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Therapist And Patient Ratings Of Therapeutic Alliance Predict Treatment Progress

a counseling session with patient and therapistThis study published in the last 2010 issue of Psychotherapy and Psychosomatics suggests that therapist and patient ratings of therapeutic alliance predict therapeutic progress. This relation may be moderated by client characteristics, including ‘personality pathology comorbidity’ (i.e., the presence of multiple diagnoses), marital status, occupational status, and the atypical character of the major depressive episode.

In the last 2010 issue of Psychotherapy and Psychosomatics, a group of researchers of the University of Ghent presents new findings on the role of the relationship between patient and therapist (therapeutic alliance).

Meta-analyses have consistently concluded that a positive therapeutic alliance is associated with better clinical outcomes and progress. To date, however, very few studies have focused on sociodemographic or clinical patient characteristics as moderators of alliance.

A multicenter longitudinal treatment outcome study was conducted to investigate the associations of patient and clinician perceptions of the therapeutic alliance with improvement in depression, and to investigate whether these associations were influenced by sociodemographic or clinical characteristics of the patient. Clinician-rated Montgomery Åsberg Depressive Rating Scale scores and both patient- and therapist-rated Helping Alliance Questionnaire (HAQ-I) scores were obtained from 567 outpatients with major depressive disorder who received 6 months of combined psycho- and pharmacotherapy.

Multilevel repeated-measures analyses indicated that patient- and therapist-rated HAQ-I scores, 4 weeks after treatment began, positively predicted subsequent clinical change after controlling for the effect of early improvement and a range of patient characteristics.

Next to alliance, early improvement, initial depressive symptom severity, a history of psychiatric disorders, and occupational status affected the rate of clinical improvement. Personality pathology comorbidity, marital and occupational status, and the atypical character of the major depressive episode (MDE) moderated the alliance-outcome relationship, depending on the informant (patient or therapist) of therapeutic alliance.

These findings suggest that therapist and patient ratings of therapeutic alliance predict therapeutic progress, and that this relation may be moderated by client characteristics, including personality pathology comorbidity, marital status, occupational status, and the atypical character of the MDE.

Material adapted from Journal of Psychotherapy and Psychosomatics.

Reference
De Bolle, M., Johnson, J.G., & De Fruyt, F. Patient and Clinician Perceptions of Therapeutic Alliance as Predictors of Improvement in Depression. Psychother Psychosom 2010;79:378-385.

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