Negative Symptoms and Poor Insight as Predictors of the Similarity Between Client and Therapist Ratings of Therapeutic Alliance in Cognitive Behavior Therapy for Patients With Schizophrenia

Roudebush VA Medical Center, Indianapolis, IN, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 03/2011; 199(3):191-5. DOI: 10.1097/NMD.0b013e31820c73eb
Source: PubMed


Recent studies have found that clients with schizophrenia rate therapeutic alliance more highly than therapists. Unclear is whether there are clinical characteristics which predict the degree of difference in client and therapist ratings. To explore this, we correlated client and therapist ratings of therapeutic alliance with baseline assessments of positive negative, and disorganized symptoms and awareness of need for treatment. Participants were 40 adults with schizophrenia enrolled in a 6-month program of cognitive behavior therapy. Results indicated that clients produced higher ratings of therapeutic alliance than therapists and that therapist and client general ratings were more disparate when clients had fewer negative symptoms and better insight. Higher overall client ratings of therapeutic alliance were linked to lower levels of positive, negative, and disorganized symptoms and better awareness of need for treatment. Higher overall therapist ratings were linked only to lower levels of disorganized symptoms among clients.

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Available from: Paul H Lysaker, Aug 05, 2014
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    • "To start with the latter, Lysaker et al. (2011) found a higher level of concordance between patients and clinicians in patients who experienced more negative symptoms and more impairments (Lysaker et al. 2011). On the other hand, Davis and Lysaker (2004) found that while more impaired patients reported better alliances, their clinicians appraised the alliances more negatively. "
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    ABSTRACT: Working alliance has been characterized as an important predictor of positive treatment outcomes. We examined whether illness insight, psychosocial functioning, social support and locus of control were associated with working alliance as perceived by both patient and clinician. We assessed 195 outpatients with psychotic or bipolar disorders. Our findings indicated that patients rated the alliance more positively when they experienced a greater need for treatment, fewer behavioral and social problems, and more psychiatric symptoms. Clinicians rated the alliance more positively in patients who reported fewer social problems and better illness insight. Patients' demographic characteristics, including being female and married, were also positively related to the clinician-rated alliance. Our results suggest that patients and clinicians have divergent perceptions of the alliance. Clinicians may need help developing awareness of the goals and tasks of patients with certain characteristics, i.e., singles, men, those with poor illness insight and those who report poor social functioning.
    Full-text · Article · Feb 2015 · Community Mental Health Journal
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    • "p = 0.07, and association with SAPS, r 2 = j0.18, p = 0.06) supports previous studies (Barrowclough et al., 2010; Lysaker et al., 2011; Neale and Rosenheck, 1995). With respect to diagnosis, inpatients with schizophrenia have previously been found to have a poorer therapeutic relationship with their clinician when compared with inpatients with other diagnoses (McCabe and Priebe, 2003). "
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    ABSTRACT: The therapeutic relationship is one of the most central and important factors in the treatment of mental health disorders. A better therapeutic relationship is associated with service engagement, medication adherence, and satisfaction with services. This study aimed to compare the demographic and clinical factors associated with the therapeutic relationship in voluntarily and involuntarily admitted psychiatric service users. We found that individuals who had been admitted involuntarily, who had a diagnosis of a psychotic disorder, and who reported higher levels of perceived pressures on admission were more likely to have a poorer therapeutic relationship with their consultant psychiatrist. Greater levels of insight and treatment satisfaction, together with higher levels of procedural justice experienced on admission, were associated with a better therapeutic relationship. We found that the level of perceived coercion on admission was not related to the therapeutic relationship. Targeted interventions to improve the therapeutic relationship, particularly for involuntarily admitted service users, are discussed.
    Full-text · Article · Mar 2014 · The Journal of nervous and mental disease
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    • "Initially, the idea of a functional working alliance could appear at odds with the perception of patients with schizophrenia suffering from reality distortion or having lack of insight into their disorder. Results from schizophrenia spectrum studies have here been somewhat conflicting, in that some have found that the level of psychotic symptoms is associated with lower patient ratings of the alliance, whereas others have not [15,21,22]. Higher levels of insight seem, with one exception only [23], to be consistently associated with higher patient ratings of the therapeutic alliance [15,17,21] and also with therapist-rated alliance in one study [21]. "
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    ABSTRACT: Background The therapeutic alliance is related to better course and outcome of treatment in schizophrenia. This study explores predictors and characteristics of the therapeutic alliance in recent-onset schizophrenia spectrum disorders including the agreement between patient and therapist alliance ratings. Methods Forty-two patients were assessed with demographic, neurocognitive, and clinical measures including the Positive and Negative Syndrome Scale (PANSS). The therapeutic alliance was measured with the Working Alliance Inventory - Short Form (WAI-S). Results Patient WAI-S total scores were predicted by age and PANSS excitative symptoms. Therapist WAI-S total scores were predicted by PANSS insight. Patient and therapist WAI-S total scores were moderately associated. Neurocognition was not associated with working alliance. Conclusion Working alliance is associated with specific demographic and symptom characteristics in patients with recent-onset schizophrenia spectrum disorders. There is moderate agreement between patients and therapists on the total quality of their working alliance. Findings highlight aspects that may increase therapists’ specificity in the use of alliance-enhancing strategies.
    Full-text · Article · May 2013 · Annals of General Psychiatry
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