The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders

Research has shown that the therapeutic alliance plays an important role in enhancing treatment outcome among individuals with a variety of disorders, including posttraumatic stress disorder (PTSD). However, the therapeutic alliance and treatment outcome has not yet been studied in dissociative disorders (DD). The current study sought to investigate the impact of alliance on treatment outcome for DD patients. Data from a naturalistic, longitudinal international treatment study of DD patients and their therapists were analyzed to determine if the alliance, as reported by patients and therapists, was associated with treatment outcome. Patients with higher self-rated alliance had fewer symptoms of dissociation, PTSD, and general distress, as well as higher levels of therapist-rated adaptive functioning. Over time, self-rated alliance scores predicted better outcomes, after controlling for patient adaptive capacities including symptom management at the time when the alliance ratings were made. Patient-rated alliance was more strongly associated with outcome than therapist-rated alliance. Therapists who work with DD patients should understand the importance of the alliance on treatment outcome. These findings are consistent with previous literature demonstrating the importance of developing and maintaining a strong therapeutic alliance, although the effect sizes of individuals with DD were stronger than what has been found in many other patient groups. A greater understanding of the impact of the alliance in traumatized individuals may contribute to better outcomes for these individuals.

研究表明，治疗同盟（therapeutic alliance）在改善多种障碍患者的治疗结局中发挥着重要作用，其中包括创伤后应激障碍（posttraumatic stress disorder, PTSD）。然而，目前尚未针对分离障碍（dissociative disorders, DD）患者群体开展治疗同盟与治疗结局的相关研究。本研究旨在探究治疗同盟对分离障碍患者治疗结局的影响。本研究对一项针对分离障碍患者及其治疗师的自然主义、纵向国际治疗研究的数据进行分析，以验证患者与治疗师报告的治疗同盟是否与治疗结局存在关联。自我报告治疗同盟得分更高的患者，其分离症状、创伤后应激障碍症状与一般心理痛苦症状更少，且治疗师评定的适应功能水平更高。随着时间推移，在控制患者适应能力（包括进行治疗同盟评定时的症状管理水平）后，自我报告的治疗同盟得分仍可预测更佳的治疗结局。患者评定的治疗同盟与治疗结局的关联强度高于治疗师评定的治疗同盟。为分离障碍患者提供诊疗服务的治疗师应充分认识到治疗同盟对治疗结局的重要性。本研究结果与既往文献一致，均证实建立并维持稳固治疗同盟的重要性；不过分离障碍患者群体的效应量显著强于诸多其他患者群体的已有研究结果。进一步深入理解治疗同盟对创伤群体的影响，或有助于改善这类人群的治疗结局。