Critical Analysis of Bachelor’s Article, Article Critique Example

Psychological interventions can result in long-lasting benefits if they are directed to the significant psychological practices. The significance of the therapeutic alliance as a crucial part of the collaboration between the therapist and the patient has been documented by psychologists of various methodological perspectives (Barber & Muran, 2010). Nevertheless, Alexandra Bachelor (1995) studied the therapeutic alliance from the involved patient’s viewpoint in her article named Clients’ Perception of the Therapeutic Alliance: A Qualitative Analysis, utilizing 66 evocative interpretations delivered by 34 patients over three stages of treatment. Using phenomenological analysis method, three comparatively dissimilar kinds of observed alliance were recognized during the treatment, which were characterized as “nurturant (46% of reports), insight-oriented (39%), and collaborative (15%)” in order to give the emphasis to psychotherapist’s facilitative assertiveness, patient’s enhanced self-understanding, and patient’s participation, correspondingly (Bachelor, 1995, p. 323). Another technique of content examination presented a list of the distinct features characteristic for patients’ observations and patients’ pervasiveness within the three kinds of alliance (Bachelor, 1995, p. 323). According to the article’s outcomes, the author described alliance variables as being not similarly pertinent for patients, and that several vital characteristics of the supposed working relations are not considered to be relevant in contemporary alliance concept.

Therefore, this research inspected the therapeutic alliance from the involved patients’ point of view, and utilized a qualitative methodology intended for the elucidation of the fundamental features that motivate patients’ alliance observations. Phenomenological examination of patients’ inscribed records acquired during the three stages of the treatment procedures, caused the delimitation of three comparatively dissimilar alliance typologies called collaborative, insight-oriented, and nurturant. Most of the patients that participated in therapy procedures observed a positive alliance both regarding nurturing or insight-focused relations, and only an insignificant number of respondents considered the alliance a cooperative struggle.

Significance of the Topic Chosen by Author

The alliance classically described as the patient and therapist arrangement of the objectives, errands of treatment, and the improvement of a therapeutic connection, is constantly regarded as a strong precondition of psychotherapy realization (Barber & Muran, 2010, p. 11). This opinion was supported by various researchers across dissimilar alliance’s raters and results (that is to say, patient, doctor, and viewer assessments) and capacities (Horvath, Del Re, Fluckiger, & Symonds, 2011, p. 12). Furthermore, relationships as the result of “alliance-outcome is supported as independent of design and treatment characteristics like randomized controlled study design, disorder-specific manual usage, specificity of primary and secondary outcomes, and cognitive behavioral therapy” (Fluckiger, Del Re, Wampold, Symonds, & Horvath, 2011, p. 27). Even though these outcomes are stout in the occurrence of some possible misperceptions, little is known about how psychotherapists’ individualities affect the cooperation (Ackerman & Hilsenroth, 2003, p. 15). Nevertheless, this issue requires further study (Constantino, Marnell, Haile, Kanther-Sista, Wolman, Zappert, & Arnow, 2008).

Experimental study of the alliance, up to the present time, has concentrated mainly on stating its connection with the theory of appropriate variables ((Horvath, Del Re, Fluckiger, & Symonds, 2011, p. 23). Although there has been substantial authentication of theory-grounded suppositions, limited data are presented regarding the actual natural surroundings, or phenomenology, or the “alliance as such—that is, the clinical reality of the phenomenon as it is understood and experienced in the actual therapeutic encounter from the perspective of the involved participants client pre-therapy characteristics” (Ackerman & Hilsenroth, 2003, p. 17). In an effort to advance the conceptualization in this sphere, Bachelor’s (1995) study pursued to clarify the alliance from the perspective of the convoluted patient by utilizing a qualitative phenomenological methodology intended for the identification of the essential content and crucial characteristics of the alliance as constantly knowledgeable. This comprehensive research tried to escalate the analysis of constant treatment sessions, discovering the metamorphoses in alliance observations between continuing and pre-therapy sessions, and producing more thorough phenomenological examination in addition to the supplementary qualitative analyses that defined pertinent characteristics of the alliance.

Description and Analysis of the Method Utilized by the Author

In this article, contemporary qualitative and diverse method techniques are utilized from the position of basic universal epistemology. The number of articles that utilize qualitative analyses in ordinary psychology research is small (Barber & Muran, 2010, p. 45). Therefore, regarding this significant principle, notwithstanding its contemporary rapid development, qualitative research is disregarded in psychological scientific articles (Barber & Muran, 2010, p. 45). Psychology nowadays mainly focuses on methodology indirectly. In the studied article, exceedingly sophisticated scientific approaches are utilized for responding scientific inquiries, but the methodological inquiries are practically not questioned.

Therefore, in this article, such suggestion permits this technique to be utilized not only regarding the existed knowledge but also regarding the future accomplishments, comprising the practical usage of verbal communications. Furthermore, the method utilized in Bachelor’s (1995) article provides a better representation of the commonsense processes involved in the treatment procedures. Qualitative methodology employed in the observed research work discloses relations between procedures; it can determine that definite relations are systematic, and appear more frequently than might be predictable. Thus, through determining different variations of the proceedings, qualitative methodology is a really beneficial technique for calculation and production of practical conclusions (Toomela 2010, p. 99).

Another method employed in Bachelor’s (1995) research is the phenomenological analysis. It is a method of qualitative research intended for discovering and accepting the existing experience of a definite occurrence (Smith, 2004, p. 33). By utilizing this method, Bachelor (1995) produced the thorough analysis of respondents’ understandings of a specific alliance. Phenomenological analysis helped the author to discover the outcomes of patients’ perception of a detailed alliance through concentrating on the existing empirical records.

The Assessment of Data Analysis Provided by the Author

In the data analysis section, the author developed an understanding of patients’ observation of therapy alliance. Double analysis was utilized; the respondents revealed their experience with the therapy alliance phenomenon using their own expressions, thus additional explanations can be presented in regard to further inquiries. Moreover, the author explained and interpreted the respondents’ observations during the subsequent personal analysis and interpretation (Bachelor, 1995).

Respondents’ evocative records were examined by four experts who utilized a five-stage content-investigative process created in the phenomenological scholarly articles (Bachelor, 1995, p. 325). The goal of phenomenological analysis is to reveal the vital importance or arrangement of the issue under research, which is described “in terms of the (psychological) meaning(s) that necessarily characterize a phenomenon in order for it to be that phenomenon, as it exists in participants’ concrete experience” (Smith, 2004, p. 35). Contradictory to the customary content-investigative processes that utilize the prior arrangement of coding systems, the phenomenological technique is fundamentally inductive, since the consequential denotation structure originates completely from personal information (Bachelor, 1995, p. 325).

To define trustworthiness, the existence or deficiency of consensus was judged at every stage of the research, and the results were separately collected for every respondent. The total calculation arrangement thus acquired was 92% (Bachelor, 1995, p. 325). The experts then conveyed, by agreement, the three resultant connotation assemblies, which were characterized on the basis of the content utilized: collaborative alliances, insight-oriented, and nurturant (Bachelor, 1995, p. 326). Thus, the results that Bachelor (1995) obtained can be regarded as trustworthy and reliable. The second technique of content examination of the expressive information was utilized as a supplement to the phenomenological analysis in order to attain more detailed information, and to make the summary of levels of specific variables and features pertinent to the therapy alliance from the patients’ points of view. Such information has proven to be supportive in producing an empirically-grounded evaluation of the therapeutic alliance.

Evaluation of Results

The article by Bachelor (1995) examined initial therapeutic alliance between “patients and behavioral health consultants (BHCs) during patients’ first appointments in an integrated primary care behavioral health service” (p. 326). Nevertheless, this is the first acknowledged research observing the therapeutic alliance in “a combined primary care setting” (Bachelor, 1995, p. 326). The author classified the three resultant meaning constructions categorized on the basis of the respondents’ points of view: collaborative alliances, insight-oriented, and nurturant (Bachelor, 1995, p. 326).

Nurturant Alliance

The nurturant-like alliance, “found in 46% of accounts (41% pretherapy, 47% initial, and 54% later phase)”, represented the patients’ understanding of therapist-delivered facilitative characteristics, especially deference and being indulgent, empathic thoughtfulness, and focused attending, which were regarded as encouraging self-disclosure (Bachelor, 1995, p. 327). Overall, nurturant-like respondents itemized several facilitative characteristics the arrangement of which looked to produce an idiosyncratic therapeutic environment regarded as confidence. Even though some (predominantly pre-therapy) patients pointed out a constructive alliance mainly in terms of relations or environment of trust, more frequently this feature was mentioned as one of some optimal psychoanalyst or rapport variables (Bachelor, 1995, p. 327). In about one third of nurturant-like patients, sociability was a feature of the alliance, observed either as a vital element (of the patient-psychoanalyst relations or of the psychoanalyst) or as surrounding or comprised among numerous facilitative characteristics.

Moreover, the psychotherapist is supposed

“to assume an active or directive role in the alliance and the therapeutic process through contributions such as questioning, providing comments and feedback, answering questions, giving advice, telling clients whether they are acting correctly, suggesting topics to consider, guiding client change, directing clients toward goals of therapy, and proposing methods, means, or solutions to improve or change self or clients’ behavior or to help clients take the necessary steps to do so” (Bachelor, 1995, p. 327).

Another psychoanalyst involvement (more characteristic for pre-therapy respondents) involved interferences focused on explanation or the revealing of underlying causes or undercurrents of difficulties. In terms of patients’ contributions to the therapy alliance, “no reference was made in 21% of nurturant-type clients’ accounts to their own contributing activities or to their role in promoting the quality of the working relationship” (Bachelor, 1995, p. 328).

Insight-Oriented Alliance

The insight-oriented therapy alliance observed in 39% of respondents’ observations was described by enhanced self-appreciation obtained through explanation of substantial patients’ data (Bachelor, 1995, p. 328). The insight-like patient was mainly concerned about the appreciation of himself or herself in a proper way, comprising seeing more obviously into fundamental reasons and dynamics of difficult circumstances and functioning. Pre-therapy records defined respondents’ anticipations of augmented self-awareness, while in-session records generally presented illustrations of the achievement of understanding through the interaction of patient’s self-revelation and psychoanalyst’ investigative or explanation work (Bachelor, 1995, p. 328). The self-appreciation of attention to patients was expressed both in comprehensive (or inclusive) and detailed problem-associated terms (Bachelor, 1995, p. 329). Thus, the former is more typical for the pre-therapy patients, and the latter is more typical for the in-session respondents.

An essential element of the insight-oriented alliance was patients’ self-disclosure. Almost one half of pre-therapy records involved unrestricted, immodest self-manifestation and revelation of personal emotions (often depending on an observed climate of faith) in the operational relations (Bachelor, 1995, p. 329). Nevertheless, almost all in-session records showed revelation of personally important content (for example, personal emotions and conflict circumstances or relations), as it was communal with the psychoanalyst and discovered, understood, or otherwise operated through.

Collaborative Alliance

Represented in 15% of respondents’ records, the collaborative alliance was described by the patients’ active participation in the treatment and progress of therapy (Bachelor, 1995, p. 329). The patents’ perceived participation was formed either of understanding of the sympathy to, or the in-therapy understanding of one’s vigorous involvement in, the therapeutic procedures. The collaborative-like respondent recognized or accepted that the process of treatment and optimistic transformation was not completely the psychoanalyst’s obligation and that every partner contributes to and is involved in, even though in a different way, the therapeutic mission (Bachelor, 1995, p. 330). The majority of pre-therapy records defined the respondents’ expected assistance to such process, while in-therapy records generally showed sessions in which patients comprehended (habitually to their amazement) that they certainly were able to contribute to the process and methods of therapy (Bachelor, 1995, p. 330).

Even though collaborative-like patients regarded themselves as contributing to the process and objectives of therapy, the psychoanalyst’s active cooperation was highlighted (Bachelor, 1995, p. 330). According to Bachelor (1995), the psychoanalyst contributed to experimental and discovery work, eased patients’ self-revelation and self-exploration or in other words empowered patients’ enhanced self-appreciation, estimated together with the patient resolutions and prospective implementations, and knowledgeably supervised the progress of therapy (Bachelor, 1995, p. 331). Perceived predominantly in treatment sessions, “the cooperative therapist also showed receptivity regarding confrontation, criticism, or evaluation of him- or herself or the conduct of therapy and could discuss with the client sources of dissatisfaction” (Bachelor, 1995, p. 331). Thus, the psychoanalyst’s sympathetic and non-defensive reaction had a constructive influence on the relationship, developing trust and the emotion of being appreciated and valued.

Individual Alliance-Relevant Characteristics

Content examination of respondents’ records at the point of personal alliance-pertinent features, “both within and across the three identified alliance types, resulted in the delineation of 16 therapist, 10 client, 7 mutual, 5 climate, and 4 effects variables” (Bachelor, 1995, p. 331). Bachelor (1995) produced some slight adjustments to this rater-resultant demonstrative list, which were considered to hold superior theoretical significance and “which involved grouping (or “ungrouping” into their original constituent variables) a few of the obtained characteristics as well as deleting variables with low incidence” (Bachelor, 1995, p. 331). Moreover, the outcomes showed that among the features respondents allied with the therapy alliance, some psychoanalysts’ variables in the assembled sample presented statistically highest regularities. Thus, the most predominant features comprised the facilitative approaches of perceived reverence and indulgence, sympathy, and (focused) listening.

In conclusion, among the variables attributed to the therapy environment or relations, a feeling of confidence usually was a perceived characteristic across different types of therapy alliance (Bachelor, 1995, p. 332). The specialized nature of the doctor-patient relations and its sociable quality were similarly comparatively highlighted, “the former found more in the collaborative and insight alliances and the latter in the nurturant alliance” (Bachelor, 1995, p. 332). Moreover, Bachelor (1995) noted that even though these features were mentioned regarding the patient-psychoanalyst relationship, closer examination of the respondents’ points of view specified that the psychoanalysts were usually the resource of the attribute, and therefore these features can be understood as psychoanalysts’ variables (p. 332). Perceived outcomes of the therapy alliance predominantly involved enhancement in apparent dysfunctional conducts or approaches, and were primarily allied with insight-like patients.

Discussion and Evaluation of the Article’s Results

The outcomes of Bachelor’s (1995) article Clients’ Perception of the Therapeutic Alliance: A Qualitative Analysis develop the conceptualization of the therapy alliance as it is connected to the involved patients’ points of view. Continual examination of the therapy alliance from the position of subtypes or typologies seems reasonable. The fundamental therapy alliance arrangements recognized in this article are not voluntarily adaptable into present alliance standpoints, with the exclusion of some characteristics of the cooperative nature, even though they do incorporate notions from other hypothetical contexts (Bachelor, 1995, p. 333). At the point of personal features, nevertheless, some fundamental therapy alliance variables are signified in the additional hypothetical or measurement attitude to the therapy alliance, even though some essential constituents (for example, confidence, psychoanalyst’ sociability, and understanding) have not attained unequivocal theoretical or experiential emphasis in the analyzed article (Bachelor, 1995, p. 333). Consequently, dissimilar opinions in this sphere are not obvious for all respondents, and are not completely illustrative for the collection of features pertinent to the respondents. The significance of the article’s outcomes can be regarded from the patients’ viewpoint. From this perspective, the quality of the therapy alliance is mainly an issue of psychoanalyst’s occupational attitudes, with the contributing features varying reliant on the specific patient involved.

In conclusion, the outcomes of the research article recommend enhanced concentration on personal therapy alliance elements. Forthcoming research in this sphere could follow the progress of “alliance profiles” grounded on discrepancy combinations of apparent alliance-pertinent features, which might be observed concerning the results, pre-therapy variables, abrasion, or other variables of concentration. The utilization of two methods of content analysis in this article, while obtaining outcomes dependable on one another, discloses transformations in the nature of data delivered by a method intended for “elucidating meaning and one designed to code data, the former clarifying how individual characteristics interrelate to constitute a subjectively coherent and meaningful state or experience” (Bachelor, 1995, p. 333). Forthcoming qualitative research could concern such issues as the patients’ involvement in break of the therapy alliance in addition to more perceptive examination of personal critical therapy alliance constituents.

References

Ackerman, S. J. & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively influencing the therapeutic alliance. Clinical Psychology Review, 23, pp.1–33.

Bachelor, A. (1995). Clients’ Perception of the Therapeutic Alliance: A Qualitative Analysis. Journal of Counseling Psychology, 42(3), pp. 323-337.

Barber, J. P. & Muran, J. C. (2010). The therapeutic alliance: An evidence-based guide to practice. New York, NY: Guilford Press.

Constantino, M. J., Marnell, M., Haile, A. J., Kanther-Sista, S. N., Wolman, K., Zappert, L., & Arnow, B. A. (2008). Integrative cognitive therapy for depression: A randomized pilot comparison. Psychotherapy Theory, Research, Practice, Training, 45, 122–134.

Fluckiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2011). Treatment and design as moderators of the relationship of the alliance and outcome: A multilevel longitudinal meta-analysis. New York, NY: Guilford Press.

Horvath, A., Del Re, A. C., Fluckiger, C., & Symonds, D. (2011). The alliance in adult psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 48, pp. 9–16.

Smith J. A. (2004). Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology, 1, pp. 39–54

Toomela, A. (2010). Biological roots of foresight and mental time travel. Integrative Psychological and Behavioral Science, 44, pp. 97–125.