title: Therapist Effects and the Impact of Early Therapeutic Alliance on Symptomatic Outcome in Chronic Fatigue Syndrome.
abstract: Few studies have examined therapist effects and therapeutic alliance (TA) in treatments for chronic fatigue syndrome (CFS). Therapist effects are the differences in outcomes achieved by different therapists. TA is the quality of the bond and level of agreement regarding the goals and tasks of therapy. Prior research suffers the methodological problem that the allocation of therapist was not randomized, meaning therapist effects may be confounded with selection effects. We used data from a randomized controlled treatment trial of 296 people with CFS. The trial compared pragmatic rehabilitation (PR), a nurse led, home based self-help treatment, a counselling-based treatment called supportive listening (SL), with general practitioner treatment as usual. Therapist allocation was randomized. Primary outcome measures, fatigue and physical functioning were assessed blind to treatment allocation. TA was measured in the PR and SL arms. Regression models allowing for interactions were used to examine relationships between (i) therapist and therapeutic alliance, and (ii) therapist and average treatment effect (the difference in mean outcomes between different treatment conditions). We found no therapist effects. We found no relationship between TA and the average treatment effect of a therapist. One therapist formed stronger alliances when delivering PR compared to when delivering SL (effect size 0.76, SE 0.33, 95% CI 0.11 to 1.41). In these therapies for CFS, TA does not influence symptomatic outcome. The lack of significant therapist effects on outcome may result from the trial's rigorous quality control, or random therapist allocation, eliminating selection effects. Further research is needed.
  
  
  BACKGROUND
  ISRCTN74156610.
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, United Kingdom.|Manchester Academic Health Science Centre, Manchester, United Kingdom.|School of Health and Human Sciences, University of Huddersfield, Huddersfield, United Kingdom.
authors.forename: Lucy P
authors.initials: LP
authors.lastname: Goldsmith
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, United Kingdom.|Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bentall
authors.affiliation: Manchester Academic Health Science Centre, Manchester, United Kingdom.|Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Shôn W
authors.initials: SW
authors.lastname: Lewis
authors.affiliation: Manchester Academic Health Science Centre, Manchester, United Kingdom.|School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Wearden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003376:Counseling; D015673:Fatigue Syndrome, Chronic / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D012648:Self Care; D016896:Treatment Outcome; D055815:Young Adult