An evaluation of the therapeutic alliance: a comparison between clients sexually abused as children and non-abused clients

Middle, Claire (1999). An evaluation of the therapeutic alliance: a comparison between clients sexually abused as children and non-abused clients. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000e283

Abstract

This exploratory study aimed to investigate whether clients who have experienced childhood sexual abuse (CSA) differ from clients who have not disclosed such abuse, in the quality of the therapeutic alliance, level of interpersonal difficulties and in the elements viewed as important in the alliance. The study used both quantitative and qualitative methodologies. Standardised questionnaires were used to investigate differences in alliance and interpersonal difficulties. Grounded theory was used to investigate the factors that were important in the therapeutic alliance for clients with a history of CSA.

The women interviewed in the CSA group reported significantly lower scores than women in the non-CSA group on the Working Alliance Inventory, although overall scores for both groups were high. There were no overall significant differences in the level of interpersonal difficulties between the two groups, although the groups did differ on one sub-scale of the Inventory of Interpersonal Problems 32.

The qualitative analysis suggested that clients from both groups raised many similar issues as important in the therapeutic alliance. These included factors relating to the therapist, to the therapy and to the client's perception of the relationship. The issues of commitment, being believed, and the therapist not showing negative reactions were mentioned only by the survivors of CSA. Overall, the qualitative analysis revealed that a wide range of factors were relevant to both groups of clients, although the factors of commitment and therapist's reactions may be particularly relevant to work with survivors of childhood sexual abuse.

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