Explorations of the therapist factors affecting alliance and outcome : internalised relational models, work involvement styles and burnout

Variation between therapists in their clinical effectiveness has been the subject of repeated investigation by psychological researchers. However, little is known about therapist factors that may affect clinical outcomes or impact upon a therapist's ability to form a strong therapeutic relationship, an empirically acknowledged mediator of outcome. This study investigated how factors such as internalised relational models, therapist's emotional relationship with their work, and therapist burnout might affect clinical outcomes or therapeutic relationship quality. The first paper was a systematic review of the research literature on therapists' internalised relational models and how they relate to the quality of the therapeutic relationship. Internalised relational models were operationalised using attachment style and introject. Overall evidence suggested that therapists' attachment styles and introject were related to the quality of the therapeutic alliance, either independently or in interaction with client's attachment style and introject. The second paper presented an empirical investigation of therapist burnout within Improving Access to Psychological Therapies (IAPT) services. The General Model of Burnout (GMB) was the basis for investigating factors hypothesised to contribute to burnout in an IAPT population, as well as factors hypothesised to be protective against burnout. The nature of therapists' emotional involvement with their work, measured using the Therapist Work Involvement Scale, was investigated as a potential addition to the GMB. The association between therapist burnout levels and clinical outcome was also examined. Therapists (n=94) completed an online survey and responses were matched with client outcomes (n=775). Results indicated that burnout in an IAPT population was predicted by high work demands, a lack of autonomy, in-session feelings of anxiety, an avoidant coping style, youth and a stressful work involvement style. Burnout was moderated by an active coping style, more autonomy, a longer period of training, more experience and a healing work involvement style. There was no indication that burnout levels or therapist work involvement style predicted client outcomes or rates of client drop-out.EThOS - Electronic Theses Online ServiceGBUnited Kingdo