title: Therapeutic relationship in the treatment of geriatric depression with executive dysfunction.
abstract: The effects of therapeutic relationship (TR) in elder mental health are understudied. A greater understanding of TR in geriatric psychotherapy is particularly needed for treating late-life depression with executive dysfunction, which predicts poor response to antidepressant medication and presents unique clinical challenges.
  
  
  
  Participants were older patients (N = 220) with major depression and executive dysfunction who received 12 weeks of problem-solving therapy or supportive therapy in a randomized control trial. Multilevel growth curve modeling and latent change scores were used to analyze TR dimensions of Understanding and Accepting at the patient level (individual patient ratings, N = 194) and therapist level (ratings of each therapist averaged across participants, N = 10).
  
  
  
  TR predicted reduction of depression in both treatment groups, while treatment×TR interactions were not significant. Patients treated by therapists with higher average Understanding (patient and therapist level) and Accepting (therapist level) ratings had greater decreases in depression. The patient level×therapist level interaction for Understanding approached statistical significance (p=.065), suggesting a synergistic effect on treatment outcome. Together, Understanding and Accepting predicted 21% of variance in depression level changes.
  
  
  
  TR was not assessed throughout the course of treatment (only after the first therapy session and at post-treatment) and did not include ratings from an objective evaluator.
  
  
  
  Assessment of patient's experience of the TR and of therapist ability to foster Understanding and Accepting can play a significant role in the delivery of geriatric psychosocial interventions.
authors.affiliation: Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA. Electronic address: rmace@suffolk.edu.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Mace
authors.affiliation: Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA. Electronic address: dgansler@suffolk.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Gansler
authors.affiliation: Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA. Electronic address: msuvak@suffolk.edu.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Suvak
authors.affiliation: Department of Psychology, Suffolk University, 73 Tremont Street, Boston, MA 02114, USA; Northwell Health Solutions, Great Neck, NY, USA. Electronic address: carla2939@gmail.com.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Gabris
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. Electronic address: parean@uw.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Areán
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. Electronic address: praue@uw.edu.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA. Electronic address: gsalexop@med.cornell.edu.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Depression; Geriatrics; Growth curve modeling; Therapeutic relationship; Treatment outcomes