Objective: The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). Method: The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. Results: Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. Conclusions: A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time.
Bibliographical noteFunding Information:
The contents of this article are solely the responsibility of the authors and do not necessarily represent the views of NIMH or the U.S. Department of Health and Human Services. The RAISE ETP study was supported in whole or in part with funds from the American Recovery and Reinvestment Act and the National Institute of Mental Health (HHSN-271-2009-00019C). Additional support was provided by a National Institute of Mental Health Advanced Centers for Intervention and/or Services Research award (P30MH090590) to the Principal Investigator, John Kane. Julia Browne received funding from The Tom and Karen Sox Summer Research Fellowship awarded by The Graduate School at UNC-Chapel Hill.
© 2019 American Psychological Association.
- Early intervention
- First episode psychosis
- Therapist effects
- Working relationship