Therapeutic alliance and early change in depression: Benefits of enhancing working alliance at the initial sessions of short-term supportive-expressive psychodynamic psychotherapy

Abstract

Aims: The present study attempted to see whether the use of supportive techniques and improving working alliance in the initial sessions of short-term supportive-expressive (SE) psychodynamic psychotherapy results in a change in symptoms of patients with depressive disorder. Materials and methods: The study was an experiential single case. The subjects were 6 women with major depressive disorder who were selected by a purposive sampling method. Measures included the Working Alliance Inventory-12, the Quality of Life Scale, and Beck Depression Inventory II. Visual analysis with graphs, mean, standard deviation and the Friedman test was used for data analysis. Results: There was no significant increase or decrease in the severity of depression on the baseline (?2 = 3.54, P=0.14) and during evaluation sessions (?2 = 0.85, P=0.65), but participants showed a significant improvement in quality of life once the sessions had started (?2 = 8.95, P=0.01). The mean scores on all three working alliance components showed a slight increase over three sessions and the scores on the bond subscale showed a significant increase (?2 = 11.56, P=0.003). Discussion: It was clear that despite a slight increase in the severity of depression in at least four participants, patients’ quality of life and working alliance, especially the bond component, improved during the initial sessions of psychotherapy. Conclusions: These findings may reflect the importance of working alliance in the initial sessions of therapy, which can lead to a change in the patient’s experience of quality of life.