The Alliance-Outcome Relationship in Cognitive Therapy for Depression: Do We Know For Whom It Matters Most?
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Date
2019-05
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The Ohio State University
Abstract
Previous research suggests the alliance-outcome relationship is moderated by key client characteristics. We examined maladaptive personality traits and prior episodes of depression as moderators of the alliance-outcome relationship in a sample of 126 clients participating in a 16-week course of cognitive therapy for depression. Outcome was either modeled as regressed change from mid- treatment to post-treatment (i.e., a change through post-treatment approach) or as within-client session-to-session changes across the first several sessions (i.e., a within-client session-to-session approach). In the within-client session-to-session approach, the alliance-outcome relationship was stronger among clients reporting fewer maladaptive personality traits, which was contrary to previous studies. In the change through post-treatment approach, the alliance-outcome relationship was stronger for those who had more prior episodes, which was also in contrast to prior research. We place our findings in the context of those in the literature, discussing how methodological and analytic differences may have played a role in the diverging findings. We highlight how different analytic approaches allow for different interpretations and how greater attention to this may be needed as the field works to integrate findings from studies of moderators of process-outcome relations.
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Keywords
Therapeutic alliance, Cognitive Therapy, Depression, Maladaptive personality traits, Prior episodes of depression