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

• 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
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/0022-006X.71.6.997

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.