Understanding why therapy allegiance is linked to clinical outcomes.

Abstract

Researchers and practitioners have long debated the meaning and importance of the relation between therapy allegiance and clinical outcomes. Leykin and DeRubeis (2009) make a meaningful contribution to this discussion and their observations will help sharpen future discourse on the topic. This commentary builds upon their observations and argues that efforts to identify and understand the mechanisms underlying the relation between therapy allegiance and therapy outcome may inform the ongoing debate and benefit the field of psychological therapy. Two potential mechanisms-investigators (via training) and therapists (via attitudes and motivation)-are reviewed and the potential yield from such research underscored.

Does Cognitive Behavioral Therapy for Youth Anxiety Outperform Usual Care in Community Clinics? An Initial Effectiveness Test

“…It is possible that the flexibility and latitude of UC afforded an advantage, and it is possible that adapting EBTs to permit focus on multiple problems could yield even better outcomes 3, 35. Second, our design included random assignment of therapists to treatment condition and training and ongoing supervision by experts in the model—procedures that are consistent with efficacy trials; however, therapists in community settings are likely to vary in their training, experience, interest, and comfort in CBT—factors that could have impacted the outcomes of the study 36, 37. By contrast, UC therapists used procedures of their own choice and with which they were presumably experienced; this may have enhanced their confidence and thereby the effectiveness of their treatment.…”

Taking allegiance seriously–implications for research policy and practice

“…This phenomenon presents a significant challenge to the credibility of evidence-based practice policies in the psychological therapies that are grounded in RCT studies. Recently, papers in this journal and elsewhere (Leykin & DeRubeis, 2009;McLeod, 2009) have reinforced the importance for the psychotherapy research community of addressing the issue of researcher allegiance. The aim of the present commentary is to consider some of the implications of taking researcher allegiance seriously, as a source of bias.…”

Die Allegianz von Forschenden als versteckter Moderator in der Psychotherapieforschung

“…Die moderierende Rolle der Allegianz ist komplex, da mehrere kausale Pfade den festgestellten Zusammenhang zwischen einseitiger Allegianz und Studienergebnissen in der Psychotherapieforschung erklären können [Cuijpers und Cristea, 2015;Leykin und DeRubeis, 2009;McLeod, 2009]. Die Allegianz von Forschenden kann dabei methodische Entscheidungen beeinflussen, wie z.B.…”

“…In diesem Sinne könnte Allegianz mit anderen Moderatoren oder Mediatoren interagieren und hätte damit weiterreichenden Einfluss auf den Behandlungseffekt. Ein strikteres Einhalten des Behandlungsmanuals durch Therapeuten kann aber auch die Effekte der charakteristischen Behandlungskomponenten erhöhen, wenn die Behandlung beispielsweise mit höherer Genauigkeit und Kompetenz durchgeführt würde [McLeod, 2009]. Schließlich ist es auch denkbar, dass vorliegende Befunde je nach Allegianz unterschiedlich interpretiert werden.…”