Agreement in patient-therapist alliance ratings and its relation to dropout and outcome in a large sample of cognitive behavioral therapy for panic disorder.

Objective The therapeutic alliance is related to treatment outcome but less is known about the agreement on alliance between patients and therapists and its relationship to outcomes. We examined the association of patient-therapist congruence of alliance perceptions, early and late in cognitive behavioral therapy for panic disorder in relation to symptom reduction and dropout. Method: Patients (n = 181) and their therapists provided alliance ratings early and late during 11-session treatment. Independent evaluators rated patients' symptomatic levels post-treatment. Polynomial regression and response surface analysis were used to examine congruence as a predictor of outcome. Results: Early in therapy, stronger combined patient-therapist alliances, regardless of agreement, predicted lower symptom severity at the end of therapy and a lower likelihood of dropout. Late in treatment, the outcome was worse when therapist ratings of the alliance were higher than those of the patient. Conclusions: Therapist-patient agreement on the strength of the alliance is important for symptom improvement and dropout. The study highlights the importance of understanding the dyadic nature of the alliance and its impact on therapeutic change.

Patient-therapist congruence and incongruence of process expectations during psychotherapy.

Recent studies suggest that patient-therapist congruence of expectations affects psychotherapy outcome. Nonetheless, most studies assessing expectations in their dyadic context have focused on outcome expectations. This study was aimed to assess whether patients and therapists view expected processes similarly, and whether these beliefs change over time to become more congruent or more dissimilar. Patients (N = 75) were assessed for process expectations at baseline and at 3 months into treatment, and their therapists (N = 17) reported on their general expectations only once, prior to the initiation of treatment. Multilevel models were fitted to assess differences between patients' and therapists' process expectations at baseline and after 3 months and changes in level of congruence. The results indicated that at baseline, therapists perceived the processing of therapist-patient relations as the expected therapeutic process, whereas patients viewed the provision of tools of cognitive control as such. No significant changes in patients' expectations after 3 months of treatment were detected; however, therapists' higher expectations of the provision of tools for cognitive control predicted increases in patients' rankings of this process. These results suggest that patients and therapists are incongruent in their views of the expected therapeutic process, and that therapists' initial views of the therapeutic process affect patients' beliefs. These findings highlight the importance of investigating process expectations in the dyadic context and set the stage for subsequent process-outcome demonstrations, focusing on the effect of patient-therapist congruence of process expectations as a potential predictor or mediator of psychotherapy outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).