title: Does the cognitive dispute of psychotic symptoms do harm to the therapeutic alliance?
abstract: We examined whether the cognitive dispute of psychotic symptoms has a negative impact on the course of the therapeutic alliance. Sixty-seven patients with persistent psychotic symptoms received either cognitive behavioral therapy (CBT) or supportive therapy. Questionnaire-based alliance ratings were repeatedly obtained throughout the course of therapy. Patient and therapist alliance ratings were examined separately. Data analyses comprised repeated measurement analyses of variance and cluster analytic procedures. Neither patient nor therapist alliance ratings showed a differential course throughout the treatments. This was despite the implementation of disputing strategies in later stages of CBT. Irrespective of the treatment condition a cluster with a positive alliance rating and a cluster with a poorer rating were found for therapist and patient ratings, respectively. Baseline symptoms and insight differentiated between the types of clusters. In conclusion, CBT-specific interventions that challenge psychotic symptoms do not necessarily negatively influence the course of the alliance.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany. andreas.wittorf@med.uni-tuebingen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Wittorf
authors.forename: Ute E
authors.initials: UE
authors.lastname: Jakobi
authors.forename: Kerstin K
authors.initials: KK
authors.lastname: Bannert
authors.forename: Andreas
authors.initials: A
authors.lastname: Bechdolf
authors.forename: Bernhard W
authors.initials: BW
authors.lastname: Müller
authors.forename: Gudrun
authors.initials: G
authors.lastname: Sartory
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Georg
authors.initials: G
authors.lastname: Wiedemann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wölwer
authors.forename: Jutta
authors.initials: J
authors.lastname: Herrlich
authors.forename: Gerhard
authors.initials: G
authors.lastname: Buchkremer
authors.forename: Stefan
authors.initials: S
authors.lastname: Klingberg
mesh_terms: D000328:Adult; D001364:Awareness; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003702:Delusions / Q000523:psychology* / Q000628:therapy*; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012944:Social Support; D011795:Surveys and Questionnaires