Drop-out and therapeutic alliance: a process analysis

Author/s Francesca Balestra, Claudia Zaccaria, Laura Fruggeri
Publishing Year 2022 Issue 2021/127 Language Italian
Pages 22 P. 85-106 File size 672 KB
DOI 10.3280/TF2021-127006
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

The study aims to investigate the relationship between therapeutic alliance and drop-out to examine which factors in the context of therapeutic sessions may be associated with early termination of therapy by clients. Five therapeutic processes with different outcomes, for a total of 24 sessions, were analyzed through a mixed methodology that included an initial descriptive analysis with SOFTA, followed by a clinical-constructionist-dialogical analysis. The results show a fluctuating trend both in the completed therapeutic processes and in the dropouts and point out the in-session factors linked to the ruptures and failures to repair the alliance.

Keywords: Drop-out, therapeutic alliance, SOFTA, therapeutic relationship, positioning, discourse analysis.

  1. Aronsson K. & Cederborg A.C. (1994). Co-narration and voice in family therapy. Voicing, devoicing, and orchestration. Text, 14: 345-370. DOI: 10.1515/text.1.1994.14.3.345
  2. Bartle-Haring S., Glebova T., Gangamma R., Grafsky E. & Delaney R.O. (2012). Alliance and termination status in couple therapy: A comparison of methods for assessing discrepancies. Psychotherapy Research, 22(5): 502-514. DOI: 10.1080/10503307.2012.676985
  3. Beck M., Friedlander M.L. & Escudero V. (2006). Three perspectives on clients’ experiences of the therapeutic alliance: A discovery-oriented investigation. Journal of Marital and Family Therapy, 32(3): 355-368. DOI: 0.1111/j.1752-0606.2006.tb01612.x
  4. Escudero V., Boogmans E., Loots G. & Friedlander M.L. (2012). Alliance rupture and repair in conjoint family therapy: An exploratory study. Psychotherapy, 49(1): 26-37. DOI: 10.1037/a0026747
  5. Eubanks C.F., Muran J.C. & Safran J.D. (2018). Alliance rupture repair: A etaanalysis. Psychotherapy, 55(4): 508-519. DOI: 10.1037/pst0000185
  6. Friedlander M.L., Escudero V. & Heatherington L. (2006). Therapeutic alliances in couple and family therapy: an empirically informed guide to practice. Washington: American Psychological Association (trad. it.: Alleanze Terapeutiche nella terapia di coppia e della famiglia. Roma: Firera & Liuzzo, 2010).
  7. Fruggeri L., Balestra F. & Venturelli E. (2020). Le competenze psicoterapeutiche. Bologna: il Mulino.
  8. Harré R., Moghaddam F.M., Pilkerton Cairnie T., Rothbart D. & Sabat S.R. (2009). Recent advances in positioning theory. Theory and Psychology, 19: 5-31. DOI: 10.1177/0959354308101417
  9. Horvath A.O. & Bedi R.P. (2002). The alliance. In: Norcross J.C., a cura di, Psychotherapy relationships that work. New York: Oxford University Press.
  10. Johnson L.N., Wright D.W. & Ketring S.A. (2002). The therapeutic alliance in homebased family therapy: is it predictive of outcome? Journal of Marital and Family Therapy, 28: 93-102. DOI: 10.1111/j.1752-0606.2002.tb01177.x
  11. Jones E. (2003). Working with the “Self ” of the therapist in consultation. Human Systems, 14(1): 7-16.
  12. Kivlighan D.M. Jr. & Shaughnessy P. (2000). Patterns of working alliance development: A typology of client’s working alliance ratings. Journal of Counseling Psychology, 47(3): 362-371. DOI: 10.1037/0022-0167.47.3.362
  13. Knobloch-Fedders L.M., Pinsof W.M. & Mann B.J. (2007). Therapeutic alliance and treatment progress in couple psychotherapy. Journal of Marital and Family Therapy, 33: 245-257. DOI: 10.1111/j.1752-0606.2007.00019.x
  14. Kreppner K. (2009). Analizzare le “strutture profonde” dei processi familiari. In: Fruggeri L., a cura di, Osservare le famiglie. Roma: Carocci.
  15. Martin D.J., Garske J.P. & Davis M.K. (2000). Relation of therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68: 438-450. DOI: 10.1037/0022-006X.68.3.438
  16. Masi M.V., Miller R.B. & Olson M.M. (2003). Differences in dropout rates among individual, couple and family therapy clients. Contemporary Family Therapy, 25(1): 63-75. DOI: 10.1023/A:1022558021512.
  17. Muñiz de la Peña C., Friedlander M. & Escudero V. (2009). Frequency, severity and evolution of split family alliances: How observable are they? Psychotherapy Research, 19(2): 133-142. DOI: 10.1080/10503300802460050
  18. Ochs E. & Taylor C. (1996). The “father knows best” dynamic in dinnertime narratives. In: Hall K., a cura di, Gender articulated: language and the socially constructed Self. London: Routledge.
  19. Robbins M.S., Liddle H.A., Turner C.W., Dakof G.A., Alexander J.F. & Kogan S.M. (2006). Adolescent and parent therapeutic alliances as predictors of dropout in multidimensional family therapy. Journal of Family Psychology, 20(1): 108-116. DOI: 10.1037/0893-3200.20.1.108
  20. Robbins M.S., Turner C.W., Alexander J.F. & Perez G.A. (2003). Alliance and dropout in family therapy for adolescents with behavior problems: Individual and systemic effects. Journal of Family Psychology, 17(4): 534-544. DOI: 10.1037/0893-3200.17.4.534
  21. Stiles W.B., Glick M.J., Osatuke K., Hardy G.E., Shapiro D.A., Agnew-Davies R., Rees A. & Barkham M. (2004). Patterns of Alliance Development and the Rupture-Repair Hypothesis: Are Productive Relationships U-Shaped or V-Shaped? Journal of Counseling Psychology, 51(1): 81-92. DOI: 10.1037/0022-0167.51.1.81
  22. Tannen D. (2007). You just don’t understand. Women and men in conversation. New York: Harper & Collins.
  23. Yoo H., Bartle-Haring S. & Gangamma R. (2016). Predicting premature termination with alliance at sessions 1 and 3: An exploratory study. Journal of Family Therapy, 38: 5-17. DOI: 10.1111/1467-6427.12031

Francesca Balestra, Claudia Zaccaria, Laura Fruggeri, Drop-out e alleanza terapeutica: un’analisi processuale in "TERAPIA FAMILIARE" 127/2021, pp 85-106, DOI: 10.3280/TF2021-127006