Therapeutic alliance and outcome in routine psychiatric out-patient treatment: Patient factors and outcome

Objective. This study investigated the importance of the therapeutic alliance in a routine psychiatric out-patient unit regarding treatment outcome and the influence of patient factors. Design. The study had a naturalistic and longitudinal design where the treatments the patient received were determined by the normal routines at the unit and were performed by a variety of staff representative of a psychiatric out-patient unit. Method. Newly admitted patients were diagnosed according to the International Classification of Diseases - 10th Revision and completed questionnaires regarding the therapeutic alliance, symptoms, and interpersonal problems at the beginning and termination of their treatment (N = 76). The time limit for the termination assessments was set at 18 months. Results. The therapeutic alliance at the beginning of treatment did not correlate with outcome, however, at the end of the treatment the alliance significantly explained about 15% of the variance of the outcome (global severity index). An improvement of the alliance during the treatment significantly correlated with most of the outcome variables. The relation of the alliance to outcome was equal among the different diagnosis groups and treatment forms. Conclusion. The results showed that the therapeutic alliance is an important variable for treatment outcome in routine psychiatric treatment, and improving the therapeutic alliance may be one of the most important factors for increasing the total effectiveness of a treatment unit.