Therapeutic alliance mediates the relationship between interpersonal problems and depression outcome in a cohort of multiple sclerosis patients

San Francisco Veteran's Affairs Medical Center, San Francisco, CA 94131, USA.
Journal of Clinical Psychology (Impact Factor: 2.12). 09/2006; 62(9):1197-204. DOI: 10.1002/jclp.20274
Source: PubMed


The relationship among therapeutic alliance, psychotherapy outcomes, and interpersonal problems was examined. The present study hypothesized therapeutic alliance would mediate the relationship between interpersonal functioning and outcome among patients with multiple sclerosis entering psychotherapy for depression. Nineteen clients received 16 weeks of individual cognitive-behavioral therapy (CBT) for depression as described by D. C. Mohr, A. C. Boudewyn, D. E. Goodkin, A. Bostrom, and L. Epstein (2001). Participants completed the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), the Inventory of Interpersonal Problems-Circumplex (IIP-C; Alden, Wiggins, & Pincus, 1990), and the Working Alliance Inventory-Client Form (WAI-C; Horvath & Greenberg, 1989). The IIP-C significantly predicted Week 16 BDI and the WAI-C at 4 weeks. When controlling for the WAI-C, the relationship between the IIP-C and BDI was no longer significant, supporting the mediational hypothesis.

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    • "depression (e.g., Crits-Christoph, Gibbons, Hamilton, Ring-Kurtz, & Gallop, 2011; Strunk, Cooper, Ryan, DeRubeis, & Hollon, 2012), (b) anxiety disorders (Hoffart, Borge, Sexton, Clark, & Wampold, 2012; Keeley, Geffken, Ricketts, McNamara, & Storch, 2011; Kendall et al., 2009; Strauss et al., 2006; Westra, Constantino , & Aviram, 2011), (c) schizophrenia (Kvrgic, Cavelti, Beck, Rüsch, & Vauth, 2012; Lecomte, Laferrière-Simard, & Leclerc, 2012; Lysaker, Davis, Outcalt, Gelkopf, & Roe, 2011; Smerud & Rosenfarb, 2011), and (d) comorbid samples (Baldwin, Wampold, & Imel, 2007; Barber, Connolly, Crits-Christoph, Gladis, & Siqueland, 2009; Howard, Turner, Olkin, & Mohr, 2006; Imel, Hubbard, Rutter, & Simon, 2013; Levin, Henderson, & Ehrenreich-May, 2012). "
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    ABSTRACT: The purpose of this meta analysis was to examine the moderating impact of substance use disorder as inclusion/exclusion criterion as well as the percentage of racial/ethnic minorities on the strength of the alliance-outcome relationship in psychotherapy. It was hypothesized that the presence of a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I substance use disorder as a criterion and the presence of racial/ethnic minorities as a sociocultural indicator are moderately correlated client factors reducing the relationship between alliance and outcome. A random effects restricted maximum-likelihood estimator was used for omnibus and moderator models (k = 94). The presence of (a) substance use disorder and (b) racial/ethnic minorities (overall and specific to African Americans) partially moderated the alliance-outcome correlation. The percentage of substance use disorders and racial/ethnic minority status was unexpectedly highly correlated in the present treatment research samples. Sociocultural contextual variables should be considered along with a DSM Axis I diagnosis of substance use disorders in analyzing and interpreting therapy process variables such as the alliance. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Full-text · Article · Jul 2013 · Journal of Counseling Psychology
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    • "Renner et al. (2012) reported a positive relation between pre-treatment communal problems and alliance, and a negative relation between both agentic problems and alliance and interpersonal distress and alliance, over and above depressive severity. Further, in an earlier investigation of depressed patients with multiple sclerosis, results provided support for the mediating role of early working alliance in the association between overall interpersonal problems and treatment outcome (Howard et al., 2006). In a sample of patients with affective and anxious diagnoses, Muran et al. (1994) reported that cold dominant problems negatively predicted whereas warm submissive problems positively predicted alliance after three weeks of cognitive therapy. "
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    ABSTRACT: INTRODUCTION: Empirical research has converged to support the concurrent association between social difficulties and psychiatric symptoms; yet, longitudinal associations between interpersonal problems and treatment outcome require clarification. The current investigation evaluated the influence of interpersonal problems assessed prior to treatment on interpersonal impacts assessed during treatment as well as on treatment outcome in outpatients with major depressive disorder (MDD). METHOD: 125 participants with a primary diagnosis of MDD were randomized to receive cognitive behavioural therapy or interpersonal therapy. Participants completed the Beck Depression Inventory-II, Hamilton Depression Rating Scale, and Inventory of Interpersonal Problems Circumplex before and after treatment. Therapists completed the Impact Message Inventory during and after treatment. RESULTS: Interpersonal distress improved over the course of treatment; all other interpersonal changes were non-significant when distress was taken into account. Pre-treatment rigidity and agentic problems predicted less reduction in depressive symptoms, whereas agentic and communal impacts upon therapists during treatment predicted greater symptom change. Overall interpersonal distress was only indirectly associated with treatment response later in treatment, through its association with agentic style. Results did not differ across therapy type, and were replicated across self-report and interviewer-rated measures of depression severity. LIMITATIONS: Limitations include the brief duration of treatment, lack of medication arm, and potentially restricted generalizability of patients in a randomized control trial to those in routine practice. CONCLUSIONS: Interpersonal style demonstrated a trait-like stability over treatment, and appears to fluctuate due to co-occurring distress. Yet, specific interpersonal styles were negative prognostic indicators, even within therapy specifically targeting interpersonal functioning.
    Full-text · Article · May 2013 · Journal of Affective Disorders
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