ABSTRACT

Both therapeutic alliance and group cohesion have been identified as “demonstrably effective” relationship elements in therapy. However, the overwhelming majority of process-outcome research has relied on clients as raters of the therapeutic relationship. A lack of convergence between client, therapist, and observer perspectives has raised questions regarding how best to measure relationships in therapy. Interest in observational measures has grown, as they may offer more objective and reliable measurements of process. This study compared the predictive validity of client and observer ratings of the alliance (Agreement and Bond) and group cohesion in the context of group cognitive behaviour therapy (CBT) for anxiety disorders. Results showed that client and observer ratings of process were not significantly correlated, and regarding the alliance, only client-rated Agreement predicted client-rated treatment gains. In contrast, both client and observer-ratings of group cohesion were found to uniquely contribute to treatment outcomes. If replicated, the findings from the present study suggest that (1) while client ratings of alliance consistently predict client-rated outcomes, the predictive validity of observer measures has yet to be established, and (2) both clients and observers provide meaningful and distinct information about group cohesion in therapy.

摘要

治疗联盟和团体凝聚力都被确定为治疗中“明显有效”的关系元素。然而，绝大多数过程-结果研究都依赖客户作为治疗关系的评估者。来访者、治疗师和观察者的观点之间缺乏一致性，这引发了关于如何最好地衡量治疗中关系的问题。对观测测量的兴趣越来越大，因为它们可以提供更客观和可靠的过程测量。本研究比较了在焦虑症群体认知行为疗法 (CBT) 的背景下，联盟的客户和观察者评级（协议和债券）和群体凝聚力的预测有效性。结果表明，客户和观察者对流程的评级没有显着相关性，关于联盟，只有客户评价的协议才能预测客户评价的治疗收益。相比之下，客户和观察者对团体凝聚力的评分都被发现对治疗结果有独特的贡献。如果重复，本研究的结果表明（1）虽然联盟的客户评级始终预测客户评级的结果，但观察者测量的预测有效性尚未确定，并且（2）客户和观察者都提供了有意义和独特的关于治疗中的团体凝聚力的信息。