The combined predictive effect of patient characteristics and alliance on long-term dynamic and interpersonal functioning after dynamic psychotherapy.
On the basis of the well-established association between early alliance and outcome, this exploratory study investigated the associations between the therapeutic alliance and long-term outcome, 3 years after treatment termination. In addition to the early alliance, pre-treatment patient characteristics and expectancies that were significantly related to early alliance were included in the statistical analyses. The data are from the First Experimental Study of Transference, a dismantling randomized clinical trial with long-term follow-up. One hundred out-patients who sought psychotherapy due to depression, anxiety and personality disorders were treated. Alliance was measured with Working Alliance Inventory after session 7. Change was determined using linear mixed model analyses. The alliance alone had a significant impact on long-term outcome of the predetermined primary outcome variables of the study: Psychodynamic Functioning Scales and Inventory of Interpersonal Problems. Contrary to common clinical wisdom, when the pre-treatment patient variables were included, more personality disorder pathology was the strongest predictor of favourable outcome, over and above the effect of the alliance, which was no longer significant. Clinical implications are discussed.
Institute of Clinical Medicine Vinderen, University of Oslo, Norway. a.g.hersoug@medisin.uio.no
Anne Grete
AG
Hersoug
Per
P
Høglend
Glen O
GO
Gabbard
Steinar
S
Lorentzen
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011575:Psychoanalytic Therapy / Q000379:methods*; D013995:Time; D014167:Transference, Psychology; D016896:Treatment Outcome; D055815:Young Adult