Therapeutic alliance in early schizophrenia spectrum disorders: a cross-sectional study

Ragnhild Johansen,Valentina C Iversen,Ingrid Melle,Knut A Hestad

doi:10.1186/1744-859x-12-14

Abstract

BackgroundThe therapeutic alliance is related to better course and outcome of treatment in schizophrenia. This study explores predictors and characteristics of the therapeutic alliance in recent-onset schizophrenia spectrum disorders including the agreement between patient and therapist alliance ratings.MethodsForty-two patients were assessed with demographic, neurocognitive, and clinical measures including the Positive and Negative Syndrome Scale (PANSS). The therapeutic alliance was measured with the Working Alliance Inventory - Short Form (WAI-S).ResultsPatient WAI-S total scores were predicted by age and PANSS excitative symptoms. Therapist WAI-S total scores were predicted by PANSS insight. Patient and therapist WAI-S total scores were moderately associated. Neurocognition was not associated with working alliance.ConclusionWorking alliance is associated with specific demographic and symptom characteristics in patients with recent-onset schizophrenia spectrum disorders. There is moderate agreement between patients and therapists on the total quality of their working alliance. Findings highlight aspects that may increase therapists’ specificity in the use of alliance-enhancing strategies.

Highlights

The therapeutic alliance is related to better course and outcome of treatment in schizophrenia
Higher scores for the Positive and Negative Syndrome Scale (PANSS) Excitative factor was associated with lower patient Working Alliance Inventory - Short Form (WAI-S) total scores, in addition to lower levels of several subscores
Higher scores for the PANSS Positive factor was associated with lower patient Working Alliance Inventory (WAI)-S goal subscores (Table 1)

Summary

Introduction

The therapeutic alliance is related to better course and outcome of treatment in schizophrenia. This study explores predictors and characteristics of the therapeutic alliance in recent-onset schizophrenia spectrum disorders including the agreement between patient and therapist alliance ratings. The first 2 to 5 years of illness are considered a critical period in the development of psychotic disorders. It is during this period that adequate treatment may substantially impact the course and outcome of illness [2,3]. A recent metaanalysis [4] indicates a drop-out rate of 13% for the psychosocial treatment of schizophrenia spectrum disorders. It is important to uncover factors that have impact on the quality and outcome of treatments

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Discussion

Conclusion