Abstract
The therapeutic alliance is considered an essential component of any clinical or psychological intervention. The therapeutic alliance can however change over time, and therefore it is relevant to determine if the alliance and its variations are related to clinical outcomes. The present study had three objectives: (1) determine the impact of the alliance measured by the client and the therapist, on clinical and psychosocial outcomes of individuals with early psychosis receiving group interventions; (2) measure the concordance between the client and the therapists’ ratings of the alliance; and (3) determine the best predictor of the client’s alliance in our sample. A total of 36 individuals with early psychosis who participated in group interventions for symptom management answered the WAI three times, and so did the group therapists. Outcomes included measures of insight, symptoms (total, positive and negative), and self-esteem. Attendance and group participation were also measured. Results suggest that the overall client’s alliance predicted total symptoms and self-esteem at post-therapy, whereas both clients’ and therapists’ ratings predicted group attendance and participation. Greater variations in the alliance overtime for the clients were somewhat linked to worse negative symptoms at post-therapy. Alliance ratings were generally high and fairly concordant between therapists and clients. Only the baseline measure of capacity for attachment, predicted the client’s overall alliance scores. Clinical implications are discussed.
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Barber, J. P., Connolly, M. B., Crits-Christoph, P., Gladis, L., & Siqueland, L. (2000). Alliance predicts patients’ outcome beyond in-treatment change symptoms. Journal of Consulting and Clinical Psychology, 68, 1027–1032.
Bentall, R., Tarrier, N., Lewis, S., Haddock, G., Kinderman, P., Kingdon, D., et al. (2002). The therapeutic alliance in early psychosis. Acta Psychiatrica Scandinavica, 106(s413), 69–106.
Birchwood, M., Smith, J., Drury, V., Healy, J., Macmillan, F., & Slade, M. A. (1994). A self-report insight scale for psychosis: Reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 89, 62–67.
Bourdeau, G., Théroux, L., & Lecomte, T. (2009). Predictors of therapeutic alliance in early psychosis. Early Intervention in Psychiatry, 3(4), 300–3003.
Castonguay, L. G., Constantino, M. J., & Holtforth, M. G. (2006). The working alliance: Where are we and where should we go? Psychotherapy: Theory, Research, Practice, Training, 43, 271–279.
Corbière, M., Bisson, J., Lauzon, S., & Ricard, N. (2006). Factorial validation of a French short-form of the Working Alliance Inventory. International Journal of Methods in Psychiatric Research, 15(1), 36–45.
Couture, S. M., Roberts, D. L., Penn, D. L., Cather, C., Otto, M. W., & Goff, D. (2006). Do baseline client characteristics predict the therapeutic alliance in the treatment of schizophrenia? Journal of Nervous and Mental Disease, 194(10-14.).
Cutrona, C. E., & Russel, D. W. (1987). The provisions of social support and adaptation to stress. Advance in personal relationships, 1, 37–67.
Davis, L. W., & Lysaker, P. H. (2007). Therapeutic alliance and improvements in work performance over time in patients with schizophrenia. The Journal of Nervous and Mental Disease, 195(4), 353–357.
Dunn, H., Morrison, A. P., & Bentall, R. P. (2006). The relationship between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive therapy for psychosis. Clinical Psychology and Psychotherapy, 13, 145–152.
Evans-Jones, C., Peters, E., & Barker, C. (2009). The therapeutic relationship in CBT for psychosis: Client, therapist and therapy factors. Behavioural and Cognitive Psychotherapy, 37(5), 527–540.
Frank, A. F., & Gundersen, J. G. (1990). The role of the therapeutic alliance in the treatment of schizophrenia: Relationship to course and outcome. Archives of General Psychiatry, 47, 228–236.
Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 37–69). New York: Oxford.
Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.
Horvath, A. O., & Greenberg, L. S. (1994). The working alliance: Therapy, research and practice. New York: John Willey and Sons.
Johnson, D. P., Penn, D. L., Bauer, D. J., Meyer, P., & Evans, E. (2008). Perdictors of the therapeutic alliance in group therapy for individuals with treatment-resistant auditory hallucinations. British Journal of Clinical Psychology, 47, 171–183.
Karam, E. A. (2010). The alliance-outcome relationship revisited: A session-by-session perspective.. Dissertation Abstracts International: Section B: The Sciences and Engineering 70(8-B), 5167.
Lecomte, T., Corbiere, M., & Laisné, F. (2006). Investigating self-esteem in individuals with schizophrenia: Relevance of the SERS. Psychiatry Research, 143, 99–108.
Lecomte, T., Cyr, M., Lesage, A. D., Wilde, J. B., Leclerc, C., & Ricard, N. (1999). Efficacy of a self-esteem module in the empowerment of individuals with chronic schizophrenia. Journal of Nervous and Mental Diseases, 187, 406–413.
Lecomte, T., & Leclerc, C. (2007). Implementing cognitive-behaviour therapy for psychosis—issues and solutions. (The Journal of the Norwegian Psychological Association) Tidsskrift for Norsk Psykologorening, 5, 588–597.
Lecomte, T., Leclerc, C., Corbière, C., Wykes, T., Wallace, C. J., & Spidel, A. (2008a). Group cognitive behaviour therapy or social skills training for individuals with a first episode of psychosis? Results of a randomized controlled trial. Journal of Nervous and Mental Disease, 196, 866–875.
Lecomte, T., Spidel, A., Leclerc, C., MacEwan, G. W., Greaves, C., & Bentall, R. P. (2008b). Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis. Schizophrenia Research, 102, 295–302.
Liberman, R. P., Wallace, C. J., Eckman, T., & Wirshing, W. (1988). Symptom management module—UCLA social and independent living skills. Camarillo: Psychiatric Rehabilitation Consultants.
Lukoff, D., Nuechterlein, K., & Ventura, J. (1986). Manual for the expanded brief psychiatric rating scale. Schizophrenia Bulletin, 12, 578–602.
Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.
Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. Lambert (Ed.), Bergin, Garfield’s handbook of psychotherapy, behavior change (5th ed.). New York: Barnes & Noble.
Solomon, P., Draine, J., & Delahey, M. A. (1995). The working alliance and consumer case management. Journal of Mental Health Administration, 22(2), 126–134.
Svensson, B., & Hansson, L. (1999). Therapeutic alliance in cognitive therapy for schizophrenic and other long-term mentally ill patients: Development and relationship to outcome in an in-patient treatment programme. Acta Psychiatrica Scandinavica, 99, 281–287.
Thewissen, V., Myin-Germeys, I., Bentall, R., de Graaf, R., Vollebergh, W., & van Os, J. (2006). Instability in self-esteem and paranoia in a general population sample. Social Psychiatry and Psychiatric Epidemiology. Epub ahead of print.
Ventura, J., Green, M. F., Shaner, A., & Liberman, R. P. (1993). Training and quality assurance with the brief psychiatric rating scale. International Journal of Methods in Psychiatric Research, 3, 221–244.
Wallace, C. J., Lecomte, T., Liberman, R. P., & Wilde, J. B. (2001). CASIG: A consumer-centered assessment for planning individualized treatment and evaluating program outcomes. Schizophrenia Research, 50, 105–119.
Weiss, K. A., Smith, T. E., Hull, J. W., Piper, A. C., & Huppert, J. D. (2002). Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders. Schizophrenia Bulletin, 28(2), 341–349.
Acknowledgements
This study was funded by grant 43975 from the Canadian Institutes of Health Research (CIHR; Drs Lecomte, Leclerc, Wykes and Wallace). The corresponding author also benefited from a salary award from CIHR to conduct this study. We would like to thank the participants who took part in this study as well as the mental health clinicians who delivered the intervention and recruited participants.
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Lecomte, T., Laferrière-Simard, MC. & Leclerc, C. What Does the Alliance Predict in Group Interventions for Early Psychosis?. J Contemp Psychother 42, 55–61 (2012). https://doi.org/10.1007/s10879-011-9184-2
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DOI: https://doi.org/10.1007/s10879-011-9184-2