Clinical factors and early life experiences associated with therapeutic alliance development in treatment for depression or binge eating

Abstract

Objective:

This study examines childhood and clinical factors theorized to impact therapeutic alliance development over the course of psychotherapy.

Method:

Raters assessed the therapeutic alliance of 212 client-therapist dyads, participating in two randomized controlled trials of schema therapy and cognitive behavioural therapy for binge eating or major depression, at three time points. Linear mixed models were used to characterize therapeutic alliance development over time and assess the influence of childhood trauma, perceived parental bonding, diagnosis and therapy type on scores.

Results:

Participants differed in initial alliance ratings for all subscales but had similar growth trajectories in all but the patient hostility subscale. A diagnosis of bulimia nervosa or binge eating disorder predicted greater initial levels of client distress, client dependency and overall client contribution to a strong therapeutic alliance, compared with a diagnosis of depression. Therapy type, childhood trauma and perceived parental bonds did not predict alliance scores.

Conclusion:

Findings highlight the potential influence of clinical and personal characteristics on alliance strength and development, with implications for maximizing treatment outcomes through anticipating and responding to these challenges.

Keywords:

• therapeutic alliance
• linear mixed models
• childhood trauma
• parental bonding

Acknowledgements

We acknowledge study coordinators Helen Kleindienst, Caroline Bray, Sarah Rowe, Andrea Bartram and Julia Martin.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Ethics Statement

The Depression and Binge Eating studies both obtained ethical approval from the relevant bodies and were lodged with the Australian and New Zealand Clinical Trials Registry (depression study registry number: ACTRN12605000723684; binge eating study registry number: ACTRN12605000721606). Additionally, this study has sought and received approval from the University of Canterbury. Human Research Ethics Committee. All participants provided informed written consent for their participation.

Data Availability Statement

The data included in this manuscript have not been made publicly available for ethical and privacy reasons.

Supplemental Data

Supplemental data for this article can be accessed at https://doi.org/10.1080/10503307.2023.2191800.

Additional information

Funding

This research was supported by funding from a University of Canterbury Doctoral Scholarship, a Lottery Health Grant, and a Programme Grant from the Health Research Council of New Zealand [grant number HRC04/292B].