Therapeutic Alliance in Depression Treatment: Controlling for Prior Change and Patient Characteristics

Although many studies report that the therapeutic alliance predicts psychotherapy outcome, few exclude the possibility that this association is accounted for by 3rd variables, such as prior improvement and prognostically relevant patient characteristics. The authors treated 367 chronically depressed...

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Bibliographic Details
Published in:Journal of consulting and clinical psychology 2003-12, Vol.71 (6), p.997-1006
Main Authors: Klein, Daniel N, Schwartz, Joseph E, Santiago, Neil J, Vivian, Dina, Vocisano, Carina, Castonguay, Louis G, Arnow, Bruce, Blalock, Janice A, Manber, Rachel, Markowitz, John C, Riso, Lawrence P, Rothbaum, Barbara, McCullough, James P, Thase, Michael E, Borian, Frances E, Miller, Ivan W, Keller, Martin B
Format: Article
Language:English
Subjects:
Adult
Antidepressive Agents, Second-Generation - therapeutic use
Behavior therapy. Cognitive therapy
Biological and medical sciences
Client Characteristics
Clinical outcomes
Clinical psychology
Cognitive Behavior Therapy
Cognitive behavioural psychotherapy
Cognitive Therapy
Combined Modality Therapy
Comorbidity
Depression
Depressive Disorder, Major - psychology
Depressive Disorder, Major - therapy
Drug Therapy
Dysthymic Disorder - psychology
Dysthymic Disorder - therapy
Female
Human
Humans
Major Depression
Male
Medical sciences
Medical treatment
Mental depression
Mental health
Middle Aged
Multimodal Treatment Approach
Nefazodone
Outcome and Process Assessment (Health Care)
Prediction
Professional-Patient Relations
Psychology
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychotherapeutic Outcomes
Psychotherapy
Recurrence
Symptom Remission
Therapeutic Alliance
Therapeutic alliances
Therapist patient relationships
Therapy
Treatment
Treatment Outcomes
Treatments
Triazoles - therapeutic use
USA
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Summary:Although many studies report that the therapeutic alliance predicts psychotherapy outcome, few exclude the possibility that this association is accounted for by 3rd variables, such as prior improvement and prognostically relevant patient characteristics. The authors treated 367 chronically depressed patients with the cognitive-behavioral analysis system of psychotherapy (CBASP), alone or with medication. Using mixed effects growth-curve analyses, they found the early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics. In contrast, neither early level nor change in symptoms predicted the subsequent level or course of the alliance. Patients receiving combination treatment reported stronger alliances with their psychotherapists than patients receiving CBASP alone. However, the impact of the alliance on outcome was similar for both treatment conditions.
ISSN:0022-006X
1939-2117
DOI:10.1037/0022-006X.71.6.997