Abstract

Objective: This study examined whether the working alliance mediated the effect of therapist competence on subsequent depression symptomology during Cognitive Behavioral Therapy (CBT). We also tested the potential moderation effect of alliance on subsequent depressive symptomology, based on participants’ cognitive aptitude.

Method: A total of 86 sessions were coded as the prediction interval across 50 patient-therapist dyads (age M = 39.22, SD = 8.78; 76% female). While accounting for prior depression, competence, and alliance levels, predictors were assessed early treatment (session 1; n = 45 sessions), mid-treatment (session 12; n = 41 sessions), and depressive symptomology was assessed at the subsequent session to the predictor assessments to investigate within-session variability of process variables.

Results: Mediation analysis revealed that the effect of early treatment therapist competence on symptom change was mediated by alliance (indirect effect: β = −.17, 95% percentile bootstrap CI [−.32, −.01]). The positive association involving early treatment alliance and next session outcome was conditional upon low cognitive aptitude levels.

Conclusions: Our result offers preliminary support for alliance as a mediator of the effect of competence, and that alliance-outcome relations vary as a function of client aptitude. These novel findings require replication and extension.

摘要

目的：本研究检验了工作联盟是否在认知行为治疗 (CBT) 期间调解了治疗师能力对随后抑郁症状的影响。我们还根据参与者的认知能力测试了联盟对随后的抑郁症状的潜在调节作用。

方法：总共 86 个会话被编码为 50 个患者治疗师对（年龄M  = 39.22，SD  = 8.78；76% 女性）的预测间隔。在考虑到先前的抑郁、能力和联盟水平的同时，评估了早期治疗（第 1 次；n  = 45 次治疗）、治疗中期（第 12 次治疗；n  = 41 次治疗）的预测因素，并在随后的治疗中评估了抑郁症状，以预测器评估以调查过程变量的会话内可变性。

结果：中介分析显示，早期治疗师能力对症状变化的影响是由联盟介导的（间接影响：β  = -.17, 95% 百分位自举 CI [-.32, -.01]）。涉及早期治疗联盟和下一次会议结果的积极关联取决于低认知能力水平。

结论：我们的结果初步支持联盟作为能力影响的中介，联盟与结果的关系随着客户能力的变化而变化。这些新发现需要复制和扩展。