OBJECTIVE Several studies have reported significant within-patient effects of the therapeutic alliance on outcome. However, it remains uncertain whether there are specific patient groups for whom an improved alliance might be particularly beneficial. The relational nature of the alliance makes patients' interpersonal problems a promising candidate for examining such differential effects. This study aims to analyze (i) between- and within-patient effects of the alliance on depression severity, (ii) the effects of patients' baseline interpersonal problems on the within-patient alliance-outcome association, and (iii) whether within-patient effects of the alliance remain significant when adjusting for patients' initial interpersonal problems. METHOD A sample of 141 patients with depression and undergoing outpatient psychotherapy completed the Inventory of Interpersonal Problems at baseline as well as a brief version of the Working Alliance Inventory and the Well-Being Index (as a proxy of depression severity) session by session. RESULTS Multilevel models revealed both significant between- and within-patient effects of the alliance on improvements in depression severity. Patients' problems relating to agency had a significant effect on the within-patient effect of alliance, with more submissive patients benefiting more from an improved therapeutic alliance. Finally, the between- and within-patient effects of the alliance remained significant when adjusting for the patients' agentic interpersonal problems and treatment condition. CONCLUSIONS The results provide evidence on which types of patients would particularly benefit from an improved therapeutic alliance. For patients suffering from low interpersonal agency and reporting problems with submissiveness, an enhanced alliance during the therapy process might improve treatment outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

中文翻译：

---

人际交往作为患者内同盟对抑郁严重程度影响的预测因子。

目的多项研究报道了治疗联盟对结局的重大患者内影响。但是，尚不确定是否存在某些特定的患者群体，对于他们而言，改善联盟可能会特别有益。联盟的关系性质使患者的人际关系问题成为检验这种差异影响的有前途的候选人。本研究旨在分析（i）联盟对抑郁严重程度的患者之间和患者内部影响，（ii）患者基本人际关系问题对患者内部联盟-结局关联的影响，以及（iii）是否在-在调整患者最初的人际关系问题时，联盟对患者的影响仍然很大。方法对141名患有抑郁症并接受门诊心理治疗的患者进行了抽样，他们在基线时完成了人际问题清单，并简要介绍了工作联盟清单和幸福指数（作为抑郁症严重程度的替代指标）。结果多层次模型显示该联盟对抑郁症严重程度改善的患者之间和患者内部均有显着影响。患者与代理相关的问题对联盟的患者内部影响具有显着影响，顺从的患者越多，改善的治疗联盟将使他们受益更多。最后，在调整患者的代理人际问题和治疗条件时，联盟在患者之间和患者内部的影响仍然很重要。结论该结果提供了证据，表明哪些类型的患者将从改善的治疗联盟中特别受益。对于人际交往能力低下且报告顺从性问题的患者，在治疗过程中加强联盟可能会改善治疗效果。（PsycINFO数据库记录（c）2019 APA，保留所有权利）。