Older Adults' Perspective on the Therapeutic Alliance
Research type
Research Study
Full title
Older Adults' Perspective on the Therapeutic Alliance - a Theory Based Qualitative Study
IRAS ID
238891
Contact name
Pauline Adair
Contact email
Sponsor organisation
Queen's University Belfast
Duration of Study in the UK
1 years, 8 months, 19 days
Research summary
Summary of Research
A qualitative study is proposed in which an existing model of the therapeutic alliance (the relationship between therapist and service user) is tested for its applicability and coherence within a sample of older adults (adults over 65 years of age) attending therapy. The research also aims to investigate which areas older adults view as salient to the formation of the alliance.
Despite the emergence of a large body of evidence relating the therapeutic alliance to therapeutic outcome, as well as the existence of psychometric tools to measure alliance, the concept remains poorly defined and understood. The Revised Theory of the Therapeutic Alliance (Ross, Polaschek & Ward, 2008) has been proposed as a clinically applicable framework for understanding how various components identified in the literature (for example environment and therapist characteristics) interact to produce the alliance. However, this model is tentative, requiring further substantiation and testing. It is proposed that an older adult population would provide a unique opportunity to test the validity of the model in accounting for their experience and perceptions. This study will utilise a theory-based interview to provide data which will be analysed using Framework Analysis, a method which enables the conceptual basis of the model to be tested whilst allowing for the emergence of new themes. Participants will be individuals over 65 attending mental health services in the South Eastern and the Western Health and Social Care Trusts. The results of this study will aid our understanding of the construct of the therapeutic alliance and may also identify ways in which practitioners can adapt their practice to consider the needs of an older adult population.Summary of Results
: Despite a large body of empirical evidence relating to the therapeutic alliance, the concept remains poorly defined. In addition, there is a limited evidence base regarding the experiences of older adults in therapy. To address this, a model of the alliance grounded in the research literature, the Revised Theory of the Therapeutic Alliance (RTTA), provides a framework to investigate this concept within an older adult population, aiming to identify factors that are perceived as relevant to and associated with the alliance. Method: A theory-based interview study utilising Framework Analysis was conducted. Participants were 13 adults over 65 years of age currently attending therapy with a clinical psychologist or CBT therapist. Results: Eight thematic domains capture the factors perceived as significant: Attachment and bond, Empowerment and change, Therapeutic tasks, Building a relationship, Coordinating therapeutic aims, Therapist characteristics and credibility, Client circumstances and attributes, Perceptions and resourcing of psychological therapies. Conclusions: Older adults’ perceptions of the therapeutic alliance are similar to other age groups; however, some issues are highlighted which may be significant to consider in therapy with older clients. Based on the accounts, some adjustments were required to the RTTA framework. Implications and limitations of the study are discussed.REC name
HSC REC B
REC reference
18/NI/0046
Date of REC Opinion
23 Mar 2018
REC opinion
Favourable Opinion