Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
Psychol Psychother. 2023 Dec;96(4):1029-1043. doi: 10.1111/papt.12494. Epub 2023 Sep 4.
Although the clinical significance of the therapeutic alliance (TA) is well documented, the literature regarding the establishment of TA and the relation between client-therapist agreement on it to short-term outcome among various diagnostic groups-and specifically among clients diagnosed with serious mental illness (SMI)-is sparse. The aim of the present study was to examine the effect of client diagnosis on the abovementioned TA characteristics.
Dyadic analyses of session-by-session (SBS) data were used to compare clients diagnosed with schizophrenia and clients diagnosed with emotional disorders (based on a clinical interview) in their TA characteristics.
TA as initially rated by clients was stronger in the emotional disorders group than in the schizophrenia group. Higher TA ratings, regardless of whether these were provided by the therapist or the client, predicted better subsequent functioning in the emotional disorders group, whereas in the schizophrenia group, this association was observed only among good-outcome cases.
Establishing TA, having client-therapist agreement on it, and having clients derive therapeutic benefit from it might be more challenging with clients with schizophrenia than with clients with emotional disorders. Special attention should be given to specific challenges and needs regarding clients' diagnosis in order to enhance favourable therapy outcomes.
尽管治疗联盟（TA）的临床意义已得到充分证明，但关于 TA 的建立以及客户与治疗师之间在 TA 上的共识与各种诊断群体（特别是被诊断为严重精神疾病（SMI）的客户）的短期预后之间的关系的文献却很少。本研究旨在检验客户诊断对上述 TA 特征的影响。
使用会话对会话（SBS）数据的对偶分析来比较基于临床访谈被诊断为精神分裂症的客户和被诊断为情绪障碍的客户的 TA 特征。
最初由客户评定的 TA 在情绪障碍组中比在精神分裂症组中更强。无论这些评分是由治疗师还是客户提供的，较高的 TA 评分都预示着情绪障碍组随后的功能更好，而在精神分裂症组中，这种关联仅在预后良好的病例中观察到。
与情绪障碍患者相比，与精神分裂症患者建立 TA、在 TA 上达成客户-治疗师共识以及让客户从中受益可能更具挑战性。应特别注意客户诊断方面的具体挑战和需求，以增强有利的治疗效果。
