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NCT Number: NCT03453957

Therapeutic Alliance Tensions and Repair in Psychotherapy Practices

This study evaluates a professional development program intended to improve the relationship or alliance between therapists and patients/clients who are receiving psychotherapy in the community. Half of the participating therapists will receive training to detect and improve alliance with new patients while half will not. The professional development training is expected to improve therapists effectiveness in identifying and correcting alliance tensions which will, in turn, improve therapeutic outcomes for patients/clients.

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Key information

Conditions

Psychotherapy Therapeutic Alliance

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University of Ottawa, Ottawa, Ontario, Canada

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About this study

Psychotherapy is the treatment of choice for many mental disorders, yet there is a gap between research and practice. Research indicates that: the therapist-patient alliance is important to reduce patient symptoms, alliance tensions are detrimental to patients, and those therapists who identify and repair alliance tensions can improve patient outcomes. In this study we will use state of the art research to train community-based therapists in evidence-based interventions to identify and repair alliance tensions. Trained therapists and their patients will be compared to therapists who provide usual care to their patients. Improvement in therapists' skills in identifying and repairing alliance tensions and how this is associated with better patient mental health outcomes will be measured. Trained therapists will be interviewed to identify the best ways of improving the training and disseminating the findings to psychotherapists across Canada. Research to improve practicing therapists' ability to identify and repair therapeutic alliance tensions will result in better mental health outcomes for patients.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Therapist

Inclusion criteria

  • regulated health professional
  • in good standing with a Canadian provincial regulatory college
  • scope of practice includes psychotherapy
  • ability to add 3 or more new, English speaking clients to caseload over 6 to 9 months
  • ability to obtain timely permission to conduct research from therapist's employing institution or health group when applicable

Exclusion criteria

  • none

Patient/Client

Inclusion criteria

  • 18 years of age or older
  • will participate in psychotherapy sessions in English
  • will see the study-affiliated therapist for a minimum of 6 sessions in the next 6 months

Exclusion criteria

  • already seeing another therapist
  • diagnosed with a neurocognitive disorder
  • diagnosed with a psychotic disorder
  • expressed suicidal behaviour in the past six months as assessed by their participating therapist

Treatment and study plan

Professional development program

Other

Professional development program consists of training including workshops and consultation sessions to enhance therapists ability to detect and repair alliance ruptures in active community based psychotherapy.

Primary outcomes

  1. Mean tension resolution rating scale

    Time frame: 6 therapy sessions over 6 weeks up to 6 months depending on the frequency of therapy

    The Rupture Resolution Rating System (3RS) is an observer-based measure to identify alliance tensions and resolution processes. Independent blind reliable trained judges will rate video recordings of 6 psychotherapy session recorded with participating clients. A mean tension score will be assigned per client which will be the average of the 6 session scores.

    score ranges from 1 (withdrawal/confrontation rupture(s) did not occur; not significant for the alliance) to 5 (withdrawal/confrontation rupture(s) occurred; significant for the alliance).

Secondary outcomes

  1. Generalized Anxiety Disorder 7-item scale (GAD-7) change from baseline

    Time frame: baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy

    Self-report measurement of severity of anxiety using the GAD-7 scale. A change in anxiety scores will be assess following 6 therapy session with data collected before therapy(baseline) and again after all 6 sessions of therapy have been completed. Scores range from 0 (low anxiety) to 27 (high anxiety) with scores over 10 being of clinical significance.

  2. Patient Health Questionnaire 9-item scale (PHQ-9) change from baseline

    Time frame: baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy

    Self-report measurement of depression symptoms using the PHQ-9 scale. A change in depression symptom scores will be assess following 6 therapy session with data collected before therapy and again after all 6 sessions of therapy have been completed. Scores range from 0 (low) to 27 (high) with scores over 10 being of clinical significance.

Sponsors and collaborators

Lead sponsor

University of Ottawa

Other

Collaborators

  • Canadian Institutes of Health Research (CIHR)

Registry information

Official study title

Therapeutic Alliance Tensions and Repair in Psychotherapy Practices: A Psychotherapy Practice Research Network (PPRNet) Study

Important dates

Study start
2018
Primary completion
2021
Study completion
2021
First posted
Mar 5, 2018
Registry last updated
May 1, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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