The alliance study is now published in the prestigious Journal of Consulting and Clinical Psychology (if I can boast a bit!): Anker, M., Owen, J., Duncan, B., & Sparks, J. (2010). The alliance in couple therapy: Partner influence, early change, and alliance patterns in a naturalistic sample. Journal of Consulting and Clinical Psychology, 78, 635–645. Congrats again to the crew!

A quick and dirty summary: N = 500 (total sample) n = 236 (subsample attending 4 or more sessions).  This study further supports both the feasibility and the importance of the feedback (PCOMS) intervention. The alliance significantly predicted outcome over and above early change, demonstrating that the alliance is not merely an artifact of client improvement but rather a force for change in and of itself. The study also found that those couples whose alliance scores ascended attained significantly better outcomes than those whose alliances scores did not improve. Together these findings suggest that therapists should not leave the alliance to chance but rather routinely assess it and discuss it with clients in each session.

Here is a discussion I had with the principal and onsite investigator, my friend, colleague, and partner in crime here at the Project, Morten Anker:

This study is significant for several reasons. First, as the Norway Feedback Study, it brings academic credibility to the use of the measures. Next it offers an antidote to the alliance nay-sayers who dismiss the alliance as only correlational despite the over 1000 studies that support the association between the alliance and outcome (this is like dismissing the association between cigarette smoking and lung cancer!) and often assert that the alliance is merely an artifact of early change. In other words, they argue that the alliance is confounded with early change and does not make any contribution beyond the client’s experience of improvement (clients experience positive alliances because they experience change). It is worthy question but it is often wielded in a way that undermines the importance of the alliance and the fact that it is second most replicated finding in the literature (the dodo bird verdict is first). This is one of only 6 studies that systematically examine this issue. Noteworthy is that we took a very stringent perspective of change. We looked at the clients who experienced reliable change so it was significant change, not just a little change. The alliance was predictive of outcome over and above early change even when that change exceeded 5 points on the ORS. Finally, the study, as mentioned, demonstrated the feasibility and benefit of routine alliance assessment.

On another note, a very interesting blog was sent to me by the author, a consumer. If you ever have any doubts about why collaborative monitoring of outcome and the alliance is a good idea, check this out from a consumer who says: “I’ve had a number of conversations with those harmed by therapy. A common thread is how resistant the profession seems to be to feedback from clients. To that end is my modest entry into the fray:” http://disequilibrium1.wordpress.com/2010/10/10/a-disgruntled-ex-psychotherapy-client-speaks-her-piece/

I am very pleased to announce that our alliance article from the Norway Feedback Project (Anker, Owen, Duncan, & Sparks, in press) was accepted in the prestigious Journal of Consulting and Clinical Psychology (JCCP). Congrats to the whole team: Morten Anker, Certified Trainer, Jesse Owen, Research Director, and Jacqueline Sparks, Project Leader. Although already well established in terms of its widespread use and validated psychometrics, this is a major step forward for the Session Rating Scale (our alliance measure), bringing it more academic credibility, and importantly, it allows mainstream scientific dissemination of the idea of continuous alliance monitoring. The Outcome Rating Scale/Session Rating Scale combo (or the Partners for Change Outcome Management System or PCOMS), btw, is the only outcome system that includes routine alliance monitoring. And the SRS is the only alliance measure specifically designed for the front line clinician for use with every client in every session.

There’s a lot of talk about what makes some therapists more effective than others, and a lot of claims unsubstantiated by research. But what really makes a difference in outcome is that tried and true but taken granted old friend, the alliance. The most definitive thing we know about what makes some therapists better than others is their ability to secure a good alliance across a variety of client presentations and personalities. This finding was recently confirmed by a sophisticated analysis by Scott Baldwin and colleagues in perhaps the premier psychotherapy research publication, JCCP. It also dispelled common folklore by demonstrating that good alliances were more of a function of what therapists brought to the table than clients; i.e., therapists adept at alliances were able to transcend type of client while other less effective therapists were not. Further, and simply put, the alliance accounts for five to seven times the amount of variance of outcome as model and technique. And, according to the bible of psychotherapy outcome research (Garfield and Bergin’s Handbook of Psychotherapy and Behavior Change, the Orlinsky, Rønnestad, and Willutzki chapter) there are over 1000 process-outcome findings that support the association between a strong alliance and positive outcome.

Despite this, however, naysayers (read model maniacs, I mean proponents) will dismiss the alliance by saying the research is only correlational. Even more damning, they say, is that we don’t know which comes first, client experience of a strong alliance or client report of change or benefit—the classic chicken or the egg question. Enter our just accepted alliance study that involved a total sample of 500 clients. The alliance significantly predicted outcome over and above early change, demonstrating that the alliance is not merely an artifact of client improvement but rather a force to be reckoned with in and of itself. Don’t let anyone tell you that the alliance is anything less than it is—the single greatest impact we can have on client change. We can continually improve our ability to form strong alliances with a broader range of clients, and thereby improve our effectiveness. Don’t leave it to change. Monitor with your clients.

A new feature just added to the website: The Heart and Soul of Change Project Mailing List. This list won’t cover you up in email or leave you hurling harsh language at me—I promise. You will only receive 4-6 updates per year about the latest training opportunities and Project happenings.  Subscribe/unsubscribe or change your profile.

Finally, the next webinar is scheduled:

Have you ever wondered how to present client directed outcome informed (CDOI) ideas and practices to a general rather than professional audience? Wonder no longer, because that is what I did in my self help book, What’s Right With You and that’s what this webinar will do:

We live in a world pervaded by the unspoken attitude that we are all basically flawed, broken, incomplete, scarred or sick: we’re labeled as dysfunctional, codependent, depressed, you name it. Contrary to popular perception and drug company ad campaigns, fifty years of research shows that positive change does not primarily emerge from examining the disorders, diseases, or dysfunctions—all the stuff that’s wrong with us—that allegedly plague the masses. Change, in truth, comes from what’s right with the people attempting it—their strengths, resources, ideas, and relational support—not the labels they are branded with, the special expertise of doctors or the magic methods or potions they peddle.

In this webinar Barry translates CDOI into a six step plan, as detailed in his self help book, What’s Right With You.

Title: What’s Right With You by Barry Duncan
Date: Friday, May 28, 2010
Time: 12:00 PM – 1:00 PM CDT

Join the CDOI Members or wait until this webinar is posted on the bookstore.