

Processing of Positive Memories Technique among Clients Reporting Traumatic Experiences: A Case Series

Many current treatments for posttraumatic stress disorder (PTSD) emphasize processing and engaging with trauma memories as the key mechanism of therapeutic change. However, promising emerging research indicates links between PTSD symptoms and positive memories. Processing positive memories, to therapeutically impact health outcomes for trauma-exposed individuals, may have several benefits, including (a) increasing access to positive coping mechanisms via activating positive affect and thoughts; (b) addressing avoidance of positive affect and thoughts; and (c) honing skills that will aid in the eventual processing of trauma memories. The present article demonstrates the utility and effects of a novel Processing of Positive Memories Technique (PPMT) with three clients who reported a history of traumatic experiences. We outline the procedures of a 5-session PPMT, that incorporates symptom assessment, detailed imaginal experiencing of positive memories, and processing of associated positive values, affect, strengths, and thoughts. We utilize longitudinal assessment data to demonstrate the clinical benefits of PPMT, such as less PTSD severity, improved mood (e.g., less negative affect), and greater self-esteem. Finally, we discuss treatment considerations based on unique client factors and treatment modalities (i.e., in-person vs. video telehealth).