Práticas de ensino de habilidades para estabelecimento e manutenção da aliança terapêutica no contexto da psicoterapia: uma revisão da literatura

Abstract

Therapeutic alliance refers to the quality and strength of the collaborative relationship between client and therapist, which is built as the therapeutic process unfolds. There is evidence that a well-established therapeutic alliance is one of the main predictors of positive outcomes in the therapeutic process for the client. However, overall, the skills required to form this bond are not systematically taught in undergraduate courses, nor are they based on evidence regarding the effectiveness of methods for teaching thes skills. In light of this, the objectives of the present study were to analyze the academic literature in order to describe: (a) the scientific rigor of the study designs employed, (b) the characteristics of intervention programs offered to teach skills for establishing and maintaining the therapeutic bond to clinical psychology students, and (c) the effects of the programs on students' repertoire and the quality of the therapeutic alliance formed with their clients. The method employed was a systematic review, following the updated version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The methodological quality of each study was assessed based on the Mixed Methods Appraisal Tool. A total of 268 publications were identified in four databases (Scientific Electronic Library Online - SciELO, PsycNET - APA, PubMed, and BVS) and imported into the Rayyan program. After the identification, screening, and abstract reading stages, 18 studies were selected for analysis. After reading the full papers to determine eligibility, nine studies were included in the systematic review. The results show that there are programs for training alliance skills (alliance focused training - AFT). Some of the skills taught involve building bonds, aswell as skills to repair ruptures in this affective bond. Relationship aspects involving commitment to the therapeutic process were also addressed. Three main strategies were found for teaching these skills: video feedbacks and role-plays activities. However, there is limited evidence regarding the effects of the programs. The main limitation of the review conducted is the multiplicity of terms being used in this area, so some relevant texts may not have been identified. In future studies, it will be important to invest in the development of an AFT program for use in Brazil, verifying the effectiveness of the teaching process with multiple informants (e.g., supervisors, therapists, clients, and observers not connected to the first three groups of informants). In this way, it will be possible to contribute to improvements in the quality of training for Brazilian psychologists and, therefore, to the effects of the psychotherapeutic services provided