Running Head : ALLIANCE IN DBT 1 The therapeutic alliance as a predictor

Objective: The purpose of the present study was to explore facets of the client and therapist-rated therapeutic alliance as predictors of suicide attempts, non-suicidal self-injury, depression, and introject during the course of two psychosocial treatments for borderline personality disorder. Method: A total of 101 women meeting DSM-IV criteria for borderline personality disorder participated in a randomized controlled trial of dialectical behavior therapy (DBT) versus community treatment by experts (CBTE). Clients and therapists rated the therapeutic alliance at four time points during one year of treatment. Results: Multilevel models showed no significant differences in client ratings of the alliance by treatment condition. DBT therapists reported greater working strategy consensus early in treatment and an overall greater alliance during treatment. Client ratings of commitment and working capacity were associated with fewer suicide attempts in DBT. Client ratings of commitment were also associated with reduced NSSI in DBT only. Therapist ratings of the alliance were predictive of reduced suicide attempts in both treatments while therapist ratings of the alliance in CTBE were predictive of increased NSSI. Client and therapist-ratings of the alliance were not significantly associated with depression or introject across both treatments. Conclusions: The study supported several theoretically predicted relationships between facets of the therapeutic alliance in DBT and suicidal behavior. Results are discussed in the context of recommendations for developing the therapeutic alliance in DBT.