Alliance Prediction of Outcome Beyond in-Treatment Symptomatic Change as Psychotherapy Processes

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Abstract
For older depressed adults treated in behavioral, cognitive, or brief dynamic therapy, we examined alliance-outcome associations over and above initial symptomatology and in-treatment symptomatic change, as therapy progressed. Patients and therapists completed the California Psychotherapy Alliance Scales, CALPAS, after the 5th, 10th, and 15th sessions. For each moment, an hierarchical multiple regression analysis was conducted with BDI scores at termination as criterion, and the following sequence of predictors: (a) initial BDI scores; (b) in-treatment BDI change scores up to where the alliance was measured; and (c) both patients' and therapists' CALPAS scores. For the whole sample, no substantial association was found between alliance and outcome (5% to 18%). Within treatment conditions, the alliance uniquely contributed to outcome with increasing variance accounted for as therapy progressed, and especially in behavior and cognitive therapy; from 19%–32% at the 5th session, to 36%–57% at the 15th. Given the small sample sizes, these findings are tentative and await replication in larger samples.

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