Tuesday, May 10 at 10:00 am
B35, Solomon Labs
TITLE: Processes of symptom change in psychotherapy: Investigating the role of therapist adherence, competence, patient skills and the therapeutic alliance
Three process-outcome investigations were conducted to elucidate the relationship between therapist adherence/competence, the therapeutic alliance, patient cognitive therapy (CT) skills and treatment outcome. In Study 1, I conducted a meta-analytic review of studies in which therapist adherence or competence was examined in relation to outcome across a variety of treatment modalities. Neither the mean adherence-outcome nor competence-outcome effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence-outcome and competence-outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence-outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance.
In Study 2, I examined the relations of two factor-analytically derived components of the Working Alliance Inventory (WAI) with depressive symptom change that occurred either prior to, or subsequent to, an early and late session of CT. Variation in symptom change subsequent to the early session was significantly related to the WAI factor that assesses therapist-patient agreement on the goals and tasks of therapy, but not to a factor assessing the affective bond between therapist and patient. In contrast, both factors, when assessed in a late session, were significantly predicted by prior symptom change. These findings may reflect the importance, in CT, of therapist-patient agreement on the goals and tasks of therapy. In contrast, the affective bond between therapist and patient may be more of a consequence, than a cause, of symptom change in CT.
In Study 3, measures of adherence and alliance were examined simultaneously in the context of CT for depression in predicting symptom change and patient use of CT skills. These relationships were examined in two separate samples in an effort to replicate findings. Results indicated a differential pattern of prediction in the two samples. In one, CT techniques exhibited a stronger association with patient CT skills and symptom change relative to the alliance, whereas the reverse pattern emerged in the second sample. A baseline symptom severity X CT techniques interaction indicated that between-study differences in intake depression severity might in part explain the process-outcome differences. These findings suggest that the nature of the therapy sample examined may influence process-outcome findings in psychotherapy research.