Examining the Alliance-Outcome Relationship: Reverse Causation, Third Variables, and Treatment Phase Artifacts

Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth and adult literatures. Despite these consistent findings, prospective associations are not sufficient to support the claim that the alliance is a change mechanism in psychotherapy. The current study examined the direction of effect of the alliance- outcome relationship, the contribution of early symptom change in treatment to the development of therapeutic alliance, and the potential for pretreatment interpersonal functioning characteristics to be third variables that account for the association between alliance and outcome. Participants were adolescents with depression and a history of interpersonal trauma that presented to a community mental health center for treatment. Findings demonstrated that a more positive therapeutic alliance predicted greater subsequent symptom improvement, even after removing symptom change occurring before the measurement of alliance. Results also suggested that early change only slightly contributed to alliance development. Finally, though pretreatment interpersonal functioning was related to the first session alliance, these pretreatment client characteristics were not related to later alliance or symptom change. Overall, results provided some support for therapeutic alliance as a mechanism of change in psychotherapy. Methodological and clinical issues are discussed.

A Discursive Perspective on China's Global Politics of Climate Change, 1992-2013

This dissertation investigates China’s recent shift in its climate change policy with a refined discourse approach. Methodologically, by adopting a neo-Gramscian notion of hegemony, a generative definition of discourse and an ontological pluralist position, the study constructs a theoretical framework named “discursive hegemony” that identifies the “social forces” for enabling social change and focuses on the role of discursive mechanisms via which the forces operate and produce effects. The key empirical finding of this study was that it was a co-evolution of conditions that shaped the outcome as China’s climate policy shift. In examining the case, a before-after within-case comparison was designed to analyze the variations in the material, institutional, and ideational conditions, with methods including interviews, conventional narrative/text analysis and descriptive statistics. Specifically, changes in energy use, the structure of decision-making body, and the narratives about sustainable development reflected how the above three types of social force processed in China in the first few years of the 21st century, causing the economic development agenda to absorb the climate issue, and turning the policy frame for the latter from mainly a diplomatic matter to a potential opportunity for better-quality growth. With the discursive operation of the “Science-based development”, China’s energy policy has been a good example of the Chinese understanding of sustainability characterized by economic primacy, ecological viability and social green-engineering. This way of discursive evolution, however, is a double-edged sword that has pushed forward some fast, top-down mitigation measures on the one hand, but has also created and will likely continue creating social and ecological havoc on the other hand. The study makes two major contributions. First and on the empirical level, because China is an international actor that was not expected to cooperate on the climate issue according to major IR theories, this study would add one critical case to the studies on global (environmental) governance and the ideational approach in the IR discipline. Second and on the theory-building level, the model of discursive hegemony can be a causally deeper mode of explanation because it traces the process of co-evolution of social forces.