title: Perceived therapist genuineness predicts therapeutic alliance in cognitive behavioural therapy for psychosis.
abstract: OBJECTIVE
  The quality of therapeutic alliance is a consistent and stable predictor of therapy outcome. Recent studies have shown therapist characteristics to be relevant predictors of the alliance in psychological therapies in general. However, little is known about the specific therapist characteristics that explain differences in therapeutic alliance in cognitive behavioural therapy for psychosis (CBTp). The aim of this study was to identify relevant therapist characteristics that predict early therapeutic alliance in CBTp.
  
  
  METHODS
  Forty-eight patients with a DSM-IV diagnosis of a psychotic disorder participating in a CBTp trial and 11 therapists were included in the analysis. Therapist characteristics as perceived by the patients (empathy, genuineness, positive regard, competence, and convincingness) were assessed at baseline. Alliance was assessed after the fifth therapy session. Data were analyzed using bivariate correlations and multivariate hierarchic regression analysis.
  
  
  RESULTS
  All therapist characteristics were positively associated with patient-rated alliance. Patient characteristics were not significantly associated with alliance and did not predict alliance in the multivariate analysis. Regression analysis revealed therapist genuineness and competence to significantly predict higher patient-rated alliance.
  
  
  CONCLUSIONS
  Our results suggest that perceived therapist genuineness is the most relevant predictor of patient-rated therapeutic alliance in CBTp. Future trials using control samples with other mental disorders could clarify whether this finding is specific to CBTp. Therapist training concepts for increasing beneficial therapist qualities are needed.
  
  
  CONCLUSIONS
  The patients' perception of the therapist as empathic, genuine, accepting, competent and convincing is associated with therapeutic alliance in CBTp. Perceived therapist genuineness and competence are the most relevant predictors of patient-rated therapeutic alliance. Training and supervision should focus on increasing basic therapist qualities. Limitations of this study include homogeneity of therapists, small sample size, and lack of a control group.
authors.affiliation: Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-Universität Marburg, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: Jung
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesjahn
authors.forename: Winfried
authors.initials: W
authors.lastname: Rief
authors.forename: Tania M
authors.initials: TM
authors.lastname: Lincoln
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004645:Empathy; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010465:Perception; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D012044:Regression Analysis; D016896:Treatment Outcome; D035502:Trust
keywords: cognitive behavioural therapy for psychosis; genuineness; schizophrenia; therapeutic alliance; therapist characteristics; therapist factors