title: Convergence in patient-therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment.
abstract: This study tested whether discrepancy between patients' and therapists' ratings of the therapeutic alliance, as well as convergence in their alliance ratings over time, predicted outcome in chronic depression treatment.
  
  
  
  Data derived from a controlled trial of partial or non-responders to open-label pharmacotherapy subsequently randomized to 12 weeks of algorithm-driven pharmacotherapy alone or pharmacotherapy plus psychotherapy. The current study focused on the psychotherapy conditions (N = 357). Dyadic multilevel modeling was used to assess alliance discrepancy and alliance convergence over time as predictors of two depression measures: one pharmacotherapist-rated (Quick Inventory of Depressive Symptoms-Clinician; QIDS-C), the other blind interviewer-rated (Hamilton Rating Scale for Depression; HAMD).
  
  
  
  Patients' and therapists' alliance ratings became more similar, or convergent, over the course of psychotherapy. Higher alliance convergence was associated with greater reductions in QIDS-C depression across psychotherapy. Alliance convergence was not significantly associated with declines in HAMD depression; however, greater alliance convergence was related to lower HAMD scores at 3-month follow-up.
  
  
  
  The results partially support the hypothesis that increasing patient-therapist consensus on alliance quality during psychotherapy may improve treatment and longer term outcomes.
authors.affiliation: a Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Laws
authors.affiliation: b Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Constantino
authors.affiliation: b Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA.
authors.forename: Aline G
authors.initials: AG
authors.lastname: Sayer
authors.affiliation: c Department of Psychology , Stony Brook University, Stony Brook , NY , USA.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Klein
authors.affiliation: d Department of Psychiatry , Weill Medical College of Cornell University , New York , NY , USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
authors.affiliation: e Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
authors.affiliation: f New York State Psychiatric Institute , Columbia University College of Physicians and Surgeon , New York , NY , USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Markowitz
authors.affiliation: g Department of Psychiatry , Emory University School of Medicine , Atlanta , GA , USA.
authors.forename: Barbara O
authors.initials: BO
authors.lastname: Rothbaum
authors.affiliation: e Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA.|h Department of Family Medicine , University of Colorado School of Medicine , Aurora , CO , USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Steidtmann
authors.affiliation: i Perlman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: e Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Arnow
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*
keywords: REVAMP; alliance; alliance convergence; chronic depression; dyadic data analysis
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