British Journal of Clinical Psychology

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Volume 50 Issue 3 (September 2011), Pages 223-338

Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy (pages 283-297)

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.

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