The working alliance (WA) has been widely identified as the key concept for psychotherapy and allied health care services. The WA, measured at different phases of diverse kinds of therapies, has been shown to robustly predict posttreatment outcomes. But the way the clients' conceptualization of the alliance evolves overtime, and the relation between this kind of conceptual change and subsequent symptom improvements, has not been investigated. Dynamic Latent Class Structural Equation Models (DLC-SEM) were applied to data drawn from two randomized clinical trials of cognitive-behavioral therapy for generalized anxiety disorder (N = 57 and 80) to evaluate several potential models of the relation between the conceptual/structural changes in patients' self-reports of the quality of the alliance and subsequent treatment outcomes. Inspection of the DLC-SEM models suggests that, overtime, between 63% and 66% of the better session-level outcome clients switched from three factors (task, goal, bond) to an integrated single factor conceptualization of the therapeutic alliance. The study indicates that the majority of patients evolve their concept of the alliance overtime: The previously distinct alliance elements become integrated into a single factor construct. These findings suggest that if such overtime development is generalizable across diverse patient/treatment populations, future research ought to take these developments into account both methodologically (i.e., how alliance is measured) and in analyzing time-series data (e.g., using DLC-SEM). By modeling the patient's dynamic concept evolution, this initial study shows a potential to empirically explore prior theoretical propositions of the evolutions (or stability) of the alliance overtime. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

---

患者联盟概念的演变及其与结果的关系：动态潜在类结构方程建模方法。

工作联盟（WA）已被广泛认为是心理治疗和相关医疗保健服务的关键概念。在不同治疗的不同阶段测量的 WA 已被证明可以有力地预测治疗后的结果。但是，客户对联盟的概念化方式随着时间的推移而演变，以及这种概念变化与随后的症状改善之间的关系，尚未得到调查。动态潜在类别结构方程模型 (DLC-SEM) 应用于从认知行为疗法治疗广泛性焦虑症（N = 57 和 80）的两项随机临床试验中提取的数据，以评估概念/结构之间关系的几个潜在模型患者对联盟质量和后续治疗结果的自我报告的变化。对 DLC-SEM 模型的检查表明，随着时间的推移，63% 到 66% 的更好的会话级结果客户从三个因素（任务、目标、纽带）转换为治疗联盟的综合单因素概念化。该研究表明，大多数患者会随着时间的推移演变他们的联盟概念：以前不同的联盟元素被整合到一个单一的因素结构中。这些发现表明，如果这种加班发展可以在不同的患者/治疗人群中推广，那么未来的研究应该在方法学（即如何衡量联盟）和分析时间序列数据（例如，使用 DLC-SEM ）。通过对患者的动态概念演变进行建模，这项初步研究显示了在经验上探索联盟加班演化（或稳定性）的先前理论命题的潜力。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。