Early symptom change in adult outpatients: Relationship with patient characteristics and therapeutic alliance.

OBJECTIVE: This study has three aims: (1) to identify early change trajectories, (2) to examine patient characteristics predicting trajectory classes, and (3) to investigate the moderating effect of trajectory class membership on the working alliance. METHOD: In a sample of 402 outpatients (M age = 38.27, 64.9% women), outcome scores (OQ-45) on three time points (sessions 1, 3, and 5) were analysed by means of Latent Class Growth Curve Analysis. A multinomial logistic regression was used to investigate whether patient's age, gender, initial distress (OQ-45), and personality traits (Dimensional Assessment of Personality Pathology-Short Form) predicted trajectory class membership. A repeated-measures ANOVA examined whether differences in trajectory classes moderated the alliance quality (Working Alliance Inventory-Short version) over time. RESULTS: Four trajectory classes were identified: High distress-no change; moderate/high distress-small improvement, low distress-moderate improvement, and moderate/low distress-strong improvement. Gender, initial distress, and emotion dysregulation significantly predicted patients' trajectory class membership. The Task/Goal alliance component increased linearly over time, whereas the Bond component followed a reversed U-shaped pattern. The alliance was not moderated by trajectory class membership. CONCLUSIONS: Four clinically relevant subgroups could be identified on the basis of the early symptom change trajectories. Gender, initial psychological distress, and emotion dysregulation predicted patient's trajectory class membership. Trajectory class membership did not influence the development of the early working alliance. PRACTITIONER POINTS: As early change in highly distressed patients (Axis I and II) is not characterized by significant symptom change, clinicians should support and facilitate emotion regulation and social skills. Investing in a strong alliance is recommended, although it does not differentiate early responders from non-responders.

Structural characteristics and external correlates of the Working Alliance Inventory-Short Form.

Controversy remains on the psychometric properties of the Working Alliance Inventory-Short Form (WAI-S). In the present study we first examined the factor structure and reliability of WAI-S scores in a sample of 557 Flemish mental health consumers. Subsequently, we investigated the relationship between early alliance quality and client's psychological dysfunctioning (symptomatic distress, interpersonal functioning and personality pathology). Participants completed the Outcome Questionnaire and the Dimensional Assessment of Personality Pathology-Short Form at start of treatment. The WAI-S was completed after the third treatment session. The structure of the WAI-S was examined using confirmatory factor analysis. Four different factor models were compared. Internal consistencies of the scales were ascertained using the Cronbach's alpha coefficient. Pearson correlations were calculated to determine the relationships between alliance ratings and the independent variables. CFA resulted in a two-factor model, with a Bond component (Contact) and a Task-Goal (Contract) component. Reliability of the WAI-S subscale scores proved to be very good. Symptomatic distress, interpersonal dysfunctioning and personality traits were associated to the Contract component of the alliance, but not to the Contact component. Clinical implications, limitations and suggestions for further research are formulated.

Clinicians' Attitudes Towards Outcome and Process Monitoring: A Validation of the Outcome Measurement Questionnaire.

Valid and reliable instruments to measure monitoring attitudes of clinicians are scarce. The influence of sociodemographics and professional characteristics on monitoring attitudes is largely unknown. First, we investigated the factor structure and reliability of the Outcome Measurement Questionnaire among a sample of Flemish mental health professionals (n = 170). Next, we examined the relationship between clinicians' sociodemographic and professional characteristics and monitoring attitudes. Construct validity was determined using a confirmatory factor analysis. Internal consistency was ascertained using Cronbach's alpha. Mean level differences in monitoring attitudes related to clinicians' gender, work setting, level of education and psychotherapeutic training, were investigated using ANOVAs. The relationships between clinicians' age, clinical experience and attitudes were calculated using the Pearson correlation coefficient. A model with one general factor and a method factor referring to reverse-worded items best fitted our data. Internal consistency was good. Clinicians with psychotherapeutic training reported more favorable monitoring attitudes than those without such training. Compared to clinicians working in subsidized outpatient services, private practitioners and clinicians from inpatient mental health clinics had more positive attitudes. Results highlight the need for sustained and targeted training, with particular focus on transforming measurement data into meaningful clinical support tools.