summarized by UMB doctoral student in clinical psychology Laura Yoviene
Nissen-Lie, H., Havik, O., Hoglend, P., Monsen, J., & Ronnestad, M. (2017). The contribution of the quality of therapists’ personal lives to the development of the working alliance. Journal of Counseling Psychology, 60 (4), 483-495.
Much research has pointed to the individual therapist as an important factor influencing the process and results of psychotherapy. Few studies, however, have examined the relationship between therapists’ personal experiences and the quality of their therapeutic work. Thus, the current study aims to investigate the effects of therapists’ personal lives, such as how satisfied they are with their personal lives and also the degree of personal burden they are experiencing, on the development of the therapeutic relationships with their clients.
A subset of data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (NMSPOP; Havik et al., 1995) were used in this study. This study included 227 clients, ranging in clinical presentation and functioning, from outpatient clinics in the Norwegian public mental health care system. Clients varied in their time in treatment, with 48% having between 20 and 40 sessions. The therapist sample consisted of 70 psychotherapists, ranging in age and experience, and with the majority of utilizing a psychodynamic therapeutic orientation.
The study focused on working alliance as a measure of therapeutic effectiveness; both the client and the therapist reported on “the degree of collaboration between the therapist and client in terms of agreement of the tasks and goals of therapy and the quality of the emotional bond between the two.
The Working Alliance Inventory (WAI; Horvath & Greenberg, 1989; Tracey & Kokotovic, 1989) was filled out by both the therapist and client at the end of the third therapy session, then after session 12, 20, and every 20th session thereafter.
Therapists’ Personal Lives:
The DPCCQ survey (Orlinsky et al., 1999) was used to capture a wide range of therapists’ experiences, including professional training, experiences, current and overall career development, current work experiences as a therapists, and also personal characteristics. Therapists completed the DPCCQ survey a maximum of 6 times during the project.
Quality of therapists’ personal lives was also evaluated, specifically looking at personal satisfaction and personal burdens.
Diagnostic assessments were administered to capture client diagnosis and functioning; in addition, client filled out several self-report questionnaires measuring levels of interpersonal distress at multiple time points throughout treatment.
Overall, a robust relationship between therapist quality of life and alliance development was found in this study. Number of treatment sessions for each client were controlled for and results show that treatment time did not affect alliance levels or growth.
- Therapists’ reports of personal conflicts and burdens had little effect on their own alliance ratings, however, these ratings were strongly, inversely related to working alliance development over time when the alliance was rated by clients.
- Therapists’ reports of high life satisfaction, including unreserved joy, satisfying intimacy, and emotional support contributed to higher therapist ratings of the working alliance, but this factor had little influence on clients’ ratings of the alliance.
The results of this study support past literature showing that therapist differ in their ability to foster a working alliance with their clients (i.e., Crits-Christoph et al, 2009 & Dinger et al., 2008). Specifically, this study demonstrates that therapists’ reports of their quality of personal lives and private relationships act as a predictors of the working alliance they are able to develop with their clients as measured by both the therapists and clients. This indicates that therapists’ quality of life influences the way they relate to their clients in the therapy room. More explicitly, the study found that differences in rater perspective were important, with therapists’ positive quality of life ratings having a trivial impact on their clients’ view of the working alliance. On the other hand, when therapists had high levels of burden or conflict in their lives, it seemed to negatively impact their clients’ rating of the working alliance. Therefore, it seems clear that therapists’ personal lives do have the potential affect their ability to have relationships with their clients; it appears that the positive aspects of the therapists’ life do not have a direct impact on their clients’ views of the relationship, but do affect their own self-efficacy as therapists, whereas the negative aspects of therapists’ lives may be able to be picked up on by clients’ and be detrimental to the working alliance.
Implications for Mentoring:
Given the quasi-therapeutic nature of mentoring relationships, parallels are frequently made between mentoring and therapeutic relationships; thus, the findings of this study have implications for youth mentoring, particularly in regard to the impact of mentors on their mentees. It may be important for mentors to know that negative experiences, dissatisfaction and/or burdens that are occurring in the their lives may affect their emotional availability and subsequently harm the closeness of the mentor-mentee relationship; accordingly, youth may be attuned to picking up on these negative experiences and/or may interpret signs of unavailability as rejection, particularly in already relationally vulnerable youths. This is certainly not to say that mentors who are experiencing distress in their lives are unable to effectively mentor youths, but it may be an important consideration in the training of mentors that understand the importance of developing their own positive coping techniques to deal with stressors in their personal lives so they do not carry over and impact the quality of the mentoring relationship or alliance and subsequently the youth.