An examination of therapeutic alliance patterns, client attachment, client interpersonal problems, and therapy outcome in process-experiential and cognitive-behavioural treatment for depression

This study investigated temporal patterns of therapeutic alliance development across treatment and their relationship to outcome, and the relationship between client attachment styles and interpersonal problems and alliance strength and patterns across treatment. Sixty-six clients diagnosed with major depression participated in one of two 16-week treatment conditions: Process-experiential therapy and Cognitive-behavioural therapy. Results revealed two alliance "shape" patterns Stable Linear and Steep Linear-Quadratic , as well as two alliance "shape and level" patterns High Strength Linear-Quadratic and Low-to-Mid Strength Stable . Results indicated that the two alliance "shape" patterns did not differentially predict treatment outcome. With respect to "shape and level" patterns, results revealed that clients with a High Strength Linear-Quadratic alliance pattern had better treatment outcomes than clients with a Low-to-Mid Strength Stable alliance pattern. In terms of client attachment style, results indicated that clients with a Steep Linear-Quadratic "shape" pattern report more discomfort with closeness at pre-treatment. Further, clients with a High-Strength Linear-Quadratic "shape and level" pattern report more confidence and less need for approval at pre-treatment. With respect to client interpersonal problems, results revealed that clients with a Steep Linear-Quadratic "shape" pattern report being more cold and distant at pre-treatment and clients with a Low-Mid Strength Stable "shape and level" pattern report being more socially inhibited, less assertive, and more overly-accommodating at pre-treatment. Lastly, results revealed that specific client attachment characteristics and interpersonal problems differentially predict total average alliance strength as well as the average strength of the client and therapist bond across treatment.