Therapeutic Alliance in Depression Treatment: Controlling for Prior Change and Patient Characteristics

Daniel N. Klein, Joseph E. Schwartz, Neil J. Santiago, Dina Vivian, Carina Vocisano, Bruce Arnow, Rachel Manber, Lawrence P. Riso, James P. McCullough, Frances E. Borian, Louis G. Castonguay, Janice A. Blalock, John C. Markowitz, Barbara Rothbaum, Michael E. Thase, Ivan W. Miller, Martin B. Keller

Research output: Contribution to journalArticlepeer-review

209 Scopus citations


Although many studies report that the therapeutic alliance predicts psychotherapy outcome, few exclude the possibility that this association is accounted for by 3rd variables, such as prior improvement and prognostically relevant patient characteristics. The authors treated 367 chronically depressed patients with the cognitive-behavioral analysis system of psychotherapy (CBASP), alone or with medication. Using mixed effects growth-curve analyses, they found the early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics. In contrast, neither early level nor change in symptoms predicted the subsequent level or course of the alliance. Patients receiving combination treatment reported stronger alliances with their psychotherapists than patients receiving CBASP alone. However, the impact of the alliance on outcome was similar for both treatment conditions.

Original languageEnglish (US)
Pages (from-to)997-1006
Number of pages10
JournalJournal of consulting and clinical psychology
Issue number6
StatePublished - Dec 2003

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health


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