Uniwersyteckie Czasopisma NaukoweThe relationship between clients’ personality traits, working alliance and therapy outcome in a training context
Słowa kluczowe:
outcome, client personality traits, HP5i, psychotherapy training, allianceAbstrakt
Background
Clients’ differences in personality include both psychopathology and normal personality variations and constitute an important factor for the therapeutic process and outcome. There is a lack of empirical data on the impact of clients’ personalities on therapeutic relationships and outcomes, particularly in a training context.
Participants and procedure
This longitudinal study investigated the relationships between client personality traits, changes in those traits after cognitive behavioral or psychodynamic short-term therapy, and clients’ perceived working alliances with their therapists and their clinical outcomes at a university training clinic in Sweden. Participants were 138 clients with moderate psychological symptoms. Personality traits were measured using the Health-Relevant Personality Inventory.
Results
The results showed that Antagonism, Impulsivity, Hedonic Capacity, and Negative Affectivity improved significantly during therapy, while Alexithymia did not. Pre-therapy personality traits were not related to perceived working alliances (Working Alliance Inventory) or therapeutic outcomes (Clinical Outcomes in Routine Evaluation Outcome Measure). Post-therapy personality traits negative affectivity, hedonic capacity and alexithymia were related to working alliance, and changes in personality traits were predictive of therapy outcome. The change in Hedonic Capacity and Negative Affectivity explained about 20% of the variance in post-therapy symptoms after controlling for pre-therapy symptoms.
Conclusions
The results suggest that therapeutic foci on hedonism (extraversion) and negative affectivity (neuroticism) could be important for working alliance formation and symptom reduction in therapy. Future research should examine whether changes in clients’ negative affectivity or hedonic capacity mediate the relation between perceived working alliance quality and clinical outcome in training and other psychotherapeutic contexts.
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Bibliografia
Alexander, L. B., Luborsky, L., Greenberg, L. S., & Pinsof, W. M. (1986). The Penn Helping Alliance scales. In L. S. Greenberg & W. M. Pinsof (eds.), The Psychotherapeutic Process: A Research Handbook (pp. 325–366). New York: The Guilford Press.
Axelsson, M. (2013). Personality and reasons for not using asthma medication in young adults. Heart & Lung, 42, 241–246. doi: 10.1016/j.hrtlng.2013.01.005
Baldwin, S. A., Murray, D. M., Shadish, W. R., Pals, S. L., Holland, J. M., Abramowitz, J. S., …, et al. (2011). Intraclass correlation associated with therapists: estimates and applications in planning psychotherapy research. Cognitive Behaviour Therapy, 40, 15–33. doi: 10.1080/16506073.2010.520731
Baldwin, S. A., & Imel, Z. E. (2013). Therapist effects, findings and methods. In M. J. Lambert (ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.) (pp. 258–297). New York, NY: Wiley.
Binder, J. L., & Betan, E. J. (2013). Core competencies in brief dynamic psychotherapy: becoming a highly effective and competent brief dynamic psychotherapist. New York: Routledge.
Blom, M. B. J., Spinhoven, P., Hoffman, T., Jonker, K., Hoencamp, E., Haffmans, P. M. J., & van Dyck, R. (2007). Severity and duration of depression, not personality factors, predict short term outcome in the treatment of major depression. Journal of Affective Disorders, 104, 119–126. doi: 10.1016/j.jad.2007.03.010
Campbell-Sills, L., Cohan, S. L., & Stein, M. B. (2006). Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behaviour Research and Therapy, 44, 585–599. doi: 10.1016/j.brat.2005.05.001
Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., …, et al. (1991). Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1, 81–91. doi: 10.1080/10503300500265025
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.
Coleman, D. (2006). Client personality, working alliance and outcome: A pilot study. Social Work in Mental Health, 4, 83–98. doi: 10.1300/J200v04n04_06
De Fruyt, F., Van Leeuwen, K., Bagby, R. M., Rolland, J.-P., & Rouillon, F. (2006). Assessing and interpreting personality change and continuity in patients treated for major depression. Psychological Assessment, 18, 71–80. doi: 10.1037/1040-3590.18.1.71
Elfström, M. L., Evans, C., Lundgren, J., Johansson, B., Hakeberg, M., & Carlsson, S. G. (2012).Validation of the Swedish version of the Clinical Outcomes in Routine Evaluation Outcome Measure (COREOM). Clinical Psychology and Psychotherapy, 20, 447–455. doi: 10.1002/cpp.1788
Evans, C., Connell, J., Barkham, M., Margison, F., McGrath, G., Mellor-Clark, J., & Audin, K. (2002). Towards a standardized brief outcome measure: psychometric properties and utility of the CORE OM. British Journal of Psychiatry, 180, 51–60. doi: 10.1192/bjp.180.1.51
Evans, C., Mellor-Clark, J., Margison, F., Barkham, M., Audin, K., Connell, J., & Mcgrath, G. (2000). CORE: Clinical outcomes in routine evaluation. Journal of Mental Health, 9, 247–255.
Field, A. (2009). Discovering statistics using SPSS (3rd ed). Washington DC: SAGE.
Gaston, L. (1991). Reliability and criterion-related validity of the California psychotherapy Alliance scales-patient version. Psychological Assessment, 3, 68–74. doi: 10.1037/1040-3590.3.1.68
Giluk, T. L. (2009). Mindfulness, Big five personality and affect: A meta-analysis. Personality and Individual Differences, 47, 805–811. doi: 10.1016/j.paid.2009.06.026
Goodwin, R. D., & Friedman, H. S. (2006). Health status and the five-factor personality traits in a national representative sample. Journal of Health Psychology, 11, 643–654. doi: 10.1177/1359105306066610
Goldberg, R. W., Rollins, A. L., & McNary, S. W. (2004). The Working Alliance Inventory: Modification and use with people with mental illness in a vocational rehabilitation program. Psychiatric Rehabilitation Journal, 27, 267–270. doi: 10.2975/27.2004.267.270
Gunnarsson, M., & Gustavsson, J. P. (2013). Normative data for HP5i based on SOM investigation 2011. Unpublished Manuscript.
Gunnarsson, M., Gustavsson, J. P., Tengström, A., Franck, A., & Fahlke, C. (2008). Personality traits and their associations with substance use among adolescents. Personality and Individual Differences, 45, 356–360. doi: 10.1016/j.paid.2008.05.004
Gustavsson, J. P., Eriksson, A. K., Hilding, A., Gunnarsson, M., & Ostensson, C. G. (2008). Measurement invariance of personality traits from a Fivefactor model perspective: Multi-group confirmatory factor analyses of the HP5 inventory. Scandinavian Journal of Psychology, 49, 459–467. doi: 10.1111/j.1467-9450.2008.00654.x
Gustavsson, J. P., Jönsson, E. G., Linder, J., & Weinryb, R. M. (2003). The HP5 inventory: definitione and assessment of five health-relevant personality traits from a five-factor model perspective. Personality and Individual Differences, 35, 69–89. doi: 10.1016/S0191-8869(02)00142-3
Hansson, W. E., Curry, K. T., & Bandalos, D. L. (2002). Reliability generalization of working Alliance inventory scale scores. Educational and Psychological Measurement, 62, 659–673. doi: 10.1177/0013164402062004008
Hatcher, R. L., & Barends, A. W. (1996). Patients’ view of the alliance in psychotherapy: exploratory factor analysis of three alliance measures. Journal of Consulting and Clinical Psychology, 64, 1326–1336. doi: 10.1037/0022-006x.64.6.1326
Hedman, E., Andersson, G., Lindefors, N., Gustavsson, P., Lekander, M., Rűck, C., …, et al. (2014). Personality change following internet based cognitive behawior therapy for severe health anxiety. PLoS One, 9, 1–18. doi: 10.1371/journal.pone.0113871
Hemphälä, M., Gustavsson, P. J., & Tengström, A. (2013). The validity of the Health-relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI) among adolescents referred for a substance misuse problem. Journal of Personality Assessment, 95, 398–406. doi: 10.1080/00223891.2012.735301
Hill, C. E., & Knox, S. (2013). Training and supervision in psychotherapy. In M. J. Lambert (ed.), Bergin and Garfield’s handbook of psychotherapy and behawior change (6th ed.) (pp. 775–812). New York, NY: Wiley.
Hirsh, J. B., Quilty, L. C., Bagby, R. M., & McMain, S. F. (2012). The relationship between agreeableness and the development of the working Alliance in patient with borderline personality disorder. Journal of Personality Disorders, 26, 616–627. doi: 10.1521/pedi.2012.26.4.616
Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233. doi: 10.1037/0022-0167.36.2.223
John, O. P., & Srivastava, S. (1999). The Big Five Trait taxonomy: History, measurement, and theoretical perspectives. In L. A. Pervin & O. P. John (eds.), Handbook of personality: Theory and Research (2nd ed.) (pp. 102–138). New York. NY: Guilford Press.
Kendler, K. S., Gatz, M., Gardner, C. O., & Petersen, N. L. (2006). Personality and major depression: A Swedish longitudinal, population-based twin study. Archives of General Psychiatry, 63, 1113–1120. doi: 10.1001/archpsyc.63.10.1113
Kenny, D. A., Manetti, L., Pierro, A., Livi, S., & Kashy, D. A. (2002). The statistical analysis of data from small groups. Journal of Personality and Social Psychology, 83, 126–137. doi: 10.1037//0022-3514.83.1.126
Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136, 768–821. doi: 10.1037/a0020327
Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., & Quill, T. E. (2009). Association of educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302, 1284–1293. doi: 10.1001/jama.2009.1384
Lahey, B. B. (2009). Public health significance of neuroticism. American Psychology, 64, 241–256. doi: 10.1037/a0015309
Lee, K.-H., & Bowen, S. (2015). Relation between personality traits and mindfulness following mindfulness-based training: A study of incarcerated individuals with drug abuse disorders in Taiwan. International Journal of Mental Health and Addiction, 13, 413–421. doi: 10.1007/s11469-014-9533-y
McWilliams, N. (2012). Beyond traits: Personality as intersubjective themes. Journal of Personality Assessment, 94, 563–570. doi: 10.1080/00223891.2012.711790
Mohaupt, H., Holgersen, H., Binder, P.-E., & Höstmark Nielsen, G. (2006). Affect consciousness or mentalization? A comparison of two concepts with regard to affect development and affect regulation. Scandinavian Journal of Psychology, 47, 237–244. doi: 10.1111/j.1467-9450.2006.00513.x
Okiishi, J. C., Lambert, M. J., Eggett, D., Nielson, L., Dayton, D. D., & Vermeersch, D. A. (2006). An analysis of therapist treatment effects: Toward providing feedback to individual therapists on their clients’ psychotherapy outcome. Journal of Clinical Psychology, 62, 1157–1172. doi: 10.1002/jclp.20272
Quilty, L. C., De Fruyt, F., Rolland, J.-P., Kennedy, S. H., Rouillon, P. F., & Bagby, R. M. (2008). Dimensional personality traits and treatment outcome in patients with major depressive disorder. Journal of Affective Disorders, 108, 241–250. doi: 10.1016/j.jad.2007.10.022
Saulsman, L. M., & Page, A. C. (2004). The five-factor model and personality disorder empirical literature: A meta-analytic review. Clinical Psychology Review, 23, 1055–1085.
Smits, D., Luyckx, K., Smits, D., Stinckens, N., & Claes, L. (2015). Structural characteristics and external correlates of the Working Alliance Inventory-Short Form. Psychological Assessment, 27, 545–551. doi: 1040-3590/15 /$12.00.
Spek, V., Nyklíček, I., Cuijpers, P, & Pop, V. (2008). Predictors of outcome of group and Internet-based cognitive behavior therapy. Journal of Affective Disorders, 105, 137–145. doi: 10.1016/j.jad.2007.05.001
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics, 6/E. Instock: Pearson.
Tang, T. Z., DeRubeis, R. J., Hollon, S., Amsterdam, J., Shelton, R., & Schalet, B. (2009). Personality change during depression treatment. Archives of General Psychiatry, 66, 1322–1330. doi: 10.1001/archgenpsychiatry.2009.166
Trull, T. J., & Sher, K. J. (1994). Relationship between the Five-factor model of personality and Axis I disorders in a nonclinical sample. Journal of Abnormal Psychology, 103, 350–360. doi: 10.1037/0021-843X.103.2.350
Westbrook, D., Kennerly, H., & Kirk, J. (2011). An introduction to cognitive behavior therapy: skills and applications (2nd ed.). London: SAGE.
Zinbarg, R. E., Uliaszek, A. A., & Adler, J. M. (2008). The role of personality in psychotherapy for anxiety and depression. Journal of Personality, 76, 1649–1688. doi: 10.1111/j.1467-6494.2008.00534.x
