Therapeutic Alliance Importance in First Session

‘The Efforts of Therapists in the First Session to Establish a Therapeutic Alliance’ written by Gregory H. MacEwan, provides a significant data on what therapists think about the importance of the first session and how it affects the whole process of treatment and the ultimate result. It is necessary to mention that the initial meeting and communication between doctor and patient is especially considerable when one is talking about psychotherapy, because a person who asks for this kind of medical help is very vulnerable. He or she needs to feel comfortable, safe and confident before talking about feelings and fears. It makes therapeutic alliance very important specifically for this type of therapy, which is a first reason why this research is topical.

Another reason why the topic is significant is mentioned by the author. MacEwan (2008) believes that the little attention has been focused on therapists’ perspectives on the impact of the first session on the development of the therapeutic alliance. He provides many examples that prove that the first meeting determines positive or negative result of the whole treatment, but he became curious about what therapists think about it. Though this research is mostly descriptive, it may be a strong base for practical improvement of the methods to hold the initial sessions.


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The structure of the thesis is clear. Gregory H. MacEwan begins with an introduction where he substantiates his experiment with the works and findings of other scholars. Main parts of the introductory parts consist of historical overview of the topic, presenting the connection between the alliance and outcome, the characteristics of therapists and what techniques they use, the importance of the development of the alliance and the plan for the study. The first and the last points help one to understand the research better, while others were discussed during the interviews with the therapists. The author discloses these items one after another and provides many details. At the end of the introduction, he presents questions that the therapists were asked, and they form the structure of the next chapter.

The second chapter explains the method that was used by the researcher, which is Consensual Qualitative Research (CQR) created by Clara Hill. This approach aims to figure out characterizations from the therapists’ reflections that are lately classified in domains. As a result, 12 domains were determined, and all of them are presented in tables.

The discussion part summarizes all results and demonstrates the background of the study. Probably, the most important components are the introduction and the main chapter. The first one allows one to understand the issues that caused this investigation, and the other part presents the research’s implementation and achievements.

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Gregory H. MacEwan provides readers with considerable theoretical and experimental background that includes works of Elizabeth Zetvel, Carl Rogers, Edward Bordin, Horrath and Dianne Symonds and others who investigated the issue of therapeutic alliance as well as communication between therapist and patient from different perspectives and using various methods. He preferred to structure the information about them not in the chronological order, but through paying attention to aims of these researches. Besides, the study of Edward Bordin became the base for one of the questions of the interview. This scholar determined three components of alliance – tasks, goals and bond – and therapists were asked which one they find to be the most important.

The data presented is relevant to the aims and objectives of the research. The researcher needs to know therapists’ opinions on the issues he finds important, so he has enough space to formulate the questions. However, some discrepancy takes place in the study. In the introduction, MacEwan mentions that the research of Horrath and Dianne Symonds proves that the alliance ratings by patients were the strongest predictors of good treatment outcome. Nevertheless, in the main part MacEwan calls this evidence questionable.

The intended audience is mostly therapists and investigators interested in the topic of therapeutic alliance, but as the work is written in quite plain language, the other part of audience may consist of students.

The strong sides of the article are that it is detailed, and all data is supported with comments of the interviewed therapists. It helps the reader to feel that real people were asked questions and one is also convinced in their professional experience and approach to clients. Besides, the author uses tables, so it is easy to perceive the results and structure them for better memorizing.

Some weaknesses were already mentioned, and another one is that some information is often repeated in different parts of the work. Probably, it was made for purpose, but sometimes, returning to the points that were already mentioned distracts the reader.

This research paid a lot of attention to therapists’ opinions, but the patients’ views were almost not mentioned. Discussing the issue of therapeutic alliance, one must take into consideration both parts. It would be interesting to interview both therapists and patients after the first session and after an end of the treatment and compare their perception of each other’s behavior. It would make the research two-sided.

Concerning the thesis’ bibliography, it is contemporary and consistent. The thesis was published in 2008, and there are the works of 2006 and 2007 years mentioned. Some of them were published earlier, but they provide important base for the author.

In general, the research leaves a good impression, because it is easily perceived and well-structured. The reader is able to assess the therapists’ thoughts about the first session, how they make clients feel comfortable, what they believe are the most important factors in communication between therapist and patient. What makes this study meritable is that MacEwan does not simply present dry results and data but allows the readers to hear the voices of real people who enjoy their job.

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