Alliance Prediction of Outcome Beyond in-Treatment Symptomatic Change as Psychotherapy Processes

Therapeutic alliance predicts symptomatic improvement session by session.

“…The results of these studies give a mixed picture of the robustness of the alliance as a predictor of outcome when that relationship is adjusted for prior symptom change. Seven studies (Barber, Connolly, Crits-Christoph, Gladis, & Siqueland, 2000; Crits-Christoph, Gibbons, Hamilton, Ring-Kurtz, & Gallop, 2011;De Bolle, Johnson, & De Fruyt, 2010;Gaston, Marmar, Gallagher, & Thompson, 1991;Klein et al, 2003;Tasca & Lampard, 2012;Zuroff & Blatt, 2006) report significant associations between therapeutic alliance and subsequent symptom change, controlling for prior symptom change. Five studies (DeRubeis & Feeley, 1990;Feeley, DeRubeis, & Gelfand, 1999;Puschner, Wolf, & Kraft, 2008;Strunk et al, 2010;Strunk et al, 2012) report no association between alliance and subsequent symptom change when prior change was controlled.…”

“…Among the studies showing a significant relationship between alliance and outcome after control for prior symptom change, three (Barber et al, 2000;Crits-Christoph et al, 2011;Gaston et al, 1991) were small to medium sized (N = 86, 45, and 54, respectively), while the remaining four (De Bolle et al, 2010;Klein et al, 2003;Tasca & Lampard, 2012;Zuroff & Blatt, 2006) were large (N = 567, 367, 238, and 191, respectively). Patient samples were more mixed than in the studies showing no alliance effect, although depression was the most common diagnosis.…”

Au-delà et en deçà des techniques cognitives béhaviorales dans le traitement des troubles graves : les facteurs communs

“…De façon plus spécifique, plusieurs chercheurs (Gaston et al, 1991) estiment que la qualité de l'alliance thérapeutique contribue à plus de 45 % de la variance des résultats thérapeutiques obtenus. De tels résultats ne peuvent être ignorés.…”

Interpersonal change as an outcome of time-limited interpersonal therapy.

“…Further, research suggests that working alliance and early symptom reductions each uniquely contribute to ultimate outcomes of psychotherapy. Gaston, Marmar, Gallagher, and Thompson (1991) found that early symptom reduction and working alliance accounted for significant and independent portions of the variance in therapy outcome. Barber, Crits-Cristoph, and Luborsky (1992) found that early alliance and early gain in therapy contributed each uniquely to outcomes of psychodynamic psychotherapy.…”

“…Thus, after the fourth session the therapist is encouraged to deliberately move from being highly complementary to the client's interpersonal pattern to being less complementary, thus moving into the middle phase of therapy. Secondly, studies which have examined stages of complementarity in therapy (Tracey, 1987;Tracey et al, 1999), the contribution of alliance to outcome (Gaston, 1990;Hartley & Strupp, 1983;Horvath & Luborsky, 1993;Lambert, 1992), and early symptom reductions (Gaston et al 1991) have been consistent with considering the first four sessions as the beginning stage of therapy.…”