Early trajectories of symptom change and working alliance as predictors of treatment outcome

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.

Keywords:

• early change
• working alliance
• growth mixture modeling
• treatment outcome
• trajectory

Disclosure Statement

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

Data Transparency and Availability Statement

The data reported in this manuscript have been collected continuously as part of a larger data collection and has not been previously published. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supplemental data

Supplemental data for this article can be accessed https://doi.org/10.1080/10503307.2022.2080028