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Cited by 103Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

Improvement of the working alliance in one treatment session predicts improvement of depressive symptoms by the next session.

Falkenström, Fredrik, Ekeblad, Annika, Holmqvist, Rolf·2016·Journal of Consulting and Clinical Psychology
DOI 10.1037/ccp0000119
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Abstract

OBJECTIVE: Developments in working alliance theory posit that the therapist's attention to fluctuations in the alliance throughout treatment is crucial. Accordingly, researchers have begun studying the alliance as a time-varying mechanism of change rather than as a static moderator. However, most studies to date suffer from bias owing to the nonindependence of error term and predictors (endogeneity). METHOD: Patients with major depressive disorder (N = 84) from a randomized trial comparing cognitive-behavioral therapy with interpersonal psychotherapy filled out the Beck Depression Inventory-II before each session. After each session, patients and therapists filled out the Working Alliance Inventory short forms. Data were analyzed using the generalized method of moments for dynamic panel data, a method commonly applied in econometrics to eliminate endogeneity bias. RESULTS: Improvement of the alliance predicted significant reduction of depressive symptoms by the next session (patient rating: b = -4.35, SE = 1.96, p = .026, 95% confidence interval [CI] [-8.19, -0.51]; therapist rating: b = -4.92, SE = 1.84, p = .008, 95% CI [-8.53, -1.31]). In addition, there was a significant delayed effect on the session after the next (patient rating: b = -3.25, SE = 1.20, p = .007, 95% CI [-5.61, -0.89]; therapist rating: b = -5.44, SE = 1.92, p = .005, 95% CI [-9.20, -1.68]). CONCLUSION: If the quality of patient-therapist alliance is improved in a given treatment session, depressive symptoms will likely decrease by the next session. The most important limitation of this study is its relatively small sample size. (PsycINFO Database Record

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Authors
Falkenström, F., Ekeblad, A., & Holmqvist, R.
Affiliations
Linköping University (SE)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2016
Volume
84
Issue
8
Pages
738-751
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/ccp0000119
OpenAlex
W2402352829
Cited by
103
References
67
Citations by year
2026: 9 · 2025: 10 · 2024: 6 · 2023: 4 · 2022: 12 · 2021: 14 · 2020: 10 · 2019: 16 · 2018: 10 · 2017: 8 · 2016: 4
FWCI
16.96
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
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, depressive symptoms, cognitive behavioral therapy, interpersonal psychotherapy, mechanisms of change, endogeneity bias, generalized method of moments, dynamic panel data, patient-therapist alliance
MeSH terms
Adult, Depressive Disorder, Major, Major Depressive Disorder, Humans, Outcome and Process Assessment, Health Care, Professional-Patient Relations, Cognitive Behavioral Therapy

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