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The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia

Published online by Cambridge University Press:  16 April 2020

Andreas Wittorf ,
Ute Jakobi ,
Andreas Bechdolf ,
Bernhard Müller ,
Gudrun Sartory ,
Michael Wagner ,
Georg Wiedemann ,
Wolfgang Wölwer ,
Jutta Herrlich  and
Gerhard Buchkremer
...Show all authors
Andreas Wittorf*
Affiliation:
University of Tuebingen, Department of Psychiatry and Psychotherapy, Tuebingen, Germany
Ute Jakobi
Affiliation:
University of Tuebingen, Department of Psychiatry and Psychotherapy, Tuebingen, Germany
Andreas Bechdolf
Affiliation:
University of Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany ORYGEN Research Centre, Melbourne, Australia University of Melbourne, Department of Psychiatry, Melbourne, Australia
Bernhard Müller
Affiliation:
University Clinics Essen, Clinic for Psychiatry and Psychotherapy, Essen, Germany
Gudrun Sartory
Affiliation:
University of Wuppertal, Department of Clinical Psychology and Psychotherapy, Wuppertal, Germany
Michael Wagner
Affiliation:
University of Bonn, Department of Psychiatry and Psychotherapy, Bonn, Germany
Georg Wiedemann
Affiliation:
University of Frankfurt, Department of Psychiatry and Psychotherapy, Frankfurt, Germany Clinical Centre Fulda, Clinic for Psychiatry and Psychotherapy, Fulda, Germany
Wolfgang Wölwer
Affiliation:
University of Duesseldorf, Department of Psychiatry and Psychotherapy, Duesseldorf, Germany
Jutta Herrlich
Affiliation:
University of Frankfurt, Department of Psychiatry and Psychotherapy, Frankfurt, Germany
Gerhard Buchkremer
Affiliation:
University of Tuebingen, Department of Psychiatry and Psychotherapy, Tuebingen, Germany
Stefan Klingberg
Affiliation:
University of Tuebingen, Department of Psychiatry and Psychotherapy, Tuebingen, Germany
*
*Corresponding author. Consultant Clinical Psychologist, University of Tuebingen, Department of Psychiatry and Psychotherapy, Osiander Strasse 24, 72076 Tuebingen, Germany. Tel.: +49 (0)7071 298 0941; fax: +49 (0)7071 29 4141. E-mail address: andreas.wittorf@med.uni-tuebingen.de
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Abstract

Background

The consistent association between therapeutic alliance and outcome underlines the importance of identifying factors which predict the development of a positive alliance. However, only few studies have examined the association between pretreatment characteristics and alliance formation in patients with schizophrenia.

Objective

The study examined whether symptoms and insight would predict the therapeutic alliance in psychotherapy of schizophrenia. Further, the associations and differences between patient and therapist alliance ratings were studied.

Methods

Eighty patients with schizophrenia spectrum disorders received manual-based psychotherapy. Assessment of symptoms and insight was conducted at baseline, and questionnaire-based alliance ratings were obtained three weeks into treatment. Patient and therapist alliance ratings were examined separately.

Results

Patient and therapist alliance ratings were not significantly correlated (r = 0.17). Patient ratings of the alliance were significantly higher than the ratings of their therapists (d = 0.73). More insight in psychosis significantly predicted higher patient ratings of the alliance. Less positive and negative symptoms were significant predictors of higher therapist alliance ratings.

Conclusion

The findings indicate that symptoms and insight have an influence on the therapeutic alliance in the treatment of schizophrenia spectrum disorders. Patients' and therapists' perceptions of the alliance do not seem to demonstrate much convergence.

Keywords

SchizophreniaPsychotherapyTherapeutic alliancePredictionSymptomsInsight
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 4 , May 2009 , pp. 259 - 267
Copyright
Copyright © Elsevier Masson SAS 2009

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