title: Two aspects of the therapeutic alliance: differential relations with depressive symptom change.
abstract: OBJECTIVE
  The therapeutic alliance has been linked to symptom change in numerous investigations. Although the alliance is commonly conceptualized as a multidimensional construct, few studies have examined its components separately. The current study explored which components of the alliance are most highly associated with depressive symptom change in cognitive therapy (CT).
  
  
  METHODS
  Data were drawn from 2 published randomized, controlled clinical trials of CT for major depressive disorder (n = 105, mean age = 40 years, female = 62%, White = 82%). We examined the relations of 2 factor-analytically derived components of the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) with symptom change on the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) that occurred either prior to or subsequent to the examined sessions. WAI ratings were obtained at an early and a late session for each therapist-patient dyad.
  
  
  RESULTS
  Variation in symptom change subsequent to the early session was significantly related to the WAI factor that assesses therapist-patient agreement on the goals and tasks of therapy but not to a factor assessing the affective bond between therapist and patient. In contrast, both factors, when assessed in a late session, were significantly predicted by prior symptom change.
  
  
  CONCLUSIONS
  These findings may reflect the importance, in CT, of therapist-patient agreement on the goals and tasks of therapy. In contrast, the bond between therapist and patient may be more of a consequence than a cause of symptom change in CT. The implications of these results and directions for future research are discussed.
authors.affiliation: Department of Psychology, University of Pennsylvania, 3815 Walnut Street, Philadelphia, PA 19104-1696, USA. webb@sas.upenn.edu
authors.forename: Christian A
authors.initials: CA
authors.lastname: Webb
authors.forename: Robert J
authors.initials: RJ
authors.lastname: DeRubeis
authors.forename: Jay D
authors.initials: JD
authors.lastname: Amsterdam
authors.forename: Richard C
authors.initials: RC
authors.lastname: Shelton
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
authors.forename: Sona
authors.initials: S
authors.lastname: Dimidjian
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales