| This study compared the strength of the therapeutic alliance in the seven most-improved and the seven least-improved outcome cases across four brief treatments for clinical depression. The treatment approaches included two psychotherapies, that is, interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) and two pharmacotherapies, imipramine plus clinical management (IMI-CM) and placebo plus clinical management (PLA-CM). The primary aim of this exploratory investigation was to determine whether the strength of the therapeutic relationship, a so-called "nonspecific factor" in psychotherapy, would be significantly associated with therapy outcome, an association which had been found in some studies of time-limited psychodynamic psychotherapy, across a range of treatments.;The results showed the following: (1) across treatments, the most-improved outcome group had a significantly stronger therapeutic alliance score than the least-improved outcome group; within treatments, however, this finding existed only for IPT; (2) therapeutic alliance scores were significantly higher in one form of psychotherapy (IPT) than in one form of pharmacotherapy (PLA-CM); (3) differences between the most-improved and least-improved outcome groups for one form of psychotherapy (IPT) were significantly larger than outcome group differences in both of the pharmacotherapies; (4) the strength of the therapeutic alliance did not change differentially over the course of therapy for any of the treatment by outcome groups studied; (5) therapists' contributions to the therapeutic alliance significantly distinguished the treatments and this could be seen as early as treatment hour 4; (6) the contribution to the therapeutic alliance of patient and therapist together had a significant effect on outcome by treatment hour 4, but this was true only for IPT.;The study suggests that the therapeutic alliance may have different characteristics and/or different degrees of importance based on the treatment approach in which it occurs. More research is advocated to further clarify the therapeutic alliance construct, both in general and specifically within each treatment approach, and to develop methods to more effectively measure the construct in different types of treatment. |
