The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders

• Main Authors: Elisabeth Cronin, Bethany L. Brand, Jonathan F. Mattanah
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2014-03-01
• Series: European Journal of Psychotraumatology
• Subjects: Dissociative; alliance; trauma; treatment; PTSD
• Online Access: http://www.ejpt.net/index.php/ejpt/article/download/22676/pdf_1

Background: Research has shown that the therapeutic alliance plays an important role in enhancing treatment outcome among individuals with a variety of disorders, including posttraumatic stress disorder (PTSD). However, the therapeutic alliance and treatment outcome has not yet been studied in dissociative disorders (DD). Objectives: The current study sought to investigate the impact of alliance on treatment outcome for DD patients. Methods: Data from a naturalistic, longitudinal international treatment study of DD patients and their therapists were analyzed to determine if the alliance, as reported by patients and therapists, was associated with treatment outcome. Results: Patients with higher self-rated alliance had fewer symptoms of dissociation, PTSD, and general distress, as well as higher levels of therapist-rated adaptive functioning. Over time, self-rated alliance scores predicted better outcomes, after controlling for patient adaptive capacities including symptom management at the time when the alliance ratings were made. Patient-rated alliance was more strongly associated with outcome than therapist-rated alliance. Conclusion: Therapists who work with DD patients should understand the importance of the alliance on treatment outcome. These findings are consistent with previous literature demonstrating the importance of developing and maintaining a strong therapeutic alliance, although the effect sizes of individuals with DD were stronger than what has been found in many other patient groups. A greater understanding of the impact of the alliance in traumatized individuals may contribute to better outcomes for these individuals.