Effects of couples' perceptions of genogram construction on therapeutic alliance and session impact: A growth curve analysis
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Preliminary evidence of the predictive validity of therapeutic alliance to outcome in couple therapy has recently been empirically established. Clinicians have asserted that genogram construction is an effective method for building the therapist-client relationship and impacting specific aspects of therapy sessions. However, this claim had not been empirically tested in a therapeutic context. The purpose of this study was to examine how the construction of a therapist administered genogram (TAGE) or a self-administered genogram (SAGE) would affect the therapeutic alliance and the session character in couple therapy across time. Eight student marriage and family therapists conducting couple therapy with 17 couples administered a TAGE, SAGE, or control treatment intervention in the second therapy session. Clients' perceptions of therapeutic alliance and session impact were measured with the Couple Therapy Alliance Scale (CTAS, Pinsof, 1986) and the Session Evaluation Questionnaire (SEQ, Stiles, 1984; Stiles & Snow, 1984a), respectively, following the first five sessions. A growth curve analysis was used to investigate within-couple member growth trajectories for individual patterns of change on the CTAS and SEQ and their subdimensions, and between-couple growth trajectories for treatment group-based patterns of change on the CTAS and SEQ and their subdimensions. Also examined was whether the growth curves of couples who completed five sessions were different from couples who terminated therapy prior to completing five sessions, and if Pinsof and Catherall's (1986) concept of split alliance was identifiable. A series of simple regressions were conducted on mean CTAS and SEQ ratings. Inspection of individual growth curves revealed minimally positive slopes on both dependent variables for the sample as a whole. Results of one-way MANOVAs showed no significant differences in couple members' growth curves based either on their participation in one of the three treatment groups, or when they were divided into therapy completer and noncompleter groups. In other words, the efficacy of genogram construction to affect the therapeutic alliance or the depth and smoothness of sessions in early therapy was called into question. When Spearman's rho and Kendall's tau correlation coefficients were used to examine the associations between domains of CTAS and SEQ by treatment group, only the CTAS tasks subscale was positively correlated with the SEQ depth index in the SAGE plus couple therapy (-HCT) group. This finding indicated that couples who completed a SAGE related the therapist's understanding of, and methods for addressing their difficulties, with the "deep" work of therapy. Finally, a two-standard deviation rule was applied to differences in mean slope scores between couple members to evaluate the presence of a split alliance. When this rule was applied to differences in mean slope scores for the whole sample, six percent of the couples experienced a split alliance. When applied within treatment groups, 14% of couples in the TAGE+CT group and 13% of couples in the SAGE+CT group experienced a split alliance. Relatively few couples, therefore, had disparate attitudes regarding their alliance with their therapist. This result may have reflected a strength of genogram construction. When considered in light of the studies limitations, particularly a small sample size and data collection weaknesses, these findings, in general, do not support genogram construction as a method for building a therapeutic alliance or enhancing the depth and smoothness of early couple therapy. Recommendations were made for future genogram construction research.