The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy - A review of empirical studies

Empirical studies are reviewed, the aim being to investigate characteristic s of the therapeutic relationship in cognitive-behavior therapy (CBT) and t o identify therapist or patient interpersonal behavior that affects treatme nt outcome. CBT is characterized by a more active and directive stance on t he part of the therapists and higher levels of emotional support than are f ound in insight-oriented psychotherapies. Therapists express high levels of empathy and unconditional positive regard, similar to those expressed by i nsight-oriented psychotherapists. Two clusters of interpersonal behavior ha ve been identified that are clearly associated with CBT outcome: (a) the Ro gerian therapist variables-empathy, nonpossessive warmth, positive regard, and genuineness; and (b) therapeutic alliance. There is some evidence for t he impact on outcome of three additional clusters of patient behavior: (a) the patients' perception of the therapist as being self-confident, skillful , and active; (b) the patients' openness to discuss their problems; and (c) the patients' pretreatment predisposition to change and to accept psycholo gical treatment as a means of achieving this. It is further concluded that relationship factors in general have a consistent but moderate impact on CB T outcome.