Self-determination theory and psychotherapy
Beth Keleher is currently in her fourth year of Ph.D. studies in the Clinical Psychology program at the University of Waterloo. She graduated from the University of Guelph in 2011 with an Honours BA in Psychology. Her research interests and clinical interests share the collective thread of common factors (e.g., therapist and client influences, therapeutic alliance) responsible for client motivation for and improvement through psychotherapy, independent of diagnosis or treatment modality. Her research interests largely centre around the potential benefits of applying a Self-Determination Theory framework for understanding the variables that influence client motivation to engage with and persist in psychotherapy. Specifically, she studies the association between basic psychological needs support (autonomy, competence, and relatedness to others) and the temporal fluctuation of motivation for emotionally demanding task completion over time.
PAST AND CURRENT PROJECTS
Proponents of Self-Determination Theory (SDT) propose that a person’s basic psychological needs (i.e. sense of autonomy, competence, and relatedness to others) as experienced in psychotherapy will affect their ability to explore experiences and events, and to make adaptive changes in goals, behaviours, and relationships (Ryan & Deci, 2008). Ryan and Deci (2008) suggest that when these needs are thwarted, they are often replaced with substitutes (e.g., extrinsic life goals) which become the focus of the person’s energy rather than striving to satisfy the unmet basic psychological need. It is theorized that clients who experience more autonomous motivation are better able to engage in therapy tasks resulting from an internal sense of responsibility for the outcome (i.e., experience more success applying what they learn in therapy to make positive changes necessary for treatment success). Research has established that more autonomously motivated individuals demonstrate more willingness to effect change and greater therapy persistence (e.g., Zuroff et al., 2012). However, research has yet to examine the contribution of basic needs satisfaction in therapy to motivation, especially in regards to motivation for proximal homework or therapeutic goals that vary from week to week. This line of research will be continued through PIRT-run studies as I complete my Doctoral dissertation.
SUMMARIES OF SUBMITTED PUBLICATIONS
Basic Psychological Needs Satisfaction, Working Alliance, and
Early Termination in Psychotherapy
Objective: The goal of these studies was to evaluate the relationship between basic psychological needs satisfaction and working alliance in psychotherapy and to determine whether client ratings of basic needs and working alliance during psychotherapy were associated with early termination of therapy.
Method: In two studies, former psychotherapy clients (n = 87 and n = 11, respectively) completed a semi-structured interview regarding basic needs satisfaction in therapy, working alliance, and status at time of termination (i.e., ending of therapy planned with therapist or unplanned).
Results: Participant ratings on the Basic Needs Satisfaction in Psychotherapy scale (BNSP) and the Retrospective Working Alliance Inventory – Short (RWAI-S) were significantly correlated in both study 1 (r = .77) and study 2 (r = .70) samples. A comparison of intercorrelations between working alliance subscales and basic needs subscales indicated higher factorial distinctiveness within the basic needs measure. T-tests comparing those who terminated psychotherapy early with those who had planned endings on scores on the BNSP and RWAI-S were significant in Study 1 (Cohen’s d = 0.65 and 1.82, respectively) but not so in Study 2 (Cohen’s d = 0.84 and 1.55), due to a lack of power.
Conclusions: Working alliance and needs measures are tapping into similar constructs in the psychotherapy context. Results suggest that the basic needs measure might tap into a wider breadth of the therapist and client interaction. Furthermore, analysis of basic needs fulfillment and working alliance measures suggests that scores on both are related to early therapy termination.
Keywords: Self-Determination Theory; Working Alliance; Dropout; Basic Psychological Needs; Common Factors
Reference:
Keleher, B., Oakman, J. M., Capobianco, K., & Mittelstaedt, W. H. (2017). Basic psychological needs satisfaction, working alliance, and early termination in psychotherapy.
Measuring the Factor Structure of a Retrospective
Working Alliance Inventory
We evaluated the factor structure of the Retrospective Working Alliance Inventory – Short and compared this measure with factor analyses of several versions (e.g., therapist, client, observer) of the prospectively-administered Working Alliance Inventory. Former psychotherapy clients (N = 87) completed a semi-structured interview regarding psychotherapy experiences, including their perception of working alliance with their therapist. Participant ratings on the RWAI-S revealed a factor structure mirroring previous findings. There was poor fit with one-factor and three-factor models of working alliance and adequate fit with a three-factor bilevel model. The factor structure for the RWAI-S did not map onto other two additional proposed models of working alliance previously demonstrated to have good fit with observer and short-form versions of the WAI (i.e., a two-factor agreement/confidence and relationship model and a corresponding two-factor bilevel model). Our retrospectively-administered measure of working alliance demonstrates the same factor structure and psychometric properties as prospective therapist and client rated WAI measures (both long and short form). Results suggest that client ratings of their experience of the therapeutic alliance retrospectively are reliable indicators of the quality of the relationship, despite the retrospective nature of the measure’s completion.
Keywords: Working Alliance Inventory, Factor Structure, Confirmatory Factor Analysis, Psychometrics
Reference:
Keleher, B. & Oakman, J. M. (2017). Measuring the factor structure of a retrospective working alliance inventory.