The Change Companies

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Stages of Change and the Working Alliance in Psychotherapy

The objective of this study was to measure the impact of the client's stage of change on the therapeutic outcome with a hypothesis that the working alliance would mediate the relationship between stage of change and therapeutic outcome. "The current study found that the working alliance mediated the relationship between the stages of change and the degree of improvement in clients' symptoms. The working alliance was able to account for 89% of the direct pathway between stages of change and outcome (Emmerling, 2006)." Also, results indicate the importance of a client's stage of change in the development and maintenance of the working alliance and its indirect effect on outcome in individual therapy (Emmerling, 2006).

The Change Companies® applies these findings through the guided content and questioning within each Journal page and within our Facilitator Guides which serve as a corollary to Interactive Journals. The personalized responses to the journaling activities become a key tool for engaging participants in their own self-change process. The open-ended questions, guided journaling exercises and other "rules of Interactive Journaling®" all contribute to the interactive nature of the intervention and enhance the helping relationship of treatment by tapping into the inner thoughts, feelings, values and goals of the individual. According to Emmerling (2006), success in building an effective therapeutic alliance is founded on the provider focusing on the individual's internal dialogue, conflicts, self-discovery process, and "enacting key internal dialogues and by helping clients articulate the hopes and desires associated with their core emotions (Greenberg, Rice, & Elliot, 1993)."

Interactive Journaling® emphasizes the participants' opportunities for choice and change and guides participants in applying knowledge to personal circumstances and challenging situations. Our Interactive Journaling® content and exercises coupled with our facilitator resources have been designed to directly engage participants in change-based exploration that is personally relevant, which is then channeled into a collaborative alliance through applying the principles of Motivational Interviewing within the facilitation process. This therapeutic alliance can then be used to mediate meaningful, positive behavior change. According to the findings of this study; "A very strong case can and has been made (e.g., Blatt & Zuroff, 2005) that the therapeutic relationship is itself a curative element in psychotherapy, but at the very least the working alliance is a vehicle for transmitting the active elements of therapy (Hartley & Strupp, 1983)."

Greenberg, L.S., Rice, L.N., & Elliot, R. (1993). Facilitating emotional change. New York: Guilford Press.

Blatt, S.J., & Zuroff, D.C. (2005). Empirical evaluation of the assumptions in identifying evidence based treatments in mental health. Clinical Psychology Review, 25, 459-486.

Hartley, D.E., & Strupp, H.H. (1994). The therapeutic alliance as an interpersonal process. In A.O. Horvath & L.S. Greenberg (eds), The working alliance: Theory, research, and practice (pp. 51-84). New York: Wiley.