Therapeutic alliance and treatment outcome in the primary care behavioral health model.
The current study investigated therapeutic alliance and clinical improvement within an integrated primary care behavioral health model. Participants included 542 primary care patients seen in two large family medicine clinics. Mental health symptoms and functioning were assessed using the 20-item Behavioral Health Measure (Kopta & Lowery, 2002) at the beginning of each patient appointment. Therapeutic alliance was measured with the Therapeutic Bond Scale (CelestHealth Solutions, 2008) following an initial appointment with one of 22 behavioral health consultants (BHCs). Primary care patients rated their therapeutic alliance following a first appointment with a BHC as statistically stronger than alliance ratings from a previously reported sample of outpatient psychotherapy patients after the second, third, and fourth psychotherapy sessions (Kopta, Saunders, Lutz, Kadison, & Hirsch, 2009). Results of a bootstrapped linear regression analysis indicated that therapeutic alliance assessed after the first primary care behavioral health appointment was not associated with eventual clinical change in mental health symptoms and functioning. A strong therapeutic alliance was able to be formed in a primary care behavioral health modality. This exceeded the magnitude found in outpatient psychotherapy alliance ratings. Early therapeutic alliance was unrelated to overall clinical improvement in primary care.
NCR Behavioral Health, LLC, Springfield, Virginia 22150, USA. kentcorso@gmail.com
Kent A
KA
Corso
Craig J
CJ
Bryan
Meghan L
ML
Corso
Kathryn E
KE
Kanzler
David C
DC
Houghton
Bobbie
B
Ray-Sannerud
Chad E
CE
Morrow
D000293:Adolescent; D000328:Adult; D000368:Aged; D001524:Behavioral Medicine; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care; D011369:Professional-Patient Relations; D015144:Southeastern United States; D011795:Surveys and Questionnaires; D055815:Young Adult