The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia.
BACKGROUND
The consistent association between therapeutic alliance and outcome underlines the importance of identifying factors which predict the development of a positive alliance. However, only few studies have examined the association between pretreatment characteristics and alliance formation in patients with schizophrenia.


OBJECTIVE
The study examined whether symptoms and insight would predict the therapeutic alliance in psychotherapy of schizophrenia. Further, the associations and differences between patient and therapist alliance ratings were studied.


METHODS
Eighty patients with schizophrenia spectrum disorders received manual-based psychotherapy. Assessment of symptoms and insight was conducted at baseline, and questionnaire-based alliance ratings were obtained three weeks into treatment. Patient and therapist alliance ratings were examined separately.


RESULTS
Patient and therapist alliance ratings were not significantly correlated (r=0.17). Patient ratings of the alliance were significantly higher than the ratings of their therapists (d=0.73). More insight in psychosis significantly predicted higher patient ratings of the alliance. Less positive and negative symptoms were significant predictors of higher therapist alliance ratings.


CONCLUSIONS
The findings indicate that symptoms and insight have an influence on the therapeutic alliance in the treatment of schizophrenia spectrum disorders. Patients' and therapists' perceptions of the alliance do not seem to demonstrate much convergence.
Wittorf
Andreas
A
University of Tuebingen, Department of Psychiatry and Psychotherapy, Tuebingen, Germany. andreas.wittorf@med.uni-tuebingen.de
Jakobi
Ute
U
Bechdolf
Andreas
A
Müller
Bernhard
B
Sartory
Gudrun
G
Wagner
Michael
M
Wiedemann
Georg
G
Wölwer
Wolfgang
W
Herrlich
Jutta
J
Buchkremer
Gerhard
G
Klingberg
Stefan
S
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001364:Awareness; D015928:Cognitive Behavioral Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000379:methods*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome