The Role of Theory-Specific Techniques and Therapeutic Alliance in Promoting Positive Outcomes: Integrative Psychotherapy for World Trade Center Responders.

World Trade Center responders demonstrate high symptom burden, underscoring the importance of refining treatment approaches for this cohort. One method is examining the impact of therapy techniques on outcomes, and the interactions between technique and alliance on outcomes. This study a) examined the interaction of early treatment techniques on integrative psychotherapy outcomes and b) explored whether associations differed at varying levels of alliance. Twenty-nine adult responders diagnosed with partial or full posttraumatic stress disorder received outpatient psychotherapy and completed weekly measures of alliance, technique, and symptom distress. Analyses indicated significant interactions between 1) alliance and psychodynamic interventions on outcomes and 2) alliance and cognitive behavioral (CB) interventions on outcomes. Clients with high alliance had better outcomes when their therapist used fewer CB techniques. No meaningful differences were found between technique and outcomes for clients with lower alliance. These findings reiterate the critical roles technique and responsiveness to the alliance play in engendering successful outcomes.

Sudden gains and deteriorations in the treatment of posttraumatic stress disorder in World Trade Center responders.

This study sought to examine the prevalence of sudden gains and deteriorations (i.e., symptom reduction/improvement during treatment) and their influence on treatment outcomes among World Trade Center responders with probable posttraumatic stress disorder. Thirty-six outpatient clients received at least three sessions of integrative psychotherapy, which included elements of psychodynamic and cognitive-behavioral therapy approaches, under routine clinical conditions. Approximately 19% of clients experienced a sudden gain and 27% of clients experienced a sudden deterioration. Those who experienced deteriorations had worse therapy outcomes compared with those who did not. Clinical implications are discussed, including the importance of routine monitoring of client treatment response for sudden deteriorations to enhance positive treatment outcomes. Future research with larger samples is needed to further evaluate the mechanisms of sudden gains and sudden deteriorations in this population.