The relationship between interpersonal problems, therapeutic alliance, and outcomes following group and individual cognitive behaviour therapy (original) (raw)
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Patient Pretreatment Interpersonal Problems and Therapeutic Alliance in Short-Term Cognitive Therapy
Journal of Consulting and Clinical Psychology, 1994
The growing consensus regarding the importance of interpersonal process in psychotherapy, as well as of interpersonal factors in self-definition, has underscored the relevance of examining patient interpersonal functioning as it relates to the development of the therapeutic alliance. This study examined the relationship of patient pretreatment interpersonal functioning (as measured by the Inventory of Interpersonal Problems and the Millon Clinical Multiaxial Inventory) to the therapeutic alliance (as measured early in treatment by a patient self-report version of the Working Alliance Inventory). On the basis of an interpersonal circumplex interpretation, the results generally indicated that friendly-submissive interpersonal problems were positively related to the development of aspects of the alliance and that hostile-dominant problems were negatively related to the development of aspects of the alliance early in short-term cognitive therapy.
Journal of affective disorders, 2012
BACKGROUND: The degree to which interpersonal problems of depressed patients improve over the course of cognitive therapy (CT) and relate to the quality of the therapeutic alliance and to symptom improvement, remains unclear. METHODS: We analyzed data of adult outpatients (N=523) with major depressive disorder participating in a clinical trial to determine the factor structure of the Inventory of Interpersonal Problems-Circumplex (IIP-C) and to relate the observed factor scores to the quality of the therapeutic alliance and symptom improvement over the course of CT. Patients received 16-20 sessions protocol (50-60min each) of individual CT according to the treatment manual by Beck et al. (1979). RESULTS: We found a three-factor structure (interpersonal distress, agency, and communion) of interpersonal problems. Interpersonal distress decreased (d=.90), but interpersonal style did not change substantively during CT (communion d=.03; agency d=.14). High initial agency scores related n...
Journal of Consulting and Clinical Psychology, 2014
Little is known about the variability of the alliance-outcome correlation across identifiable client subsets. This question was explored in a sample of 60 clients receiving cognitive therapy for depression, from which an overall correlation of .23 was observed between alliance ratings and subsequent symptom change. Method: We examined interactions between the observer-rated version of the Working Alliance Inventory-Short Observer-Rated version (WAI-O; Tracey & Kokotovic, 1989) and client demographics, features of depression, personality, and other clinical features in predicting subsequent symptom change. Results: After correcting for multiple comparisons, interactions between the WAI-O and the number of prior depressive episodes, as well as the severity of baseline anxiety symptoms, were significant predictors of symptom change. When both interactions were controlled for, number of prior depressive episodes emerged as a statistically significant moderator. The alliance predicted outcome in the subgroup of clients with 0-2 prior episodes (r ϭ .52), but not in those with 3 or more prior episodes (r ϭ Ϫ.02). These findings were obtained despite similar univariate distributions on the alliance and symptom change in the 2 subgroups. Discussion: Differences that were observed in the predictive relation of alliance to outcome as a function of number of prior episodes suggest that different therapy processes may account for change in these subgroups. If the pattern observed in the present study is replicated, it would suggest that the alliance-outcome association has been both underand overestimated.
Psychotherapy Research, 2007
The aim of this study was to investigate the importance of therapists' and patients' interpersonal problems as well as the impact of the therapeutic alliance on symptomatic outcome in psychotherapy. Of interest were direct effects of interpersonal problems, represented through the dimensions of affiliation and control, as well as possible interaction effects between patient and therapist variables on outcome. Further hypotheses referred to therapist differences in the predictive impact of the therapeutic alliance for outcome. Outcome ratings of 1,513 psychotherapy inpatients treated by 31 psychodynamically oriented individual psychotherapists were studied. Therapists' and patients' interpersonal dispositions were assessed with the Inventory of Interpersonal Problems, and patients answered standardized outcome measures before and after therapy and retrospectively evaluated the therapeutic alliance at discharge. The results indicate that dominant patients profited better from their therapy and that therapists' interpersonal disposition did not have a direct influence on outcome. The influence of the therapeutic alliance on outcome varied among the therapists. The general positive effect of therapeutic alliance on outcome was stronger for less affiliative therapists. Limitations of the study and implications of the results are discussed.
Psychiatry Research, 2016
Information on how the patient's interpersonal problems predict alliance development during long-term therapy is lacking. The aim of this study was to explore how the patient's pre-treatment interpersonal problems predict the development of alliance in long-term psychotherapy. Altogether 128 adult outpatients experiencing mood or anxiety disorder were assigned to long-term psychodynamic psychotherapy in the Helsinki Psychotherapy Study. The Inventory of Interpersonal Problems (IIP) total score and the eight octant scores, assessed at baseline, were used as predictors. The trajectories of change in patient-and therapist-rated Working Alliance Inventory (WAI) were used as outcome measures at 7, 12, and 36 months of follow-up after baseline. Study of the changes by time showed that the patient-rated alliance was significantly improved by the 36-month follow-up, i.e. the most usual end-point of therapy, in persons with higher pre-treatment level of the IIP total score. Low total IIP score and low to moderate level of hostile type problems showed no slope of improvement of patient-rated alliance during followup. The therapist-rated alliance showed a similar course as the patient-rated alliance with the exception of a faster improvement for higher IIP scores. In conclusion, a higher level of patients' interpersonal problems predicted favorable alliance development.
Journal of Affective Disorders, 2013
Background: Previous studies reported inconsistent findings regarding the association of interpersonal problems with therapy outcome. The current study investigates if interpersonal problems predict process and outcome of three different treatments for depression. Methods: The data originate from a randomized clinical trial comparing supportive-expressive psychotherapy, antidepressant medication and pill-placebo for treatment of depression. Interpersonal problems were used as predictors of alliance, symptomatic improvement and premature termination of treatment.
Pattern of alliance and outcome in short-term individual psychotherapy
Psychotherapy: Theory, Research, Practice, Training, 1995
Pattern of change in the therapeutic alliance across time-limited, 20-session individual psychotherapy was investigated with the procedure of hierarchical linear modeling (HIM) in two samples of 32 psychiatric outpatients, those with low and those with high quality of object relations (QOR). Significant (p < .05) variation in the pattern of change in the therapeutic alliance was found within each sample.
The Journal of psychotherapy practice and research
Early sessions of patients categorized as dropouts (n = 25), good outcome (n = 28), and poor outcome (n = 20) completers of a 40-session protocol of short-term psychotherapy were compared to determine predictive validity of in-session measures of therapeutic alliance and interpersonal behavior (Working Alliance Inventory, Session Evaluation Questionnaire, and Interpersonal Adjective Scale). A number of significant differences were found among the three groups: both patients and therapists in the dropout group rated the relationship as more problematic than those in the good outcome group, and patients in the dropout group also rated the relationship as more problematic than those in the poor outcome group, while therapists' ratings did not distinguish dropouts from poor outcome. Differences between good and poor outcome groups were nonsignificant. These findings have clinical significance, particularly in early identification of patients at risk for treatment failure.
The Journal of Psychotherapy Practice and Research, 1998
Early sessions of patients categorized as dropouts (n = 25), good outcome (n = 28), and poor outcome (n = 20) completers of a 40-session protocol of short-term psychotherapy were compared to determine predictive validity of in-session measures of therapeutic alliance and interpersonal behavior (Working Alliance Inventory, Session Evaluation Questionnaire, and Interpersonal Adjective Scale). A number of significant differences were found among the three groups: both patients and therapists in the dropout group rated the relationship as more problematic than those in the good outcome group, and patients in the dropout group also rated the relationship as more problematic than those in the poor outcome group, while therapists' ratings did not distinguish dropouts from poor outcome. Differences between good and poor outcome groups were nonsignificant. These findings have clinical significance, particularly in early identification of patients at risk for treatment failure.
Behaviour Research and Therapy, 2016
Objective: The research on the association between the working alliance and therapist competence/ adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder (SAD) and panic disorder (PD). Method: Eighty-two clinically referred patients (58.5% female; age: M ¼ 33.6 years, SD ¼ 10.3) with PD (n ¼ 31) or SAD (n ¼ 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses. Results: Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout. Conclusion: The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.