Patient-therapist convergence in alliance ratings as a predictor of outcome in psychotherapy for generalized anxiety disorder.

Autor: Coyne AE; a Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA., Constantino MJ; a Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA., Laws HB; b Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA., Westra HA; c Department of Psychology , York University , Toronto , ON , Canada., Antony MM; d Department of Psychology , Ryerson University , Toronto , ON , Canada.
Jazyk: angličtina
Zdroj: Psychotherapy research : journal of the Society for Psychotherapy Research [Psychother Res] 2018 Nov; Vol. 28 (6), pp. 969-984. Date of Electronic Publication: 2017 Mar 29.
DOI: 10.1080/10503307.2017.1303209
Abstrakt: Objective: Although patients and therapists aligning over time on their perceptions of alliance quality is regarded as clinically important, few studies have examined the influence of such dyadic convergence on psychotherapy outcomes. This study tested whether early treatment convergence in patient-therapist alliance ratings was associated with subsequent worry and distress reduction in psychotherapy for generalized anxiety disorder (GAD), and whether treatment type and the dyad members' initial alliance perceptions moderated these associations.
Method: Data derived from a randomized trial for which patients with severe GAD received either 15 sessions of standard cognitive-behavioral therapy (CBT; n = 43) or CBT integrated with motivational interviewing (n = 42). Patients and therapists rated the alliance after each session. Patients rated worry after each session, and their distress multiple times.
Results: As predicted, dyadic multilevel modeling revealed that early alliance convergence was associated with greater subsequent worry (p = .03) and distress (p = .01) reduction, and the combination of low initial patient-rated alliance and low convergence was associated with the worst outcome for the distress variable (p = .04).
Conclusions: Results suggest that alliance convergence may be an important clinical process that bears on outcome, rendering it an important marker for therapist responsiveness.
Databáze: MEDLINE
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