Assessing the therapeutic alliance with the five-factor model: An expert-based approach

In psychotherapy, therapeutic alliance is an integrative factor influencing the effectiveness of treatment. This alliance depends on the bond between therapist and patient.ObjectivesThis study investigates patient's psychological variables likely to facilitate or hamper a psychotherapeutic process.MethodsWe asked 38 clinicians to assess the importance of each domain and facet of the Five-factor model (five domains and thirty facets) supposed to facilitate or hamper therapeutic alliance.ResultsResults indicate that high openness, agreeableness and conscientiousness are perceived as favourable to therapeutic alliance. Beyond these results, we preferably focus on facets of the Five-factor model to assess their relevance for the facilitation or hindrance of therapeutic alliance. According to clinicians, 17 facets are supposed to affect positively therapeutic alliance: A2 (straightforwardness), O3 (feelings), C5 (self-discipline), O5 (ideas), O6 (values), C2 (order), O1(fantasy), C1 (competence), E2 (gregariousness), E1 (warmth), A6 (tender-mindedness), N5 (impulsiveness), A3 (altruism), C4 (achievement striving), E4 (activity), N1 (anxiety) and C6 (deliberation). Thirty-eight facets were supposed to have a negative effect on therapeutic alliance: A5 (modesty), A2 (straightforwardness), A1 (trust), C3 (dutifulness), E3 (assertiveness), E1 (warmth), A4 (compliance), O3 (feelings), C4 (achievement striving), N3 (depression), A6 (tender-mindedness), O5 (ideas), A3 (altruism), E5 (excitement-seeking), N5 (impulsiveness), O2 (aesthetics), E2 (gregariousness) and O1 (fantasy).ConclusionOn this basis, we propose three experimental scores investigating the proneness to access therapy based on the Five-Factor Model.     

Le cancer prostatique: quoi de neuf?

Recent advances, particularly in the fields of biology and nuclear medicine, have improved our understanding of carcinoma of the prostate and, thereby, have contributed to a more precise application of the different therapeutic approaches currently available. Although cytology and "immunological" assay of prostate phosphatases have not replaced rectal examinations in the diagnosis of this condition, it is now possible to assess its stage and "aggressivity" very accurately. Staging the disease demands exhaustive investigation, especially when the cancer is small; although blood-born metastases can be rapidly demonstrated, it is much more difficult to affirm the localised, purely intracapsular form of epithelioma; lymphography and surgical "picking" of lymph nodes should be considered in some cases. The stage and evolution of the cancer, and the general condition of the patient may indicate therapeutic abstention, palliative treatment (hormone therapy) and, all too rarely, an attempt at radical surgical care. There are a number of therapeutic choices of sometimes surprising, sometimes disappointing efficacy, especially in cases "escaping" oestrogen control, heralded by a rise in phosphatase levels.