The Role of the Therapeutic Alliance in Psychotherapy and Pharmacotherapy Outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program
Abstract
The relationship between therapeutic alliance and treatment outcome was examined for depressed outpatients who received interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Outcome was assessed from patients’ and clinical evaluators’ perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy. Ratings of patient contribution to the alliance were significantly related to treatment outcome; ratings of therapist contribution to the alliance and outcome were not significantly linked. These results indicate that the therapeutic alliance is a common factor with significant influence on outcome.
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The characteristics of another person are key to a therapeutic relationship's success, and outcomes depend on the quality of this relationship.
“The characteristics of another person (even if virtual or momentary) are key to a therapeutic relationship's success [139], and outcomes depend on the quality of this relationship [78, 128, 132].”
From Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers. (2025) · cites this paper as [78]
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Sexual fulfilment, wellbeing and risk considerations for people with sexual attractions to children
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The influence of comorbid personality disorders on recovery from depression
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The Sexual Values and Behaviors Discrepancy Model
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Rehabilitation Outcomes and Assessment: Toward a Model of Complex Adaptive Rehabilitation
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- Authors
- Krupnick, J. L., Sotsky, S. M., Elkin, I., Simmens, S., Moyer, J., Watkins, J., & Pilkonis, P. A.
- ORCID
- Pilkonis, Paul A.
- Venue
- Focus
- Published
- 2006-04
- Volume
- 4
- Issue
- 2
- Pages
- 269-277
- ISSN
- 1541-4094 (ISSN-L)
- 1541-4108
- OpenAlex
- W2136907769
- Cited by
- 111
- References
- 27
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 5 · 2023: 6 · 2022: 9 · 2021: 6 · 2020: 8 · 2019: 8 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 8 · 2014: 5 · 2013: 5 · 2012: 3
- FWCI
- 2.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- FOCUS The Journal of Lifelong Learning in Psychiatry (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- therapeutic relationship, depression, interpersonal psychotherapy, cognitive behavioral therapy, imipramine, pharmacotherapy, treatment outcomes, outpatients, patient contribution, placebo response
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