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 catechism geographicall, historical and chronologicall 1719

Notebook of unlined pages with paper marbled cover holding a handwritten copy of Tutor Flynt's "Catechism" likely copied by Harvard student John Wolcott in 1719. The volume lists questions and accompanying answers on various academic subjects. On the last page, the inscription "John Wolcott [the name is crossed over] his geography, 1719" indicates Wolcott (1702-1747), a member of the Harvard class of 1721, copied the book.

A study of English for the advanced grades of deaf pupils /

Cover title: English for advanced grades of deaf pupils, book III.

Inventory of the collection of pictures, miniatures, decorative furniture, porcelain, objects of art, books, &c. /

Cover title: The Jones collection.

The life and times of Charles James Fox /

Mode of access: Internet.

The life of William, lord Russell; with some account of the times in which he lived.

Mode of access: Internet.

Account of the war in Spain and Portugal, and in the south of France, from 1808, to 1814, inclusive.

Mode of access: Internet.

National estuarine inventory : land use and the Nation's estuaries /

Mode of access: Internet.

The visitation of Cheshire in the year 1580,

Mode of access: Internet.