-Lisa Firestone, Ph.D., is a clinical psychologist,- Psychology Today…Dec.22 / 2016
Over the years, research has confirmed what so many therapists have known intuitively, that the therapeutic relationship itself ‘(Group Relatedness or therapist-Client Relatedness)’ is essential to the success a patient experiences. Some studies have even called it the most important common factor in successful outcomes. When a task force put together by APA’s Society of Clinical Psychology set out to identify empirically supported treatments, they found that the “therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment” and that “the therapy relationship accounts for why clients improve (or fail to improve) at least as much as the particular treatment method.”
Dr. John Norcross, who headed up the task force, defined the therapeutic alliance as referring to “the quality and strength of the collaborative relationship between client and therapist, typically measured as agreement on the therapeutic goals, consensus on treatment tasks, and a relationship bond.” Along with empathy and genuineness, this alliance represents an integral part of the therapeutic relationship. Research shows, time and time again, that this alliance plays an extremely important role in the change process.
The Relationship Between the Therapeutic Alliance and Treatment Outcome in Two Distinct Psychotherapies for Chronic Depression…Journal of Consulting and Clinical Psychology © 2013 American Psychological Association 2013, Vol. 81, No. 4, 627– 638 0022-006X/13/$12.00 DOI: 10.1037/a0031530
Bruce A. Arnow, Dana Steidtmann, Christine Blasey, and Rachel Manber Stanford University School of Medicine
Daniel N. Klein State University of New York at Stony Brook
Barbara O. Rothbaum Emory University School of Medicine
Aaron J. Fisher Stanford University School of Medicine
Michael J. Constantino University of Massachusetts Amherst
John C. Markowitz Columbia University/New York State Psychiatric Institute
Michael E. Thase University of Pennsylvania School of Medicine
James H. Kocsis Weill Medical College of Cornell University
The Relationship Between the Therapeutic Alliance and Treatment Outcome in Two Distinct Psychotherapies for Chronic Depression Bruce A. Arnow, Dana Steidtmann, Christine Blasey, and Rachel Manber Stanford University School of Medicine Michael J. Constantino University of Massachusetts Amherst Daniel N. Klein State University of New York at Stony Brook John C. Markowitz Columbia University/New York State Psychiatric Institute Barbara O. Rothbaum Emory University School of Medicine Michael E. Thase University of Pennsylvania School of Medicine Aaron J. Fisher Stanford University School of Medicine James H. Kocsis Weill Medical College of Cornell University Objective: This study tested whether the quality of the patient-rated working alliance, measured early in treatment, predicted subsequent symptom reduction in chronically depressed patients. Secondarily, the study assessed whether the relationship between early alliance and response to treatment differed between patients receiving cognitive behavioral analysis system of psychotherapy (CBASP) vs. brief supportive psychotherapy (BSP). Method: 395 adults (57% female; Mage 46; 91% Caucasian) who met criteria for chronic depression and did not fully remit during a 12-week algorithm-based, open-label pharmacotherapy trial were randomized to receive either 16 –20 sessions of CBASP or BSP in addition to continued, algorithm-based antidepressant medication. Of these, 224 patients completed the Working Alliance Inventory-Short Form at Weeks 2 or 4 of treatment. Blind raters assessed depressive symptoms at 2-week intervals across treatment using the Hamilton Rating Scale for Depression. Linear mixed models tested the association between early alliance and subsequent symptom ratings while accounting for early symptom change. Results: A more positive early working alliance was associated with lower subsequent symptom ratings in both the CBASP and BSP, F(1, 1236) 62.48, p .001. In addition, the interaction between alliance and psychotherapy type was significant, such that alliance quality was more strongly associated with symptom ratings among those in the CBASP treatment group, F(1, 1234) 8.31, p .004. Conclusions: The results support the role of the therapeutic alliance as a predictor of outcome across dissimilar treatments for chronic depression.