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As noted by Joyce et al. Most explorations of the shape of alliance change have been done in the context of individual treatment, although no consistent results have emerged. Rather, a great number of patterns have been identified across different studies, including no growth stable alliancelinear and increasing, linear and decreasing, quadratic U-shapedinverted-U-shaped, etc.
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Replicating any one pattern of results has been difficult; for example, Stiles et al. However, Stiles and colleagues instead identified four distinct alliance growth patterns, none of which was U-shaped; only a subset of patients with a V-shaped trajectory a rupture-repair sequence experienced differentially improved outcomes. Across the studies of alliance change in treatment, the diversity of patterns may be attributable to the wide range of methods used in previous work e.
Additionally, there are individual and treatment-level factors that may contribute to both initial alliance levels as well as the overall trajectory of alliance development in treatment. For example, patient expectations of improvement and levels of symptom severity predict alliance ratings and alliance growth Connolly Gibbons et al.
Given the established importance of the alliance in therapeutic work, identification of such salient variables may help clinicians identify situations where the alliance has the potential to be less robust and work to mitigate them. Alliance in group treatments for PTSD Individuals with posttraumatic stress disorder PTSD are perhaps particularly likely to have difficulty developing a robust therapeutic alliance.
Such difficulties are often a barrier to individuals accessing and engaging in treatment. Group therapy has been found to provide an opportunity for these individuals to reduce social isolation and begin to build trust in a context in which symptoms are normalized and shared by other members in the group Foy et al. Group therapy has been a mode of treatment for trauma-related problems as far back as the s Foy et al.
Given the theoretical and empirical support for the importance of social connection in group treatment for PTSD, it is especially important to examine the alliance that group members develop with each other. We therefore sought to examine the trajectory of change in alliance among this difficult-to-treat patient population.
Does alliance vary depending on the type of group treatment? In addition to examining the overall shape of change in alliance during group treatment for PTSD, we recognized that treatment type is one variable that may impact alliance. Specifically, it is possible that the type of group treatment may impact alliance development over time. For instance, treatments that focus on skill building may not foster as much group alliance as groups that focus on building social support within the group.
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In an example from the individual treatment literature, Constantino and Smith-Hansen found that patients with bulimia nervosa who received interpersonal therapy demonstrated greater alliance growth compared to patients who received cognitive-behavioral therapy. Unfortunately, most studies of group alliance have focused only on a single treatment condition, rather than comparing alliance levels across treatments within the same study.
However, these results alone are insufficient for our understanding of how different group treatments may foster different levels of alliance initially or, as was found by Constantino and Smith-Hansenwhether the rate of change in alliance differs as the treatments progress. The impact of interpersonal trauma Recent distinctions between different types of trauma and their potential differential trajectories for recovery suggest that this factor may also impact the development of alliance.
One particular distinction differentiates between interpersonal forms of trauma and non-interpersonal forms of trauma. Interpersonal trauma is typically defined as events in which an individual is personally assaulted or violated by another human being. Interpersonal trauma includes sexual assault, intimate partner violence, and child physical or sexual abuse.
Non-interpersonal forms of trauma include fires, disasters, and motor vehicle accidents. Chung and Breslau found that survivors of assaultive interpersonal violence reported higher levels of PTSD symptoms, especially emotional numbing and exaggerated startle response, than those who experienced other types of traumatic events.
It is understandable that individuals who have experienced an interpersonal violation may have difficulty connecting with others and may intentionally withdraw from social connections.
These responses have clear consequences: Notably, while the distinction between interpersonal and non-interpersonal trauma seems to have clear implications for the functioning and psychopathology of survivors, the degree to which it impacts therapeutic processes such as alliance has yet to be examined.
Miller for advice, and he tells her she's always looking for men like her father — that will keep a distance between them. Fran decides then to make Mr. Sheffield change, and when that doesn't work, she decides to quit her job and change herself. Not wanting to let her go, Mr. Sheffield Maxwell calls her Fran. Although they agree on not doing it in front of others yet, Max and Fran take their first step on the road of commitment.
Fran tries to convince Maxwell to let Niles take her, so they can call each other by their first names all weekend, but Max needs Niles there so he sends Fran instead. There, she is flattered by all the luxury, and by how much the Sultan looks like Mr. After the Sultan invites Fran to stay with him forever, she thinks he proposed and says no. And when she decides to fly back to NY, she is surprised to see that her passport and clothes are missing, and there are guards at her door.
Meanwhile, Niles tricks C. Sheffield's birthday and she uses his gift to look good, but Niles had tickets to Koorestan instead. Sheffield goes to Koorestan to rescue her, but turns out the Sultan only wanted her to be his nanny. Sheffield says he loves Fran, and doesn't take it back! Charles Shaughnessy plays a double role as the Sultan and Mr.
January 28, The Engagement Fran is thrilled to tell the family that Maxwell has told her he loved her, and this time he didn't take it back! Everybody is happy for her except for C. Maxwell reveals to Niles that he bought an engagement ring and is going to propose to Fran tonight. He, of course, can't keep a secret and tells Fran, who tells Sylvia, in a chain reaction that results in virtually everybody knowing about it. Maxwell asks Fran to invite her family over because they're having a very important dinner at the Rainbow Room and they should all be there.
All the Sheffield and Fine families gather and wait for Maxwell, who never shows up for he is mugged by punks at the theater. Afraid something happened to him because she was sure he wouldn't just leave her waitingFran goes after him, and finds a passed out Mr. Sheffield behind the theater.
He was knocked out by burglars who stole his watch and Fran's ring. Nevertheless, he proposes to Fran. March 4, The Dinner Party Maxwell decides to shop for a new ring for Fran, and Sylvia asks them to go to their uncle Stanley's, because he is family. But once there, they change their minds and go to Cartier instead. Fran gets an astonishing ring and they are mentioned in the social column and Fran's name is mistyped Fran Fone But Fran starts to see that she might not be very well accepted among Maxwell's rich friends: Hurt and afraid she might not be good enough for Maxwell, she goes to the park and meets a homeless man.
She offers him chicken and opens her heart for him, giving him her address and offering him to drop by at anytime he feels hungry. That man turns out to be one of the richest men in the city and he ends up sponsoring Maxwell's new play.
Meanwhile, Sylvia gets Maxwell and the kids to call her "ma" and "nana"; Niles has fun by showing Ms. Babcock the engagement ring. March 11, Homie-Work Fran decides that even though she's marrying Maxwell, she still wants to work.
She decides to help him with his new play. They have to find a rapper and Fran gets Sammy's grandson, who is a gift wrapper instead. In major trouble, Fran has to turn the nerd gift wrapper into a music rapper in less than 24 hours to prove to Mr. Sheffield that she is not stupid.
March 18, The Reunion Show Fran attends her high school reunion and is surprised to see that all her old friends are getting divorced, while she's the only one getting engaged. Trying not to be affected by all the negativity, Fran discusses with Maxwell the little things of life as a couple - which side of the bed they sleep on, what to do on the weekends, and how many children they'll have.
That becomes an issue because Maxwell doesn't want anymore children, while Fran does. After realizing how much motherhood means to Fran, Maxwell says they'll plan it in the future, leaving them plenty of time to practice.
Meanwhile, Niles goes through depression without having Ms. Babcock around to tease on; and Gracie gets scared she'll be sent away to a boarding school after a friend tells her it happened after her dad married her stepmother.
Guest Star Ray Romano March 25, Immaculate Concepcion Maxwell's father unexpectedly passes away, and in his will he leaves everything to Concepcion, a secret daughter he had with a flamenco dancer.
Afraid that the Sheffields are going bankrupt, Fran visits Concepcion trying to persuade her to share the money with her siblings, but can't. Knowing what if feels like being poor, Fran tells Maxwell that she'll understand if he decides to marry a rich woman in order to keep his lifestyle.
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Then Sheffield's lawyer arrives with the news: Concepcion decided to share her money, all because Fran made her feel like family. Niles plays tricks on Ms. Babcock, making her doubt her own sanity. April 1, The Pre-nup Pressured by his family, Maxwell wants Fran to sign a pre-nup, which upsets her. Unbelievably, Val is the one that opens her eyes to what's happening and how it is better for Fran to sign it. Brighton has an ice-skating accident and is taken to the hospital, and Fran is not allowed in because she's not his legal guardian.
So she disguises herself as a nun much like in guest Whoopi Goldberg 's Sister Act in order to see him. In the hospital room, Fran tells Brighton, Maggie and Gracie that she loves them like they were hers. After listening to that, Maxwell decides he doesn't want Fran to sign any pre-nup, but the adoption papers that will make Fran the kids' mother. April 29, The Best Man Maxwell's brother, Nigel, is back to throw him a bachelor party, and Fran is terrified because Maxwell doesn't know that she almost married Nigel a year and a half ago.
She tries to keep it a secret, but after Nigel gets drunk at the party, he tells Maxwell, just as Fran comes out of the cake in a surprise for him after Sylvia confessed that Morty cancelled his wedding and ran off with the cake girl - Sylvia! Fran and Maxwell have a fight over it, and they end up calling the wedding off, until C. So Fran gets Marla Maples, who had a quick fling with Maxwell a year and a half ago, and confronts Maxwell.
They finally realize they love each other and call the wedding back on.