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 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.
Klein
Daniel N
DN
Department of Psychology and Psychiatry, State University of New York at Stony Brook, 11794-2500, USA. daniel.klein@stonybrook.edu
Schwartz
Joseph E
JE
Santiago
Neil J
NJ
Vivian
Dina
D
Vocisano
Carina
C
Castonguay
Louis G
LG
Arnow
Bruce
B
Blalock
Janice A
JA
Manber
Rachel
R
Markowitz
John C
JC
Riso
Lawrence P
LP
Rothbaum
Barbara
B
McCullough
James P
JP
Thase
Michael E
ME
Borian
Frances E
FE
Miller
Ivan W
IW
Keller
Martin B
MB
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010879:Piperazines; D011369:Professional-Patient Relations; D012008:Recurrence; D014230:Triazoles / Q000627:therapeutic use*
D018687:Antidepressive Agents, Second-Generation; D010879:Piperazines; D014230:Triazoles; C051752:nefazodone