Therapist Adherence, Patient Alliance, and Depression Change in the NIMH Treatment for Depression Collaborative Research Program.

Therapist Adherence;Patient Alliance;TDCRP;Interpersonal Psychotherapy for Depression;Cognitive Behavioral Psychotherapy for Depression;Psychology;Social Sciences;Psychology

Minonne, Giovanni A.Van Etten Lee, Michelle ;

University of Michigan

关键词: Therapist Adherence;    Patient Alliance;    TDCRP;    Interpersonal Psychotherapy for Depression;    Cognitive Behavioral Psychotherapy for Depression;    Psychology;    Social Sciences;    Psychology;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/60744/gminonne_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Using data from the National Institute of Mental Health Treatment of DepressionCollaborative Research Program (NIMH TDCRP), this dissertation examined therelationship between the patient alliance (Vanderbilt Therapeutic Alliance Scale patientfactor) and therapist adherence to five subscales of the Collaborative StudyPsychotherapy Rating Scale: Cognitive Behavior Therapy (CBT), Interpersonal Therapy(IPT), Clinical Management (CM), Facilitative Conditions (FC), and ExplicitDirectiveness (ED) and their influence on depression change as measured by the BeckDepression Inventory. Analyses were conducted using path models examining theinterrelationship between early and later alliance and adherence as predictors ofdepression change for the full TDCRP sample (n = 239) and for each treatmentcomprising the TDCRP: CBT (n = 59), IPT (n = 61), imipramine plus clinicalmanagement (IMI-CM; n = 57), and placebo plus clinical management (PLA-CM; n =62). The results indicate that, in each of the treatments, early patient alliance predictedlater patient alliance, and later patient alliance predicted depression change. Earlytherapist adherence rarely predicted later therapist adherence and later therapistadherence rarely predicted depression change with the following exceptions. Later IPTadherence predicted greater reductions in depression in IPT and later CBT adherencepredicted greater reductions in depression in both IPT and in PLA-CM. Across all thetreatments, there was a positive relationship between both IPT and FC adherence andpatient alliance, and a negative relationship between both ED and CM adherence andpatient alliance. In each treatment group, the relationship between adherence and thepatient alliance was different. In IPT, greater ED predicted reduced patient alliance. InCBT and PLA-CM, greater CM adherence predicted reduced patient alliance. Earlypatient alliance predicted: (a) greater later FC, IPT, and CBT adherence in CBT; (b)greater IPT adherence in IPT; and (c) greater FC adherence in PLA-CM.These results have important implications for psychotherapy training and clinicalpractice. Particularly relevant are the findings that non-target techniques had a positiveinfluence on patient alliance and depression change, and that therapist directivenessnegatively influenced the patient alliance in IPT. In sum, this study highlights thecomplex interrelationship of relational and technical dimensions of psychotherapy.