Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy.

  • Johansson P
  • Høglend P
  • Hersoug A
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Abstract

OBJECTIVES. Patient expectancy has been regarded as an important predictor of psychotherapy outcome, for more than half a century. In recent years, some evidence has emerged indicating that the therapeutic alliance may mediate the association between expectancy and outcome. DESIGN. In this dismantling, randomized clinical study, 100 out-patients who sought psychotherapy due to depression, anxiety, and personality disorders, were assigned to 1 year of dynamic psychotherapy with and without transference interpretation. METHODS. Patients' pre-treatment target expectancies and global expectancy were measured in this clinical trial. Tests of mediation were performed with two patient-rated and one therapist-rated measure of the therapeutic alliance, using regression analyses. Six putative moderators of the mediational paths were explored. RESULTS. Global Optimism was significantly associated with two clinician-rated outcome measures - the Psychodynamic Functioning Scales and Global Assessment of Functioning. Both patient ratings, but not the therapist rating of alliance mediated the association between global expectancy and clinician-rated outcome. None of the putative moderators had a significant effect. CONCLUSION. The results, together with previous findings, indicate that the expectancy-alliance-outcome mediational chain is a general phenomenon, not limited to subgroups of patients or modes of treatment. ©2010 The British Psychological Society.

Author-supplied keywords

  • adult
  • article
  • attitude to health
  • clinical trial
  • comparative study
  • controlled clinical trial
  • controlled study
  • doctor patient relation
  • epidemiology
  • female
  • health personnel attitude
  • human
  • human relation
  • male
  • mental disease
  • methodology
  • middle aged
  • psychotherapy
  • randomized controlled trial
  • treatment outcome

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Authors

  • P Johansson

  • P Høglend

  • A G Hersoug

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