Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence, childhood sexual abuse history, and social support.
- 1 January 2010
- journal article
- Published by American Psychological Association (APA) in Journal of Consulting and Clinical Psychology
- Vol. 78 (6), 974-979
- https://doi.org/10.1037/a0020758
Abstract
Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline. At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures. Early alliance was associated with PE adherence (r = .32, p < .05) and overall treatment completion (r = .19, p < .05). Only trauma-related social support predicted the strength of early alliance beyond the effects of treatment condition (β = .23, p < .05); CSA history was not predictive of a lower early alliance. Given the associations with adherence, clinicians may find it useful to routinely assess alliance early in treatment. Positive trauma support, not CSA history, may be particularly important in the development of a strong early therapeutic alliance.Keywords
This publication has 14 references indexed in Scilit:
- Risk indicators and psychopathology in traumatised children and adolescents with a history of sexual abuseEuropean Child & Adolescent Psychiatry, 2007
- Role of treatment alliance in the clinical management of bipolar disorder: Stronger alliances prospectively predict fewer manic symptomsPsychiatry Research, 2006
- Therapeutic Alliance, Negative Mood Regulation, and Treatment Outcome in Child Abuse-Related Posttraumatic Stress Disorder.Journal of Consulting and Clinical Psychology, 2004
- Attachment Patterns and Working Alliance in Trauma Therapy for Victims of Political ViolencePsychotherapy Research, 2000
- Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.Journal of Consulting and Clinical Psychology, 2000
- Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review.Journal of Consulting and Clinical Psychology, 2000
- Predicting the therapeutic alliance in alcoholism treatment.Journal of Studies on Alcohol, 2000
- A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims.Journal of Consulting and Clinical Psychology, 1999
- The Role of the Alliance in the Pharmacologic Treatment of DepressionPublished by Physicians Postgraduate Press, Inc ,1997
- The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorderJournal of Traumatic Stress, 1996