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Does the working alliance mediate the effect of routine outcome monitoring (ROM) and alliance feedback on psychotherapy outcomes? A secondary analysis from a randomized clinical trial.

https://arctichealth.org/en/permalink/ahliterature299441
Source
J Couns Psychol. 2019 Mar; 66(2):234-246
Publication Type
Journal Article
Randomized Controlled Trial
Date
Mar-2019
Author
Heidi Brattland
John Morten Koksvik
Olav Burkeland
Christian A Klöckner
Mariela Loreto Lara-Cabrera
Scott D Miller
Bruce Wampold
Truls Ryum
Valentina Cabral Iversen
Author Affiliation
Department of Mental Health.
Source
J Couns Psychol. 2019 Mar; 66(2):234-246
Date
Mar-2019
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Adult
Feedback, Psychological
Female
Health Personnel - standards - trends
Humans
Male
Norway - epidemiology
Professional-Patient Relations
Psychotherapy - standards - trends
Treatment Outcome
Abstract
Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM system that provides session-by-session feedback on clients' well-being and the alliance. Adult individuals (N = 170) referred for hospital-based outpatient mental health treatment were randomized to individual psychotherapy either with the PCOMS ROM system, or without (treatment as usual [TAU]). Treatment was provided by the same therapists (N = 20) in both conditions. A multilevel mediation model was developed to test if there was a significant indirect effect of ROM on client impairment at posttreatment through the alliance at 2 months' treatment controlled for first-session alliance. Alliance ratings increased more from session 1 to 2 months' treatment in the ROM than TAU condition, and alliance increase was associated with less posttreatment impairment. A significant indirect effect of ROM on treatment outcomes through alliance increase (p = .043) explained an estimated 23.0% of the effect of ROM on outcomes. The results were consistent with a theory of the alliance as one mechanism through which ROM works. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
PubMed ID
30702322 View in PubMed
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Multilevel Exploratory Factor Analysis of the Feeling Word Checklist-24.

https://arctichealth.org/en/permalink/ahliterature292733
Source
Assessment. 2017 Oct; 24(7):907-918
Publication Type
Journal Article
Date
Oct-2017
Author
Karin Lindqvist
Fredrik Falkenström
Rolf Sandell
Rolf Holmqvist
Annika Ekeblad
Agneta Thorén
Author Affiliation
1 The Erica Foundation, Stockholm, Sweden.
Source
Assessment. 2017 Oct; 24(7):907-918
Date
Oct-2017
Language
English
Publication Type
Journal Article
Keywords
Checklist
Emotions
Factor Analysis, Statistical
Female
Health Personnel - psychology
Humans
Male
Multilevel Analysis
Professional-Patient Relations
Psychometrics - methods
Psychotherapy - instrumentation - methods - standards
Reproducibility of Results
Self Report
Sweden
Abstract
Emotional reactions are a vital part of the therapeutic relationship. The Feeling Word Checklist-24 (FWC-24) is an instrument asking the clinician (or the patient) to report to what degree he or she has experienced various feelings during a therapeutic interaction. The aim of this study was to assess the factor structure of the clinician-rated FWC-24 when taking dependencies in the data into account. The sample was deliberately heterogeneous and consisted of 4,443 ratings made by 101 psychotherapists working with different psychotherapy methods in relation to 191 patients of different ages, genders, and with different primary diagnoses. A random intercept-only model revealed large intraclass correlation coefficients at the therapist level, indicating that a multilevel analysis was warranted. A two-level exploratory factor analysis with therapists as the between level and patients plus sessions as the within level was conducted. The items from FWC-24 were found to be best represented by four factors on the between level and four factors on the within level. The factor structures were largely similar on the two levels and were labeled Engaged, Inadequate, Relaxed, and Moved. The different factors explained different amounts of variance on different levels, indicating that some factors are more therapist dependent and some more patient dependent.
PubMed ID
26893388 View in PubMed
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