The therapeutic alliance in a naturalistic psychiatric setting: temporal relations with depressive symptom change
Open accessAbstract
Objective Numerous studies have reported associations between the therapeutic alliance and depressive symptom improvement in outpatient samples. However, little is known regarding the temporal relationship between the alliance and symptom change among relatively severely depressed patients receiving treatment in naturalistic, psychiatric hospital settings.Method Adult patients with major depression (n = 103) receiving combined cognitive behavioral therapy and pharmacological treatment at a psychiatric hospital completed repeated assessments of the therapeutic alliance and depressive symptoms, as well as a pretreatment assessment of their expectation of symptom improvement.Results Results indicated that the alliance and treatment outcome expectancies significantly predicted subsequent depressive symptom change. However, in a model in which prior symptom change and treatment outcome expectancies were statistically controlled, the alliance-outcome association was rendered nonsignificant. The alliance was significantly associated with prior symptom improvement.Conclusions Findings highlight the importance of controlling for plausible third variable and temporal confounds to minimize biased estimates of alliance-outcome associations in future studies. Overall, results were more consistent with the alliance being a consequence, rather than a cause, of symptom change. Finally, findings contribute to a growing body of evidence supporting the role of treatment outcome expectancies in predicting symptom improvement, even within our relatively severely depressed sample.
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“Elsewhere, in a naturalistic study, Webb et al. (2014) demonstrated that the task component was statistically associated with treatment outcomes after controlling for temporal confounders (patient expectations and prior symptom change)22.”
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“Similarly, the alliance has also been studied in intensive treatments delivered via partial hospitalization programs for depression (Webb et al., 2014) and eating disorders (Rienecke et al., 2016).”
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- Authors
- Webb, C. A., Beard, C., Auerbach, R. P., Menninger, E., & Björgvinsson, T.
- Affiliations
- Harvard University (US)
- McLean Hospital (US)
- Corresponding author
- Webb, Christian A.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 61
- Pages
- 70-77
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC4280259
- OpenAlex
- W2031445557
- Cited by
- 38
- References
- 50
- Citations by year
- 2026: 1 · 2025: 6 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 4 · 2016: 4 · 2015: 4
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- McLean Hospital
- NIMH National Research Service Award (1F32MH099810-01)
- National Institute of Mental Health (K23MH097786)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- therapeutic relationship, major depressive disorder, temporal relations, psychiatric hospitalization, cognitive behavioral therapy, pharmacotherapy, severe depression
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Combined Modality Therapy, Depression, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Professional-Patient Relations, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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