Research Studies

Participate in a Psychotherapy Practice Research Network (PPRNet) Study to Train Psychotherapists to Repair Therapeutic Alliance Tensions

Improving psychotherapists’ effectiveness

The Psychotherapy Practice Research Network (PPRNet) invites you to participate in research to improve psychotherapists’ effectiveness. The goal of this study is to provide therapists with professional development training and ongoing consultations to improve their clients’ outcomes. The training and consultations will help therapists to detect and repair tensions in the therapeutic alliance. Detecting and repairing therapeutic alliance tensions is a skill that can be improved through training regardless of the specific approach a therapist takes. This study was funded by the Canadian Institutes of Health Research (CIHR) and approved by the research ethics boards at the University of Ottawa and Mt. Sinai Hospital in Toronto. We carefully designed the study to minimize yours and your clients’ time commitment while maximizing the skills that you will learn. Please review the study information, eligibility criteria, timeline, and time commitment. We are happy to answer all of your questions. Please feel free to contact our research coordinator or myself using the contacts listed below. Watch this YouTube video on the study for more information.

Study Goal & Objectives

To raise therapists' expertise in managing the therapeutic alliance so that clients will receive the most benefit
We will provide participating therapist with evidence-based education and ongoing case consultations on how to improve and repair the therapeutic alliance to enhance their clients’ mental health outcomes
80 therapists who provide psychotherapy and their clients from across Canada will participate in this study

Therapeutic Alliance

Patient-therapist agreement on the tasks and goals of psychotherapy, and the relational bond
A positive alliance increases the effectiveness of psychotherapy and allows specific interventions (e.g., Cognitive-Behavioural Therapy, Interpersonal Psychotherapy, Short-term Dynamic Psychotherapy, Emotion-Focused Therapy) to work.

Repairing Alliance Tensions

Alliance tensions occur often, typically go undetected, and can cause poorer client outcomes
Psychotherapists can be trained to identify and repair alliance tensions with evidence-based methods

Benefits of Participating

Free professional development training

Evidence-based training workshops on therapeutic alliance tension and repair provided by leading experts in the field
3 to 6 monthly group case consultation sessions with the trainers to discuss cases and to support your learning
Training manual and training CD
All therapists will receive the same training and consultations
Group assignment (immediate training group vs delayed training control group) will determine the timing of receiving the training and consultations

Free Samsung android tablet provided to therapists to facilitate efficient completion of study

Eligibility Checklist

Therapists

In good standing with your provincial regulatory college
Psychotherapy is within your regulated scope of practice
Provide psychotherapy in English
Able to include 3 to 7 new clients from your caseload

Clients

About to start a course of therapy with you as their therapist
18 years of age or older
Not currently seeing another mental health professional
Do not have a psychotic or neurocognitive disorder
Have not displayed suicidal behaviour in the past 6 months
Will receive at least 6 sessions within the next 6 months with you as their therapist

Participation and Time Commitment

Therapists

You will be randomly allocated to one of two study conditions:

Professional development training group who receive immediate training and ongoing consultation sessions.

Control group who receive the professional development training and consultations after they complete the study therapy sessions with participating clients.

You will:

Provide informed consent to participate in the study
Provide study information to all new clients (interested clients will contact PPRNet to enrol)
Participate in professional development activities: 2 workshops plus 3 to 6 monthly virtual case consultations
Video record 6 therapy sessions of each enrolled client using the tablet we provide
Complete brief questionnaires before, during, and after treatment of each client (about your client, the alliance, and about yourself)

Clients

Interested clients will contact the study coordinator to enrol in the study
Provide informed consent to participate in the study
Agree to have 6 therapy sessions video recorded
Complete brief questionnaires before, during, and after treatment (health history, the alliance, level of distress)

Therapist Flow Through the Study

As a therapist, your path through the study will depend on which condition you are randomized. If you are randomized to the professional development condition, you will receive the 2-day professional development workshop as soon as possible after you are enrolled. You will then be required to fill out pre-therapy questionnaires taking approximately 15 minutes, and inform your new clients of the study. With each enrolled client, you will video record 6 therapy sessions and fill out post-session questionnaires (which take less than 5 minutes each). During this therapy phase you will also receive free case consultations from our study experts. Once you have completed the therapy phase, you will fill out post-therapy questionnaires, taking approximately 15 minutes. Three months after you have completed the therapy video recordings you will be asked to fill out a final questionnaire.

If you are randomized to the control group, you will proceed directly to filling out the pre-therapy questionnaires taking approximately 15 minutes, and inform your new clients of the study. With each enrolled client, you will video record 6 therapy sessions and fill out post-session questionnaires (which take less than 5 minutes each). Once you have completed the therapy phase, you will fill out post-therapy questionnaires, taking approximately 15 minutes. Three months after you have completed the therapy video recordings you will be asked to fill out a final questionnaire. Once completed, you will be offered the free professional development workshop and case consultations from our study experts.

Frequently Asked Questions by Therapists

How much of my time will it take to participate in this study?

Therapists’ time commitment is spread out over about 6 to 8 months, including:
- A 2-day workshop to learn to identify and repair therapeutic alliance tensions
- 6 2-hour evening group case consultations by phone or Skype with an expert consultant
- About 15 minutes to fill out questionnaires before a client starts therapy and after a client completes the study
- Less than 5 minutes after each study therapy session to fill out a questionnaire

How much of my client’s time will it take to participate in this study?

Clients’ time commitment is also spread out over several months, including:
- About 15 minutes to fill out questionnaires before, after, and 3 months after the 6 study therapy sessions
- Less than 5 minutes after each study therapy session to fill out a questionnaire

Where and when will the workshops take place?

The first workshop for therapists randomized to receive the professional development training is in Toronto in March 2018, and the second will be in Ottawa in June 2018. Future workshops will be added with new dates and locations.

Where will the therapy take place?

This is a practice-based study, so the therapy will take place in your own office.

How many of my clients will be enrolled in the study and for how long?

Between 3 to 7 new clients of yours will be enrolled each for 6 sessions of therapy with you.

Can I continue seeing clients after the 6 therapy sessions for the study?

Yes, you can provide clients with more therapy if they need it.

Is video recording the 6 therapy sessions for the study necessary?

Yes, it is the main way we have of assessing how well you applied what you learned about identifying and repairing alliance tensions.

Will the video recording be confidential and will it interfere with therapy sessions?

The videos are confidential and will be treated with the highest level of care and privacy. We will encrypt the video files so that no one but a few members of the research team has access to them.
Our experience with video recording in training centres is that clients and therapists quickly forget about the recording once the session gets going.

What happens if I am randomly assigned to the control group of therapists?

You and your clients will participate in the study in the same way as others, except your training and consultations will be delayed until after your participation in the study is completed.

How will my clients and I benefit from participating in this study?

Your expertise and effectiveness as a therapist to identify and repair alliance tensions will increase.
Clients’ mental health outcomes may improve from your increased expertise.

What other incentives are there to participate?

You will received a free 2-day training workshop, a free manual and CD, and up to 6 case consultation sessions with expert consultants.
You will also keep the Samsung android tablet used to video record sessions and complete questionnaires.
Both you and your clients will be contributing to knowledge about what improves psychotherapy relationships and how best to train therapists so that client mental health outcomes can improve.

Study Background

The current study is informed by findings from PPRNet’s participatory research with therapists and by research on patient values.

PPRNet conducted a national survey of over 1000 practicing psychotherapists who identified improving the therapeutic relationship and professional development among their top rated research priorities. See our publications tab for links to this published research.
Surveys suggest that patients place a higher value on the therapeutic relationship with the therapist relative to technical aspects of psychotherapy. Read more about these finding using the links below:
- Important characteristics of therapy: community members vs. therapists
- Non-improved patients view psychotherapy

Research Ethics

This study has been approved by the research ethics board at the University of Ottawa and Mt. Sinai Hospital, Toronto.

For any questions regarding the ethical conduct of this study, contact the research ethics office at
University of Ottawa, 613-562-5387, or Mt. Sinai 416-586-4875.

Support and Collaborations

This study is funded by Canadian Institutes of Health Research (CIHR) and will be conducted by PPRNet in collaboration with investigators from Mount Sinai Hospital in Toronto, the University of Toronto, the University of British Columbia, and the University of Alberta.