Therapeutic Relationship Utilizing the HAQ-2 to Examine Thesis

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Therapeutic Relationship

Utilizing the HAQ-2 to Examine the Therapeutic Alliance

The therapeutic relationship, sometimes referred to as the helping alliance or working alliance, is one of the most important predictors of psychiatric patient outcome. This relationship is used as a tool to help promote positive patient outcomes. Relationships are a two-way street, resulting either transference or a lack of connection between the therapist and the patient. This study will explore the ability of clinical psychologists to the health of the therapeutic relationship. The ability to accurately assess the therapeutic relationship plays an important role in the ability to adjust treatment regimes accordingly. The ability to repair an ailing relationship is an important part of the healing process. This research will explore the appropriateness of the Health Alliance Questionnaire-2 (HAQ-2) as an instrument for measuring psychologist ability to assess the therapeutic relationship in an upcoming study.

Part 1: Therapeutic Relationship or Client-Therapist Attachment?

Understanding the Elements of the Therapeutic Relationship

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Although many other factors can affect ability of a client to reach therapeutic goals, the therapeutic relationship is one of the most important predictors of client outcome. The therapist must be able to motivate the patient to participate in the prescribed treatment, take their medications, and make the necessary lifestyle changes for their success. A healthy therapeutic relationship can be an excellent tool in achieving goals. In a positive relationship, the therapist acts as a coach for the patient. However, in an unhealthy relationship, the therapist can cause irreparable damage to the patient. Therefore, it is important for the therapist to understand and be able to assess their relationships with clients.

Thesis on Therapeutic Relationship Utilizing the HAQ-2 to Examine Assignment

In order to better understand the dynamics of the therapeutic relationship, one must attempt to understand as much as possible about the factors that influence the relationship. The therapeutic relationship is an important predictor in individual outcomes during psychotherapy (Horvath & Bedi, 2002). The therapeutic relationship has also been shown to affect the outcome of couples in therapy under a number of circumstances, accounting for as much as 5-22% of the therapeutic outcome (Knobloch-Fedders, 2007). These sources indicate that inconsistency exists between studies that measured different phases of the treatment process. However, this does not undermine the importance of the therapeutic relationship in the final success of the therapy.

Many variables affect treatment outcome, and it may be difficult to determine how much of the outcome can be directly attributed to the therapeutic alliance. Llgen, Finney & Moos (2006) found that the therapeutic alliance could counteract the effect of low self-esteem in patients being treated for alcohol abuse. This study found that in patients with high self-esteem, the therapeutic relationship had little impact on outcomes. However, in patients with low self-esteem, the therapeutic relationship had the ability to change the outcome from a negative one to a positive one.

Several factors affect the ability to form a strong therapeutic relationship. For instance, the attitude of the patient and their internal motivation can have an impact on the ability to form a strong therapeutic relationship. Patients that are highly motivated and ready for change are more likely to form a positive therapeutic relationship than those that are resistant to change (BCR, 2006). Perfectionists also have problems with the therapeutic relationship (BCR, 2006). Anxiety and cognitive impairment can also affect the ability to form a positive therapeutic relationship (BCR, 2006). Patients that are better adjusted in the beginning of the therapy sessions are more likely to build a positive therapeutic relationship than those that have a poor relationship from the start (BCR, 2006). Patients bring certain things with them into the relationship and these things have a direct impact on the ability to form a positive therapeutic relationship.

Therapists must realize that the patient will bring with them some things that affect the ability to build a positive relationship. However, it was also found that therapists must bring certain things with them in order to make the relationship a success. Therapists who bring expertise and empathy with them are more likely to influence the relationship in a positive manner (BCR, 2006; Feller & Cottone, 2003). A therapist with these qualities will be able to make adjustments throughout the treatment in order to build a relationship.

The therapeutic alliance occurs in a number of treatment settings, even in the absence of face-to-face contact. Children who received cognitive-behavioral treatment via telephone formed a therapeutic alliance with their specialists, even though they had no face-to-face contact (Lingley-Pottie & McGrath, 2008). Both the therapist and the patient share in the responsibility for developing a positive therapeutic alliance (Meissner, 2006). The therapeutic alliance begins to develop in the assessment stage of treatment and carries through the entire treatment process (Hilsenroth, Peters, & Ackerman, 2004).

Several factors can help patients feel as if the therapeutic relationship is a positive one. They are getting little extras from the treatment, looking for common ground, feeling like the practitioner sincerely cares, practitioner availability, practitioner flexibility and the opportunity for the patient to have input into the treatment (Ware, Tugenber, & Dickey, 2004). Communication skills by the therapist cannot be emphasized enough in the development of a positive patient perception. Communication by the medical practitioner was found to be a facto in patient's overall satisfaction, their willingness to adhere to treatment plans, treatment outputs, and the likelihood of filing a malpractice claim (Cruz & Pincus, 2002). The study found that doctors could be more responsive to patient needs without lengthening visits (Cruz & Pincus, 2002).

These studies demonstrate the importance of developing a positive therapeutic relationship early in the treatment process; both the patient and the therapist play an important role in the therapeutic relationship. The patient can carry past emotional baggage with them, which can have a negative impact on the therapeutic relationship. The therapist must actively work to provide positive communication and make adjustments to promote a positive therapeutic relationship. These are the key elements in the therapeutic relationship that can affect treatment outcomes.

Understanding Client-Therapist Attachment

One can understand the importance of developing a positive therapeutic relationship, but sometimes, too much attachment can develop from a client standpoint. The therapeutic relationship requires that certain boundaries be set to define where the therapeutic relationship begins and when a taboo boundary has been crossed. Every person has certain boundaries in their lives that help to define their personal space. Often these boundaries are not well defined and it can be difficult to judge where another person's boundaries lie. However, these boundaries can play in important role in helping the therapeutic

The technical term for our personal space is the intersubjective field. These boundaries fall into the categories of propriety, space, behavioral, verbal and energetic (Rand, 2008). When boundaries are crossed unintentionally, both the therapist and the client can be emotionally harmed (Rand, 2008). In order to avoid this dilemma, the therapist must understand these various types of boundaries in themselves and in their clients. They must attend to them and make certain that they are not crossed. Making boundaries concrete can play an important role in making certain that undesirable attachments are not crossed (Rand, 2008).

The inability to adhere to behavioral boundaries begins in childhood. Crossing behavioral boundaries can result in resentment of the client or the therapist (Rand, 2008). Verbal boundaries are closely connected to social space (Rand, 2008). One of the more common examples of verbal boundaries occurs when the client asks the therapist a question. The therapist must decide whether to answer the client honestly, or to answer in a way that will best suit the client's needs. Physical boundaries mean the space around us and the proximity in which we feel comfortable with another person. Sometimes one person may feel uncomfortable and the other is unaware of it (Rand, 2008). The therapist must be aware of these various boundaries and make certain that they are not violated.

Client attachment to the therapist can stem from a memory of parental care giving (Woodhouse, Schlosser, & Crook, et al., 2003). Clients are more apt to develop an attachment to their therapist after a longer or ongoing therapy plan, than during treatment plans that are short duration (Woodhouse, Schlosser, & Crook, et al., 2003). Clients engaged in more transference when client-therapist attachment developed (Woodhouse, Schlosser, & Crook, et al., 2003).

The nature of therapy is such that the therapist seeks to develop relationships with clients that promote the sharing of intimate feelings (Parish, & Eagle, 2003). The therapist must seek to understand each patient's attachment style. In doing so, they can take steps to prevent the client from forming an unhealthy relationship (Parish, & Eagle, 2003). One must remember that therapy will not continue forever in most cases. At some point, the relationship will end. The client that has formed an unhealthy relationship with their therapist may experience the separation as a loss, causing more trauma in the long-term.

There has not been a significant amount of literature published on the unhealthy client-therapist relationship. It is generally considered a… [END OF PREVIEW] . . . READ MORE

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