Introduction

We explored the working alliance as measured by both clients and therapists. The working alliance has been known to predict the outcome of psychotherapy and is often considered an important common factor. This study raised the question of how to conceptualize the working alliance in the blended format.

Methods

This was an exploratory study derived from a randomized controlled trial comparing bCBT and face-to-face cognitive behavioural therapy (ftf CBT) on depression. The change in depressive symptoms was measured with the Patient Health Questionnaire (PHQ-9) and the working alliance was measured using the Working Alliance Inventory.

Analyses

Correlation coefficients were calculated for the working alliance as reported by clients and therapists, working alliance was then examined at item and dimension level (task, bond, goal). Linear regression models were applied to investigate the predictive value of the working alliance on treatment outcome. Interaction between the level of working alliance and treatment condition was also considered.

Results

Client and therapist working alliance ratings correlated at r = 0.44 and clients rated the working alliance higher than therapists (x̄_clients = 48.6, x̄_therapists = 44.6). ftf CBT and bCBT had comparable joint working alliance ratings (x̄_ftf = 46.4, x̄_bCBT = 46.8). Items had little deviation apart from item 4 with high positive values. The level of working alliance from the total sample did not significantly predict outcome based on the client's perspective. Contrarily, seen from the therapist's perspective, it did (b = 0.00, p = .044). Using the mean from these predictors as a composite variable, was also significant (b = 0.00, p = .039, R²_adj = 0.07). There was no significant interaction with treatment condition.

Discussion

Clients and therapists may lay emphasis on different aspects of the working alliance. The finding that therapist-rated working alliance was better than client working alliance at predicting outcome went against common findings; this pattern may be specific to bCBT.

Conclusion

Clients rated the working alliance slightly higher than therapists on average. Clients and therapists as well as treatment conditions had different profiles on dimension deviations. Therapist ratings of the working alliance appeared to better predict treatment outcome than client ratings. Joint working alliance predicted outcome using client and therapist composite means. The working alliance was equally strong in ftf CBT and bCBT. The absence of interaction with treatment condition indicated that the working alliance was equally predictive of outcome in ftf CBT as in bCBT.

中文翻译：

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抑郁症混合与面对面认知疗法的工作联盟：随机对照试验的二次分析

介绍

我们探索了由客户和治疗师衡量的工作联盟。众所周知，工作联盟可以预测心理治疗的结果，并且通常被认为是一个重要的共同因素。这项研究提出了如何以混合形式概念化工作联盟的问题。

方法

这是一项探索性研究，源自一项比较 bCBT 和面对面认知行为疗法 (ftf CBT) 治疗抑郁症的随机对照试验。使用患者健康问卷 (PHQ-9) 测量抑郁症状的变化，使用工作联盟清单测量工作联盟。

分析

计算客户和治疗师报告的工作联盟的相关系数，然后在项目和维度级别（任务、纽带、目标）检查工作联盟。应用线性回归模型来研究工作联盟对治疗结果的预测价值。还考虑了工作联盟水平与治疗条件之间的相互作用。

结果

来访者和治疗师工作联盟评分的相关性为r  = 0.44，并且来访者对工作联盟的评分高于治疗师（x̄_客户 = 48.6，x̄_治疗师 = 44.6）。ftf CBT 和 bCBT 具有可比的联合工作联盟评级 ( x̄ _ftf  = 46.4, x̄ _bCBT  = 46.8)。除了具有高正值的项目 4 之外，项目几乎没有偏差。从客户的角度来看，总样本中的工作联盟水平并不能显着预测结果。相反，从治疗师的角度来看，它确实（b  = 0.00，p = .044)。使用这些预测变量的平均值作为复合变量也很重要（b  = 0.00，p  = .039，R ² _adj  = 0.07）。与治疗条件没有显着的相互作用。

讨论

客户和治疗师可能会强调工作联盟的不同方面。治疗师评定的工作联盟在预测结果方面优于来访者工作联盟的发现与普遍的发现相反；这种模式可能是 bCBT 特有的。

结论

客户对工作联盟的平均评分略高于治疗师。客户和治疗师以及治疗条件对尺寸偏差有不同的描述。工作联盟的治疗师评级似乎比客户评级更能预测治疗结果。联合工作联盟使用客户和治疗师的复合方法预测结果。工作联盟在 ftf CBT 和 bCBT 方面同样强大。与治疗条件没有相互作用表明工作联盟对 ftf CBT 和 bCBT 的结果具有同样的预测作用。