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

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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: Falkenström, Fredrik
Ekeblad, Annika
Holmqvist, Rolf
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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Improvement of the working alliance in one treatment session predicts improvement of depressive symptoms by the next session.

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