Department of Psychosomatic Medicine and Psychotherapy, University of Tuebingen, Germany.
Center for Psychological Psychotherapy, University of Heidelberg, Germany.
Psychol Psychother. 2017 Dec;90(4):649-667. doi: 10.1111/papt.12131. Epub 2017 May 12.
The therapeutic alliance is intensively investigated in psychotherapy research. However, there is scarce research on the role of the specific diagnosis of the patient in the formation of the therapeutic alliance. Hence, the aim of this study was to address this research gap by comparing the alliance in different mental disorders.
Our sample comprised 348 patients (mean age = 40 years; 68% female; 133 patients with depression, 122 patients with somatoform disorders, and 93 patients with eating disorders).
Patients completed the Working Alliance Inventory and measures of therapeutic outcome in early, middle, and late stages of inpatient psychotherapy. We applied multivariate multilevel models to address the nested data structure.
All three disorder groups experienced positive alliances that increased across the course of therapy and showed similar alliance-outcome relations that were of comparable strengths as in current meta-analyses. However, we found perspective incongruence of alliance ratings from patient and therapist in the three disorder groups.
Our results generally indicate that the working alliance is of importance irrespective of the specific mental disorder. Perspective incongruence feedback of working alliance experiences could help to strengthen coordination between patient and therapist and thereby improve the therapeutic process. Further implications of these findings are discussed.
We found no differences in the strengths of alliance ratings and alliance-outcome associations in depressive, somatoform, and eating disorder patients. This indicates that the working alliance is of general clinical importance irrespective of the disorder group and should be a central target in all therapies. We found perspective incongruence in alliance ratings between patient and therapist in all three disorder groups. Perspective incongruence feedback of working alliance experiences could help to strengthen coordination between patient and therapist and thereby improve the therapeutic process.
治疗联盟在心理治疗研究中受到了广泛的关注。然而，关于患者特定诊断在治疗联盟形成中的作用的研究却很少。因此，本研究旨在通过比较不同精神障碍患者的联盟来填补这一研究空白。
我们的样本包括 348 名患者（平均年龄为 40 岁；68%为女性；133 名抑郁症患者，122 名躯体形式障碍患者，93 名饮食障碍患者）。
患者在住院心理治疗的早期、中期和晚期完成了工作联盟量表和治疗结果的测量。我们应用多元多层模型来解决嵌套数据结构的问题。
所有三组障碍患者都经历了积极的联盟，这些联盟在治疗过程中逐渐增强，并表现出与当前元分析中相当的联盟-结果关系，其强度相似。然而，我们发现三组障碍患者的联盟评价存在视角不一致。
我们的研究结果普遍表明，无论特定的精神障碍如何，工作联盟都是很重要的。工作联盟体验的视角不一致反馈可以帮助加强医患之间的协调，从而改善治疗过程。进一步讨论了这些发现的意义。
我们在抑郁、躯体形式和饮食障碍患者中发现，联盟评价的强度和联盟-结果的关联没有差异。这表明，工作联盟具有普遍的临床重要性，无论障碍组如何，都应成为所有治疗的核心目标。我们在所有三组障碍患者中都发现了患者和治疗师之间的联盟评价视角不一致。工作联盟体验的视角不一致反馈可以帮助加强医患之间的协调，从而改善治疗过程。
