THE ROLE OF THE THERAPEUTIC ALLIANCE IN PSYCHOTHERAPY AND PHARMACOTHERAPY OUTCOME - FINDINGS IN THE NATIONAL INSTITUTE OF MENTAL-HEALTH TREATMENT OF DEPRESSION COLLABORATIVE RESEARCH-PROGRAM

The relationship between therapeutic alliance and treatment outcome wa s examined for depressed outpatients who received interpersonal psycho therapy, cognitive-behavior therapy, imipramine with clinical manageme nt, or placebo with clinical management. Clinical raters scored videot apes of early, middle, and late therapy sessions for 225 cases (619 se ssions). Outcome was assessed from patients' and clinical evaluators' perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both ps ychotherapies and for active and placebo pharmacotherapy. Ratings of p atient contribution to the alliance were significantly related to trea tment outcome; ratings of therapist contribution to the alliance and o utcome were not significantly linked. These results indicate that the therapeutic alliance is a common factor with significant influence on outcome.