THERAPEUTIC BOND FOUND TO BE KEY IN IMPROVING DEPRESSIVE SYMPTOMS
REGARDLESS OF TYPE OF TREATMENT USED
Psychotherapy, Cognitive-Behavior Therapy, Drug Therapy and Placebo Are Compared
by Janice L. Krupnick, Ph.D., Stuart M. Stotsky, M.D., Sam
Janet Moyer, M.A., John Watkins, Ph.D., Irene Elkin, Ph.D.
and Paul A.
The therapeutic bond formed between therapist
and patient has been found to be a leading influence on a patient's
recovery regardless of type of treatment used. "This is the first empirical study to compare the therapeutic
alliance established between therapist and patient and its effect
on improving depressive symptoms in not only different types of
psychotherapy but also in pharmacotherapy," said psychologist and
lead author Janice L. Krupnick, Ph.D. Dr. Krupnick and six other
researchers determined whether the therapeutic bond had an
influence on a patient's depression regardless of the treatment
modality. These researchers examined 225 depressed outpatients who received either
interpersonal psychotherapy, cognitive-behavior therapy, an
antidepressant medication (imipramine) in a supportive environment
or a placebo pill in a supportive environment by 28 therapists (10
psychologists and 18 psychiatrists).
To improve the validity of the study, videotapes of the 619
sessions were watched by trained clinical observers who rated the
depressive symptoms of the patients and the strength of the
therapeutic alliance at the third, ninth and fifteenth session.
Specifically, the clinical observers rated how much the patient's
and therapist's own contribution to the therapeutic relationship
helped reduce the patient's depression. "This study's methodology
is an improvement over previous alliance studies," said Dr.
Krupnick, "because ratings on observations of full-session
videotapes were used versus using ratings from clinical observers
of only brief segments."
In all the treatment groups, the trained evaluators reported
that improvement in the patient's mental state was attributed to
the good therapeutic relationship. And that the degree to which a
patient could be engaged in a good relationship with his/her
therapist was the leading force in reducing a patient's depression.
These findings, said Dr. Krupnick, "especially the strong
association between alliance and reduced depression in the
imipramine and placebo groups give further support to how important
the therapist-patient bond is in improving a patient's mental
state." From these conclusions and other research in this area,
Dr. Krupnick warns about the dangers of primary care doctors
treating depression with drugs when there is no therapeutic
relationship. "This could really impede a person's chance of
getting better," she said.
Janice L. Krupnick, Ph.D., Stuart M. Stotsky, M.D., Sam Simmens, Ph.D., Janet Moyer, M.A., John Watkins, Ph.D., Irene Elkin, Ph.D., Paul A. Pilkonis, Ph.D. (1998). The Role of the Therapeutic Alliance in Psychotherapy and Pharmacotherapy Outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.
Journal of Consulting and Clinical Psychology,
Vol. 64, No. 3, pp 532-539.
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