title: Helping alliance and outcome in psychotherapy: what predicts what in routine outpatient treatment?
abstract: This naturalistic longitudinal study analyzed the reciprocal dependency of the helping alliance and symptom outcome over the course of mid- and long-term outpatient psychotherapy as practiced in routine care in Germany. Patient-rated helping alliance and symptom distress were assessed repeatedly over a 2-year period in a sample of 259 outpatients in psychodynamic, cognitive-behavioral, and psychoanalytic psychotherapy. Hierarchical linear models showed that initial symptom distress negatively predicted subsequent quality of the helping alliance but not vice versa. Only initial symptom distress affected symptom status at the last treatment session. These results raise doubts about the helping alliance being a strong predictor of outcome and indicate that other patient and therapist variables might be more important for treatment success.
authors.affiliation: Department of Psychiatry II, Ulm University, Ulm, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Puschner
authors.forename: Markus
authors.initials: M
authors.lastname: Wolf
authors.forename: Susanne
authors.initials: S
authors.lastname: Kraft
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010348:Patient Care Team; D011446:Prospective Studies; D013001:Somatoform Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome