Department of Clinical Psychology and Psychotherapy.
Department of Psychology and Logopedics.
J Consult Clin Psychol. 2020 Apr;88(4):338-349. doi: 10.1037/ccp0000475. Epub 2019 Dec 19.
Several studies have reported significant within-patient effects of the therapeutic alliance on outcome. However, it remains uncertain whether there are specific patient groups for whom an improved alliance might be particularly beneficial. The relational nature of the alliance makes patients' interpersonal problems a promising candidate for examining such differential effects. This study aims to analyze (i) between- and within-patient effects of the alliance on depression severity, (ii) the effects of patients' baseline interpersonal problems on the within-patient alliance-outcome association, and (iii) whether within-patient effects of the alliance remain significant when adjusting for patients' initial interpersonal problems.
A sample of 141 patients with depression and undergoing outpatient psychotherapy completed the Inventory of Interpersonal Problems at baseline as well as a brief version of the Working Alliance Inventory and the Well-Being Index (as a proxy of depression severity) session by session.
Multilevel models revealed both significant between- and within-patient effects of the alliance on improvements in depression severity. Patients' problems relating to agency had a significant effect on the within-patient effect of alliance, with more submissive patients benefiting more from an improved therapeutic alliance. Finally, the between- and within-patient effects of the alliance remained significant when adjusting for the patients' agentic interpersonal problems and treatment condition.
The results provide evidence on which types of patients would particularly benefit from an improved therapeutic alliance. For patients suffering from low interpersonal agency and reporting problems with submissiveness, an enhanced alliance during the therapy process might improve treatment outcome. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
多项研究报告称治疗联盟对结果有显著的患者内效应。然而，目前尚不确定是否存在特定的患者群体，对于这些患者来说，改善联盟可能特别有益。联盟的关系性质使患者的人际问题成为研究这种差异效应的有希望的候选者。本研究旨在分析：（i）联盟对抑郁严重程度的患者内和患者间效应；（ii）患者基线人际问题对患者内联盟-结果关联的影响；（iii）当调整患者初始人际问题时，联盟的患者内效应是否仍然显著。
141 名患有抑郁症并正在接受门诊心理治疗的患者在基线时完成了人际关系问题清单，以及工作联盟清单和幸福感指数（作为抑郁严重程度的替代指标）的简短版本，每次就诊时都要完成。
多层次模型显示，联盟对抑郁严重程度的改善既有显著的患者间效应，也有显著的患者内效应。患者在代理机构方面的问题对联盟的患者内效应有显著影响，更顺从的患者从改善的治疗联盟中获益更多。最后，当调整患者的代理人际问题和治疗条件时，联盟的患者间和患者内效应仍然显著。
研究结果为哪些类型的患者将特别受益于改善的治疗联盟提供了证据。对于人际代理能力低且报告顺从问题的患者，治疗过程中增强联盟可能会改善治疗结果。
