Congruence in patient and therapist-rated alliance predicts subsequent depressive symptoms in cognitive behavioral therapy for depression

Abstract

Objective: The therapeutic alliance is a dyadic process involving both patient and therapist perspectives. We investigated the effect of patient and therapist agreement on the alliance in cognitive behavioral therapy for depression. Method: Patients (N = 191) were drawn from two studies of cognitive behavioral therapy for depression provided over 16 weeks. Alliance data were collected from patients and therapists at the first four sessions. Patients provided symptom data at each session. We used multilevel polynomial regression with response surface analysis to investigate the effect of alliance agreement and disagreement on symptoms. Results: The within-person strength of patient and therapist-rated alliance (given agreement) predicted lower within-person symptoms. The nature and degree of the discrepancy in patient and therapist alliance scores was not a significant predictor. Conclusion: Patients and therapist alliance strength in early sessions (given agreement) predicted greater symptom change. Future research is needed to examine whether specific patient characteristics can be used to identify for whom the alliance plays a more or less important role.