ABSTRACT

Objective

We aim to examine how different trajectories of symptom change and working alliance in early psychotherapy predict treatment outcomes.

Method

We performed a growth mixture model (GMM) to examine trajectories of symptom change and working alliance in the first five therapy sessions in a sample of 272 outpatients and tested the association of early symptom trajectories and alliance patterns with treatment outcome.

Results

We identified two symptom trajectories: high symptom/steady change (63.2%) and early improving (36.8%), and four alliance development patterns: undeveloped alliance (40.1%), strengthening moderate alliance (31.6%), optimal alliance (17.3%), and improved alliance (11%) in early psychotherapy. The symptom trajectories and alliance patterns both independently and interactively predicted treatment outcomes. The optimal alliance was generally associated with the best outcome. The effect of improved alliance on treatment outcome was moderated by symptom trajectories: for high symptom/steady change subgroup, the improved alliance was related to better treatment outcome, whereas for early improving subgroup, the improved alliance was associated with poorer outcome.

Conclusions

Patients fell into different trajectories regarding symptom reduction and alliance development in early psychotherapy that affected final treatment outcome. Combining early symptom trajectories and alliance trajectories simultaneously can facilitate routine outcome monitoring and contribute to the prediction of treatment outcome.

中文翻译：

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症状变化的早期轨迹和工作联盟作为治疗结果的预测指标

摘要

客观的

我们旨在研究早期心理治疗中症状变化的不同轨迹和工作联盟如何预测治疗结果。

方法

我们执行了一个增长混合模型 (GMM)，以检查 272 名门诊患者在前五次治疗期间的症状变化轨迹和工作联盟，并测试了早期症状轨迹和联盟模式与治疗结果的关联。

结果

我们确定了两种症状轨迹：高症状/稳定变化（63.2%）和早期改善（36.8%），以及四种联盟发展模式：未开发联盟（40.1%）、加强适度联盟（31.6%）、最佳联盟（17.3%），并改善了早期心理治疗中的联盟(11%)。症状轨迹和联盟模式既独立又交互地预测了治疗结果。最佳联盟通常与最佳结果相关。改善联盟对治疗结果的影响由症状轨迹调节：对于高症状/稳定变化亚组，改善的联盟与更好的治疗结果相关，而对于早期改善的亚组，改善的联盟与较差的结果相关。

结论

在影响最终治疗结果的早期心理治疗中，患者在症状减轻和联盟发展方面陷入了不同的轨迹。同时结合早期症状轨迹和联盟轨迹可以促进常规结果监测并有助于预测治疗结果。