What is it about?

Working alliance is considered an important determinant of outcome of psychotherapy. Our study aimed to compare the development of working alliance among patients with childhood-abuse-related posttraumatic stress disorder in three variants of prolonged exposure therapy (PE): standard PE, intensive PE (iPE), and PE preceded by skill training (STAIR+PE). We also examined the effect of alliance on treatment outcome and dropout.

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Why is it important?

We found that in the treatment of Childhood-Abuse-related Posttraumatic Stress Disorder (CA-PTSD), all three variants of prolonged exposure therapy fostered positive development of the working alliance. Across conditions, working alliance did not precede symptom decline. Therapists should strive for a strong alliance at the beginning of treatment as this reduces the likelihood of dropout.

Perspectives

This study demonstrates that individuals with PTSD report strong alliances with therapists in a variety of trauma-focused therapies. No clear evidence was found that alliance should be built prior to the start of exposure-based treatment sessions. Clinicians are advised to assess the patient's evaluation of the relationship with the therapist early in treatment, as a negative evaluation increases the chance of dropout.

Danielle Oprel
Universiteit Leiden

Read the Original

This page is a summary of: Working alliance in exposure-based treatments of posttraumatic stress disorder related to childhood abuse., Journal of Consulting and Clinical Psychology, July 2024, American Psychological Association (APA),
DOI: 10.1037/ccp0000899.
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