Oh G-d, A Borderline: Clinical Diagnostics As Fundamental Attribution Error Page: 10
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predictive of depression, interpersonal problems, self-esteem, and dysfunctional attitudes while
no significant differences on these outcomes was observed between cognitive behavioral therapy
and process-experiential therapies. A meta-analysis by Martin, Garske, and Davis (2000) found
that the therapeutic relationship's relation to outcome variables is moderate, though consistent,
and does not appear to be impacted by moderator variables like type of outcome measure used,
type of outcome rater, type of alliance assessment, or type of treatment. This suggests that
despite some methodological variability in the meta-analytic process, the therapy relationship is
still a robust predictor of success. An earlier meta-analysis (Horvath & Symonds, 1991) also
found a consistent, moderate effect of therapeutic relationship with positive therapy outcome
with similar robustness with respect to moderating variables.
Some meditational studies have sought to determine more clearly what it is about a good
therapeutic relationship that yields positive outcomes. Therapeutic working alliance mediates the
relationship between interpersonal problems and depression (Howard, Turner, Olkin, & Mohr,
2006). It appears that the therapeutic relationship likewise mediates the relationship between
self-critical perfectionism and sustained client adjustment (Blatt, Zuroff, Hawley, & Auerbach,
2010). Regardless of the specific pathways by which therapeutic alliance is beneficial to therapy,
or whether the Dodo bird effect continues to gain support, it is clear that the therapeutic
relationship is a fundamental element and robust predictor of positive therapeutic outcome.
Developing therapeutic alliance, in part, requires that the therapist be able and willing to
accept the client as they are, where they are, and for all of their behaviors, good and bad (Rogers,
1957). When personal biases or stigmas get in the way of therapeutic alliance development there
are, data suggests, likely to be problems with the efficacy of treatment. Motivational
interviewing literature specifically emphasizes that clinicians should be careful in their use of
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Schmalz, Jonathan. Oh G-d, A Borderline: Clinical Diagnostics As Fundamental Attribution Error, thesis, December 2011; Denton, Texas. (digital.library.unt.edu/ark:/67531/metadc103389/m1/16/: accessed March 26, 2017), University of North Texas Libraries, Digital Library, digital.library.unt.edu; .