Publications: 1998
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Agnew-Davies, R., Stiles, W.B., Hardy, G.E., Barkham, M., & Shapiro, D.A. (1998). Alliance structure assessed by the Agnew Relationship Measure (ARM). British Journal of Clinical Psychology, 37 , 155-172. Objectives. We used a new instrument, the Agnew Relationship Measure (ARM), to examine the alliance's dimensionality and to construct scales for use in future studies. Design. We studied the alliance as reported on the ARM by both clients and therapists in the Second Sheffield Psychotherapy Project, a randomised comparison of two contrasting time-limited psychotherapies for depression. Methods. Clients ( N = 95) and therapists ( N = 5) completed parallel forms of the ARM after every session ( N = 1120) . Results. Five scales were constructed, based on results of simultaneous components analyses and considerations of conceptual coherence and comparability across client and therapist perspectives. Conclusions. Bond, partnership, and confidence overlapped statistically (consistent with previous studies), but there are conceptual and empirical reasons for retaining the distinctions. Openness represented a relatively independent dimension. The client initiative scale had low internal consistency but the items may have value for future investigations.
Hardy, G.E., Rees, A., Barkham, M., Field, S.D., Elliott, R., & Shapiro, D.A. (1998). Whingeing versus working: Comprehensive Process Analysis of a "vague awareness" event in psychodynamic-interpersonal therapy. Psychotherapy Research, 8, 334-353. A client-identified significant event in psychodynamic-interpersonal therapy is analysed using Comprehensive Process Analysis (CPA), a narrative research method for describing and understanding the significance, effects, and context of clinical events. The analysis of the event identifies components of a vague awareness event, which match the stages proposed in the allowing/accepting model of Greenberg and Safran (1987). Four additional stages to this model are identified and discussed. Therapist management of vague awareness events is discussed. The analysis of the event suggests that the therapist needs to attend to the therapy process, be active in managing the event through suggesting to the client how to proceed, through confrontation and through reframing of the client's in-session behavior.
Macran, S., & Shapiro, D.A. (1998). The role of personal therapy for therapists: A review. British Journal of Medical Psychology, 71, 13-25. This paper reviews the research literature on personal therapy and makes some recommendations for how future work in this area may be improved. Despite the general acceptance of the importance of personal therapy amongst therapists, there has been relatively little research to evaluate its effectiveness. The vast majority of studies have consisted of surveys of therapists' opinions and experiences of therapy or naturalistic comparisons across therapists who have or have not had therapy. The interpretation of most findings is compromised because of small sample sizes and confounding variables, nevertheless some conclusions can be made. Whilst the majority of therapists feel that they have benefited professionally from personal therapy there is very little empirical evidence that it has any measurable effect on client outcome. However, there is some evidence that personal therapy has a positive effect on those therapist qualities often cited as constructive to client change (e.g., empathy, warmth, genuineness). What is evident is that there is a need for more methodologically sound research as well as a more theoretical understanding of how personal therapy affects clinical practice, before any firm conclusions can be drawn about its usefulness. It is suggested that it may be more useful for future research in this area to focus on therapy process rather than client outcome.
Stiles, W.B., Agnew-Davies, R., Hardy, G.E., Barkham, M., & Shapiro, D.A. (1998). Relations of the alliance with psychotherapy outcome: Findings in the Second Sheffield Psychotherapy Project. Journal of Consulting and Clinical Psychology, 66, 791-802. Clients ( n = 79) and therapists ( n = 5) rated their alliance using parallel forms of the Agnew Relationship Measure (ARM) after every session of their time-limited psychodynamic-interpersonal or cognitive-behavioral treatments for depression. The ARM assesses 5 dimensions of the alliance: Bond, Partnership, Confidence, Openness, and Client Initiative. Treatment outcome was assessed as residual gain from pre-treatment assessment to end of treatment, 3-month follow-up, and 1-year follow-up on 6 standard measures. Some aspects of the alliance as measured by the ARM were correlated with clients' gains in treatment. The strength of the association varied across assessment measures, occasions of outcome assessment, ARM scales, and the session number when the alliance was measured.
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