Differential Reflection of the Relationship between Therapeutic Alliance and Outcome in a Day Treatment Hospital Setting

Abstract

The therapeutic alliance is considered to be a significant and empirically well-documented determinant of therapeutical success. The aim of the present study was to replicate this effect using a large daily clinical sample and to consider different aspects of the therapeutic relationship in an extreme group of particularly low relationship satisfaction separately. A longitudinal examination of a sample of n=809 patients (M=34,32; SD=10,7; 72,6% female) in a day care hospital setting was carried out. Using multiple regression analysis, the link between therapeutic alliance (Helping Alliance Questionnaire; HAQ-S) in the third week and therapeutic outcome (Brief Symptom Inventory-18; BSI-18) was investigated. Analyses have been conducted for the overall sample as well as for the extreme group representing the lowest decile regarding relationship satisfaction and the remaining 90%. A distinction was also made between the 2 subscales of the HAQ, satisfaction with the relationship and satisfaction with the outcome. The therapeutic alliance after 3 weeks was a significant predictor for therapeutic outcome. Within the extreme group with initially low relationship satisfaction, relationship satisfaction proved to be a significant and strong predictor for therapeutic outcome, but was not useable for the prediction of individual cases due to wide confidence interval (β=0,622; 95% CI [0,051; 1,095]). In contrast, the relationship satisfaction in the remaining 90 percent explained no additional variance of therapeutic outcome beyond the explanation by satisfaction with the outcome (β=0,244; 95% CI [0,176; 0,391]). The results emphasize the importance of therapeutic alliance also in a day care hospital setting. Relationship satisfaction plays a central, other factors exceeding role in the prediction of therapeutic outcome only in the extreme group of particularly dissatisfied patients. Ensuring at least a sufficiently good therapeutic relationship is of great importance and therefore requires early identification and, if necessary, intervention.