Development of the Therapeutic Alliance in Alternative Settings to Psychiatric Hospitalization: An Open Comparative Study
Abstract
Objective:
The quality of the patient-therapist alliance is one of the most consistent predictors of outcomes across therapeutic settings. In recent years, new therapeutic settings have been developed to address societal needs, such as online hospitalization and residential treatment. The aim of this article was to describe how the alliance develops in these settings.
Methods:
Patients (N=188) were recruited from Sheba Medical Center psychiatric wards (N=61), Sheba online/telepsychiatric hospitalization (N=39), and Soteria Houses (residential care) (N=88) in Israel. Patients and therapists completed the Session Alliance Inventory after the first therapy session and at discharge or treatment termination.
Results:
Strength of alliance increased significantly from pre- to posttreatment, beyond treatment setting. No significant differences were found in development of alliance over time across the three groups. Although no interaction effect was detected, exploratory simple effect analyses indicated that the Soteria group exhibited a significant increase in patient-rated (b=0.32, 95% CI=0.02, 0.63, p=0.038) and therapist-rated (b=0.31, 95% CI=0.09, 0.54, p=0.007) alliance, the hospital group showed only a significant patient-rated increase (b=0.39, 95% CI=0.06, 0.73, p=0.022), and the online group showed no increase in alliance.
Conclusions:
Two psychiatric hospitalization alternatives allowed alliances to develop in a manner similar to that in traditional hospitalization; nonetheless, patterns of alliance formation and development varied. Future studies should explore whether these dynamics affect therapy outcomes across the three treatment settings.
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.- Personal login
- Institutional Login
- Sign in via OpenAthens
- Register for access
-
Please login/register if you wish to pair your device and check access availability.
Not a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).