title: Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy.
abstract: OBJECTIVES. Patient expectancy has been regarded as an important predictor of psychotherapy outcome, for more than half a century. In recent years, some evidence has emerged indicating that the therapeutic alliance may mediate the association between expectancy and outcome. DESIGN. In this dismantling, randomized clinical study, 100 out-patients who sought psychotherapy due to depression, anxiety, and personality disorders, were assigned to 1 year of dynamic psychotherapy with and without transference interpretation. METHODS. Patients' pre-treatment target expectancies and global expectancy were measured in this clinical trial. Tests of mediation were performed with two patient-rated and one therapist-rated measure of the therapeutic alliance, using regression analyses. Six putative moderators of the mediational paths were explored. RESULTS. Global Optimism was significantly associated with two clinician-rated outcome measures - the Psychodynamic Functioning Scales and Global Assessment of Functioning. Both patient ratings, but not the therapist rating of alliance mediated the association between global expectancy and clinician-rated outcome. None of the putative moderators had a significant effect. CONCLUSION. The results, together with previous findings, indicate that the expectancy-alliance-outcome mediational chain is a general phenomenon, not limited to subgroups of patients or modes of treatment.
authors.affiliation: Ullevaal University Hospital, Oslo, Norway.
authors.forename: Paul
authors.initials: P
authors.lastname: Johansson
authors.forename: Per
authors.initials: P
authors.lastname: Høglend
authors.forename: Anne Grete
authors.initials: AG
authors.lastname: Hersoug
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods; D014167:Transference, Psychology; D016896:Treatment Outcome; D055815:Young Adult