Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA.
Department of Psychology, Mississippi State University, Starkville, Mississippi, USA.
Clin Psychol Psychother. 2020 Nov;27(6):858-886. doi: 10.1002/cpp.2475. Epub 2020 Jun 8.
The nature and quality of the relationship between therapist and client in psychotherapy, known as therapeutic alliance, have been proposed as one of the most important factors for successful treatment outcome, which has been has robustly supported across many types of treatment, populations, raters of alliance (i.e., client, therapist, or observer), and alliance measures. However, most research on alliance and treatment outcome has been conducted in children and adults with internalizing problems (e.g., mood and anxiety disorders) or children with externalizing problems (e.g., conduct disorder), despite the fact that alliance may be particularly important for adults with externalizing problems such as problematic aggression, who may have high levels of resistance, blaming, and interpersonal problems. Very limited research has examined the role of alliance in individuals who present to treatment due to high levels of aggressive behaviour specifically (e.g., those convicted of a violent offence). The current systematic review examined the extant research on the relationship between alliance and outcome in treatment of highly aggressive individuals, as well as those who are diagnosed with a disorder for which aggression is a primary symptom (i.e., post-traumatic stress disorder, antisocial personality disorder, and borderline personality disorder). Overall, it was shown that alliance has a positive impact on treatment outcome among those engaging in or at risk for problematic aggression. Additionally, the alliance-outcome relationship may be affected by therapy modality, alliance rater perspective, and potential mechanisms of alliance. Implications for future research, including utilizing more primarily aggressive samples, are discussed.
心理治疗中治疗师和客户之间的关系的性质和质量，称为治疗联盟，被认为是成功治疗结果的最重要因素之一，这在许多类型的治疗、人群、联盟评估者（即客户、治疗师或观察者）和联盟措施中得到了强有力的支持。然而，大多数关于联盟和治疗结果的研究都是在有内化问题（例如情绪和焦虑障碍）的儿童和成人或有外化问题（例如行为障碍）的儿童中进行的，尽管联盟对于有外化问题的成年人可能特别重要，例如有问题的攻击性，他们可能有很高的抵抗力、责备和人际关系问题。非常有限的研究考察了联盟在因攻击性行为水平高而接受治疗的个体中的作用，例如那些因暴力犯罪而被定罪的人。目前的系统审查检查了关于高度攻击性个体治疗中联盟与结果之间关系的现有研究，以及那些被诊断为攻击性是主要症状的障碍的个体（即创伤后应激障碍、反社会人格障碍和边缘型人格障碍）。总的来说，结果表明，在有或有问题的攻击性风险的个体中，联盟对治疗结果有积极影响。此外，联盟-结果关系可能受到治疗模式、联盟评估者的观点以及联盟的潜在机制的影响。讨论了对未来研究的影响，包括利用更主要的攻击性样本。
