Hostname: page-component-f554764f5-sl7kg Total loading time: 0 Render date: 2025-04-13T20:08:59.224Z Has data issue: false hasContentIssue false
  • English
  • Français

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: [email protected]
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Amador, X., Flaum, M., Andreasen, N.C., Strauss, D.H., Yale, S.A., Clark, S.C.et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994;51:826–836CrossRefGoogle ScholarPubMed
Amador, X., Strauss, D.H., Yale, S.A., Gorman, J.M.Awareness of illness in schizophrenia. Schizophr Bull 1991;17:113–132CrossRefGoogle Scholar
Amador, X.F., Strauss, D.H., Yale, S.A., Flaum, M.M., Endicott, J., Gorman, J.M.Assessment of insight in psychosis. Am J Psychiatry 1993;150:873–879Google ScholarPubMed
Bale, R., Catty, J., Watt, H., Greenwood, N., Burns, T.Measures of the therapeutic relationship in severe psychotic illness: a comparison of two scales. Int J Soc Psychiatry 2006;52:256–266CrossRefGoogle ScholarPubMed
Bortz, J., Döring, N.Forschungsmethoden und evaluation 2nd ed.BerlinSpringer 1995CrossRefGoogle Scholar
Calsyn, R.J., Klinkenberg, W.D., Morse, G.A., Lemming, M.R.Predictors of the working alliance in assertive community treatment. Community Ment Health J 2006;42:161–175CrossRefGoogle ScholarPubMed
Cohen, J.A power primer. Psychol Bull 1992;112:155–159CrossRefGoogle ScholarPubMed
Constantino, M.J., Castonguay, L.G., Schut, A.J.The working alliance: a flagship for the “scientist“practitioner” model in psychotherapyTryon, G.Counseling based on process research New YorkAllyn & Bacon 2002 81–131Google Scholar
Couture, S.M., Roberts, D.L., Penn, D.L., Cather, C., Otto, M.W., Goff, D.Do baseline client characteristics predict the therapeutic alliance in the treatment of schizophrenia?. J Nerv Ment Dis 2006;194:10–14CrossRefGoogle ScholarPubMed
Cummings, A.L., Martin, J., Hallberg, E.T., Slemon, A.Memory for therapeutic events, session effectiveness, and working alliance in short-term counseling. J Couns Psychol 1992;39:306–312CrossRefGoogle Scholar
Davis, L.W., Lysaker, P.H.Neurocognitive correlates of therapeutic alliance in schizophrenia. J Nerv Ment Dis 2004;192:508–510CrossRefGoogle Scholar
Fenton, L.R., Cecero, J.J., Nich, C., Frankforter, T.L., Carroll, K.M.Perspective is everything: the predictive validity of six working alliance instruments. J Psychother Pract Res 2001;10:262–268Google ScholarPubMed
Fitzpatrick, M.R., Iwakabe, S., Stalikas, A.Perspective divergence in the working alliance. Psychother Res 2005;15:79CrossRefGoogle Scholar
Frank, A.F., Gunderson, J.G.The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry 1990;47:228–236CrossRefGoogle ScholarPubMed
Gehrs, M., Goering, P.The relationship between the working alliance and rehabilitation outcomes of schizophrenia. Psychosoc Rehabil J 1994;18:43–54Google Scholar
Gelso, C.J., Carter, J.A.The relationship in counseling and psychotherapy: components, consequences, and theoretical antecedents. Couns Psychol 1985;13:155–243CrossRefGoogle Scholar
Gharabawi, G.M., Bossie, C.A., Turkoz, I., Kujawa, M., Mahmoud, R., Simpson, G.The impact of insight on functioning in patients with schizophrenia or schizoaffective disorder receiving risperidone long-acting injectable. J Nerv Ment Dis 2007;195:976–982CrossRefGoogle ScholarPubMed
Gibbons, M.B.C., Crits-Christoph, P., de la Cruz, C., Barber, J.P., Siqueland, L., Gladis, M.Pretreatment expectations, interpersonal functioning and symptoms in the prediction of the therapeutic alliance across supportive-expressive psychotherapy and cognitive therapy. Psychother Res 2003;13:59–76CrossRefGoogle Scholar
Grawe, K., Braun, U.Qualitätskontrolle in der Psychotherapie [Quality control in the psychotherapy practice]. Z Klin Psychol Psychother 1994;23:242–267Google Scholar
Hersoug, A.G., Monsen, J.T., Havik, O.E., Hoglend, P.Quality of early working alliance in psychotherapy: diagnoses, relationship and intrapsychic variables as predictors. Psychother Psychosom 2002;71:18–27CrossRefGoogle ScholarPubMed
Horvath, A.O., Bedi, R.P.Psychotherapy relationships that work: therapists contributions and responsiveness to patientsNorcross, J.C.The alliance New YorkOxford University Press 2002 37–69Google Scholar
Horvath, A.O., Symonds, B.D.Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Couns Psychol 1991;38:139–149CrossRefGoogle Scholar
Johnson, D.P., Penn, D.L., Bauer, D.J., Meyer, P., Evans, E.Predictors of the therapeutic alliance in group therapy for individuals with treatment-resistant auditory hallucinations. Br J Clin Psychol 2007;47:171–183CrossRefGoogle ScholarPubMed
Kay, S.R., Fiszbein, A., Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276CrossRefGoogle Scholar
Kemp, R., David, A.Psychological predictors of insight and compliance in psychotic patients. Br J Psychiatry 1996;169:444–450CrossRefGoogle ScholarPubMed
Kivlighan, D.M.Moderating effects of client attachment on the counselor experience-working alliance relationship. J Couns Psychol 1998;37:16–21Google Scholar
Kivlighan, D.M., Arthur, E.G.Convergence in client and counselor recall of important session events. J Couns Psychol 2000;47:79–84CrossRefGoogle Scholar
Klingberg, S., Sickinger, S., Wittorf, A., Buchkremer, G.Kognitiv-verhaltenstherapeutische Behandlung von Positivsymptomatik psychotischer Störungen: Hintergrund und Therapiekonzeption der POSITIVE-Studie [Cognitive-behavioral therapy on positive symptoms of psychotic disorders: background and treatment rational of the POSITIVE-study]. Nervenheilkunde 2008;27:1014–1020Google Scholar
Lehrl, S.Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B) 2nd ed.NürnbergPerimed-Spitta 1992Google Scholar
Lincoln, T., Lüllmann, E., Rief, W.Correlates and long-term consequences of poor insight in patients with schizophrenia: a systematic review. Schizophr Bull 2007;33:1324–1342CrossRefGoogle ScholarPubMed
Martin, D.J., Garske, J.P., Davis, M.K.Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 2000;68:438–450CrossRefGoogle ScholarPubMed
McCabe, R., Priebe, S.Are therapeutic relationships in psychiatry explained by patients' symptoms? Factors influencing patient ratings. Eur Psychiatry 2003;18:220–225CrossRefGoogle ScholarPubMed
McEvoy, J.P., Apperson, L.J., Appelbaum, P.S., Ortlip, P., Brecosky, J., Hammill, K.et al.Insight in schizophrenia. Its relationship to acute psychopathology. J Nerv Ment Dis 1989;177:43–47CrossRefGoogle ScholarPubMed
McEvoy, J.P., Freter, S., Merritt, M., Apperson, L.J.Insight about psychosis among outpatients with schizophrenia. Hosp Community Psychiatry 1993;44:883–884Google ScholarPubMed
Michalakeas, A., Skoutas, C., Charalambous, A., Peristeris, A., Marinos, V., Keramari, E.et al.Insight in schizophrenia and mood disorders and its relation to psychopathology. Acta Psychiatr Scand 1994;90:46–49CrossRefGoogle ScholarPubMed
Mintz, A.R., Dobson, K.S., Romney, D.M.Insight in schizophrenia: a meta-analysis. Schizophr Res 2003;61:75–88CrossRefGoogle ScholarPubMed
Neale, M.S., Rosenheck, R.A.Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv 1995;46:719–721Google Scholar
Olfson, M., Glick, I., Mechanic, D.Inpatient treatment of schizophrenia in general hospitals. Hosp Community Psychiatry 1993;44:40–44Google ScholarPubMed
Reis, B.F., Brown, L.G.Reducing psychotherapy dropouts: maximizing perspective convergence in the psychotherapy dyad. Psychotherapy 1999;36:123–136CrossRefGoogle Scholar
Saunders, S.M.Pretreatment correlates of the therapeutic bond. J Clin Psychol 2001;57:1339–1352CrossRefGoogle ScholarPubMed
Schneider, S., Klingberg, S.Die therapeutische Allianz in der rezidivprophylaktischen Psychotherapie bei schizophrenen Störungen [The therapeutic alliance in individual psychotherapy for relapse prevention in schizophrenic disorders]. Nervenheilkunde 2008;27:988–996Google Scholar
Schwartz, R.C.Insight and illness in chronic schizophrenia. Compr Psychiatry 1998;39:249–254CrossRefGoogle ScholarPubMed
Solomon, P., Draine, J., Delaney, M.A.The working alliance and consumer case management. J Ment Health Adm 1995;22:126–134CrossRefGoogle ScholarPubMed
Stewart, M., Roter, D.Communicating with medical patients LondonSage 1989Google Scholar
Svensson, B., Hansson, L.Therapeutic alliance in cognitive therapy for schizophrenic and other long-term mentally ill patients: development and relationship to outcome in an in-patient treatment programme. Acta Psychiatr Scand 1999;99:281–287CrossRefGoogle Scholar
Tarrier, N., Yusupoff, L., McCarthy, E., Kinney, C., Wittkowski, A.Some reasons why patients suffering from chronic schizophrenia fail to continue in psychological treatment. Behav Cogn Psychother 1998;26:177–181CrossRefGoogle Scholar
Tryon, G.S., Blackwell, S.C., Hammel, E.F.A meta-analytic examination of client–therapist perspectives of working alliance. Psychother Res 2007;17:629–642CrossRefGoogle Scholar
Wittorf, A., Weber, R., Herrlich, J., Wiedemann, G., Wölwer, W., Buchkremer, G.et al.Therapieakzeptanz und therapeutische Beziehung in der frühen Phase der Verhaltenstherapie bei Negativ-Symptomatik der Schizophrenie [Treatment acceptance and therapeutic relationship in the early stage of cognitive behavioral therapy on negative symptoms of schizophrenia]. Nervenheilkunde 2008;27:1007–1013Google Scholar
Yen, C.F., Yeh, M.L., Chen, C.S., Chung, H.H.Predictive value of insight for suicide, violence, hospitalization, and social adjustment for outpatients with schizophrenia: a prospective study. Compr Psychiatry 2002;43:443–447CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.