The relevance of the working alliance for diagnosis and treatment selection in psychotherapy patients

The process of treatment selection in psychotherapy is still not very well understood. As process-outcome-research has been able to demonstrate that the working alliance is predictive for therapy success, the present study addressed the question as to whether the therapeutical relationship is as well relevant for both the diagnostical process and treatment selection. The sample consisted of n = 301 patients presenting at a psychotherapy outpatient department. The quality of the working alliance was assessed immediately after the diagnostical interview using a scale called "initial working alliance" which was developped by Rudolf in the Berlin Psychotherapy Study. Findings are presented concerning associations with sociodemographic (effect of age) and disorder-related variables (effect of diagnostical classification). The working alliance was significantly correlated with features of patients' subjective theories of the illness, such as causal attributions, locus of control, and treatment expectations. Furthermore, there were substantial correlations with indicators of a common understanding of the problem of the patient, as judged by the interviewer. Moreover, it could be demonstrated that the selection of both psychotherapeutic measures and settings was influenced by the quality of the therapeutic relationship. Finally, correlations between the working alliance and prognostic ratings proved to be very high. Thus, prognostical judgements may be conceptualized as judgements of the question if the therapist can imagine that he personally would accept this particular patient for treatment, on the basis of his or her experience of the relationship with the patient. These findings suggest that the working alliance has a high significance in the process of diagnosis and treatment selection.