Therapeutic alliance in face-to-face and telephone-administered cognitive behavioral therapy.
OBJECTIVE
Telephone-administered therapies have emerged as an alternative method of delivery for the treatment of depression, yet concerns persist that the use of the telephone may have a deleterious effect on therapeutic alliance. The purpose of this study was to compare therapeutic alliance in clients receiving cognitive behavioral therapy (CBT) for depression by telephone (T-CBT) or face-to-face (FtF-CBT).


METHODS
We randomized 325 participants to receive 18 sessions of T-CBT or FtF-CBT. The Working Alliance Inventory (WAI) was administered at Weeks 4 and 14. Depression was measured during treatment and over 1 year posttreatment follow-up using the Hamilton Rating Scale for Depression and Patient Health Questionnaire-9.


RESULTS
There were no significant differences in client or therapist WAI between T-CBT or FtF-CBT (Cohen's f² ranged from 0 to .013, all ps > .05). All WAI scores predicted depression end of treatment outcomes (Cohen's f² ranged from .009 to .06, all ps < .02). The relationship between the WAI and depression outcomes did not vary by treatment group (Cohen's f² ranged from 0 to .004, ps > .07). The WAI did not significantly predict depression during posttreatment follow-up (all ps > .12).


CONCLUSIONS
Results from this analysis do not support the hypothesis that the use of the telephone to provide CBT reduces therapeutic alliance relative to FtF-CBT.
Department of Preventive Medicine.
Colleen
C
Stiles-Shields
Department of Preventive Medicine.
Mary J
MJ
Kwasny
Department of Preventive Medicine.
Xuan
X
Cai
Department of Preventive Medicine.
David C
DC
Mohr
D000328:Adult; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D019114:Remote Consultation; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome