Therapeutic Alliance in Depression Treatment: Controlling for Prior Change and Patient Characteristics.

Klein, Daniel N.; Schwartz, Joseph E.; Santiago, Neil J.; Vivian, Dina; Vocisano, Carina; Castonguay, Louis G.; Arnow, Bruce A.; Blalock, Janice A.; Manber, Rachel; Markowitz, John C.; Riso, Lawrence P.; Rothbaum, Barbara O.; McCullough, James P.; Thase, Michael E.; Borian, Frances E.; Miller, Ivan W.; Keller, Martin B.

doi:10.1037/0022-006x.71.6.997

Cited by 239 publications

(203 citation statements)

References 32 publications

Supporting

Mentioning

167

Contrasting

Unclassified

Order By: Relevance

“…Many studies have failed to statistically adjust for the effects of individual counsellors, but this is problematic as there is evidence that similar training and qualifications do not guarantee that therapists are equivalent in their delivery of therapy (Crits-Christoph et al, 1990;McLellan et al, 1988). Finally, client and counsellor pre-treatment characteristics suspected to contribute to both poor alliance and dropout, and thus having the potential to act as confounders, were assessed at intake, thereby addressing concerns raised by Klein et al (2003). In the multivariate model predicting length of retention, these potential confounders were included as covariates, partialling out their influence on the alliance-dropout relationship.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from the inconsistencies in findings regarding rater perspectives, a further difficulty in interpreting the results in this area has been highlighted by Klein et al (2003), that is whether there is enough evidence that the therapeutic alliance really predicts retention, or whether the association between the alliance and retention is caused by characteristics that may contribute to both poor alliances and poor retention. This key question has not been addressed within the field of substance misuse research (Meier et al, 2005a).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The role of the early therapeutic alliance in predicting drug treatment dropout

Meier

Donmall

McElduff

et al. 2006

Drug and Alcohol Dependence

123

View full text Add to dashboard Cite

Background: To investigate the role of the therapeutic alliance in predicting length of retention in residential drug treatment. Methods:The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Counsellor and client information was assessed at intake, and the average total scores of client and counsellor ratings on the WAI-S (obtained during weeks 1 to 3) were use as the alliance measure. Length of retention and treatment completion (stay beyond 90 days) were used as measures of retention.Results: Clients with weak counsellor rated alliances dropped out of treatment significantly sooner than clients with strong counsellor-rated therapeutic alliances, whether or not the model adjusted for individual counsellor effects and potential confounders including psychological wellbeing, treatment motivation and readiness, coping strategies, and attachment style. The client rated alliance did not predict length of retention. Apart from the alliance, pre-treatment crack use, secure attachment style and better coping strategies were associated with shorter retention, whereas greater confidence in treatment, older client age and better education predicted treatment completion. Counsellors with greater experience of delivering drug counselling retained clients longer. Conclusions:The findings of this study stress the importance of treatment professionals attending to the therapeutic alliance in drug treatment, as counsellors' alliance ratings were found to be amongst the strongest predictors of dropout. Using alliance measures as clinical tools may help treatment practitioners to become aware of the risk of disengagement early on. Prospective studies are needed to evaluate whether strategies of reallocating clients with poor alliances to different counsellors lead to improvements in retention.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of the early therapeutic alliance in predicting drug treatment dropout

Meier

Donmall

McElduff

et al. 2006

Drug and Alcohol Dependence

123

View full text Add to dashboard Cite

show abstract

“…It is often claimed that the therapeutic alliance is a mediator and mechanism of therapeutic change since the stronger the alliance, the greater the change observed (Klein et al, 2003). Correlational studies also show that alliance at the beginning of treatment predicts improvement in symptoms at the end (Cloitre, Chase Stovall-McClough, Miranda, & Chemtob, 2004).…”

Section: [Page 36 ]mentioning

confidence: 99%

The changing shape of clinical practice: Driven by science or by pragmatics?

Fonagy

2010

Psychoanalytic Psychotherapy

View full text Add to dashboard Cite

“…Numerous studies indicate a correlation between working alliance and improved effectiveness of various psychotherapies (including individual therapies, group therapy and family therapy) [3][4][5][6][7][8]. Freud considered working alliance to be a form of positive transcendence in patients, which helps them to trust the therapist's professional ability.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic alliance and early change in depression: benefits of enhancing working alliance at the initial sessions of short-term supportive–expressive psychodynamic psychotherapy

Shateri¹,

Lavasani²

2018

Arch Psych Psych

View full text Add to dashboard Cite

SummaryAims: The present study attempted to see whether the use of supportive techniques and improving working alliance in the initial sessions of short-term supportive-expressive (SE) psychodynamic psychotherapy results in a change in symptoms of patients with depressive disorder. Materials and methods:The study was an experiential single case. The subjects were 6 women with major depressive disorder who were selected by a purposive sampling method. Measures included the Working Alliance Inventory-12, the Quality of Life Scale, and Beck Depression Inventory II. Visual analysis with graphs, mean, standard deviation and the Friedman test was used for data analysis.Results: There was no significant increase or decrease in the severity of depression on the baseline (χ 2 = 3.54, P=0.14) and during evaluation sessions (χ 2 = 0.85, P=0.65), but participants showed a significant improvement in quality of life once the sessions had started (χ 2 = 8.95, P=0.01). The mean scores on all three working alliance components showed a slight increase over three sessions and the scores on the bond subscale showed a significant increase (χ 2 = 11.56, P=0.003).Discussion: It was clear that despite a slight increase in the severity of depression in at least four participants, patients' quality of life and working alliance, especially the bond component, improved during the initial sessions of psychotherapy. Conclusions:These findings may reflect the importance of working alliance in the initial sessions of therapy, which can lead to a change in the patient's experience of quality of life.working alliance, depression, psychodynamic therapy

show abstract

Therapeutic Alliance in Depression Treatment: Controlling for Prior Change and Patient Characteristics.

Cited by 239 publications

References 32 publications

The role of the early therapeutic alliance in predicting drug treatment dropout

The role of the early therapeutic alliance in predicting drug treatment dropout

The changing shape of clinical practice: Driven by science or by pragmatics?

Therapeutic alliance and early change in depression: benefits of enhancing working alliance at the initial sessions of short-term supportive–expressive psychodynamic psychotherapy

Contact Info

Product

Resources

About