The state of therapeutic alliance at a neurophysiological level in the symptomatically anxious : effect on the therapeutic process

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NO FULL TEXT AVAILABLE. This thesis contains 3rd party copyright material. ----- This study attempted to establish neurophysiological correlates during high therapeutic alliance (TA) between client and therapist. Therapeutic Alliance is the special relationship established between client and therapist comprised of interactive relational and integrative technical aspects, which sets it apart from other relationship constructs (Horvath & Greenberg, 1994). It is also the essential healing element common to all forms of psychotherapeutic modalities (Bozarth & Wilkins, 2001). The aim of this study was to assess neurophysiological variables such as electroencephalography (EEG) activity, heart rate and heart rate variability (HRV) (a measure of autonomic activity), skin conductance and blood pressure in clients with symptomatic anxiety during high TA. This thesis also investigated links between lifestyle, behaviours, mood states and anxiety as predictors of developing a positive therapeutic alliance (TA). Thirty clients aged 43.8 ± 11.5 years (males: n= 15 females: n=--= 15) underwent six, weekly 1-hour psychotherapy se sions ( 180 hours of repeated measures). Simultaneous physiological measures of skin conductance resonance (SCR) were continuously recorded du1ing each psychotherapy session to establish the therapeutic index (TI), a measure of (TA). EEG was measured from the pre-frontal, temporal, parietal and occipital sites during the sessions. Simultaneous cardiac data was also obtained during the entire session. State and trait anxiety, Working Alliance Inventory (WAI) and cardiac measures were also obtained before and after each session. The Profile of Mood States (POMS) and Lifestyle Questionnaire (LAQ) were administered at the start of therapy. Results showed that the pre-frontal (p=0.045), parietal (p=0.01) and occipital sites (p=0.045) were significantly associated with high TA. State anxiety (p=0.0004) and heart rate (p<0.001) decreased after each session and continued to decline over the six sessions. High therapeutic alliance was also linked to high HRV parameters (p=0.03) with higher anxiety levels (p=0.02) also linked to lower HRV parameters. High HRV parameters were also linked to higher mood scores (p=0.03).There were significant links between clients' lifestyles (p=0.01 ), stress (p=0.04), other behaviours and high TA. A high therapeutic alliance was found to be significantly linked to depression (p=0.01 ), anxiety (p=O.O 1 ), client feelings of guilt (p=0.04), lower post state anxiety (p=0.01) and diastolic blood pressure (p=0.03). Results show that the measure of physiological TA contradicted the subjective appraisal of TA using the WAI, suggesting that the physiological calculation is a more accurate barometer of the state of therapeutic alliance. These empirical findings establish that the notion of intersubjectivity in therapy has a neurophysiological basis which affirms the impact of both the 'inter and intrapersonal' dynamic in psychotherapy. These results support the state of therapeutic alliance (TA) as both an objective construct and a tool of therapy. It also raises the question of using physiology as an index to establish TA as opposed to just a c1ienttherapist reported model and in the clinical training of psychotherapists. Future research could broaden this study by incorporating a longer sessional time frame, investigating other autonomic nervous system parameters, broadening the client base to include those with affective disorders like depression, and further investigating the impact of heaii rate and heart-rate variability in clients.
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