Therapeutic Alliance in Antidepressant Treatment: Cause or Effect of Symptomatic Levels?

Background: Previous studies have shown that in psychotherapy alliance is a predictor of symptomatic change, even while accounting for the temporal precedence between alliance and symptoms. However, the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result, rather than the cause, of symptomatic change. The current prospective study examined whether the alliance predicts outcomes in psychopharmacology, while controlling for previous symptomatic change throughout the course of treatment. Methods: Data from a psychopharmacological randomized controlled trial for the treatment of adult major depression (n = 42), including the patients’ rating of the alliance with the physicians, were analyzed. Multilevel models controlling for autoregressive lag of the dependent variable were used in all analyses to examine the effect of alliance on outcome. Results: The effect of alliance on outcome, while controlling for prior symptomatic levels, was significant and restricted to the middle phase of treatment (week 4, p = 0.005), when most of the reductions in symptoms were obReceived: October 5, 2014 Accepted after revision: February 6, 2015 Published online: March 28, 2015 Sigal Zilcha-Mano, PhD Department of Psychology, University of Haifa Mount Carmel Haifa 31905 (Israel) E-Mail sigalzil @ gmail.com © 2015 S. Karger AG, Basel 0033–3190/15/0843–0177$39.50/0