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.

The presence of a woman : images of La Malinche in el Lienzo de Tlaxcala

La Malinche’s serene face and beautifully dressed figure dominates the first half of the lost sixteenth century manuscript El Lienzo de Tlaxcala, which exists today in the form of a copy made after the original. In this paper I propose an expanded study of these twenty-one representations of La Malinche as they offer insight into the Tlaxcalan’s reverence, respect, and spiritual belief in La Malinche. The Tlaxcalan leaders recognized her influence on both the Spanish and indigenous leaders during the conquest and cleverly designed a painted narrative to reinforce their connection with La Malinche to enhance their position with the Spanish. Through a multi layered study that consists of a detailed account of her biography in contrast to gender roles in Pre-Hispanic America, as well as formal and iconographic analysis of rarely examined images from the Lienzo de Tlaxcala that link La Malinche to the Virgin Mary, and a review of the ethnographic research on religious beliefs among contemporary Tlaxcalans, I will demonstrate that the mutable history of this woman made her the ideal supernatural protagonist for the people of Tlaxcala.