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Eur J Psychotraumatol. 2014 Mar 6;5. doi: 10.3402/ejpt.v5.22676. eCollection 2014.

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

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1
Department of Psychology, Towson University, Towson, MD, USA.

Abstract

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.

KEYWORDS:

Dissociative; PTSD; alliance; trauma; treatment

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