Quality of the therapeutic working alliance as a factor in intensive residential treatment of obsessive-compulsive disorder

• Published in: Psychotherapy research Vol. 33; no. 4; pp. 442 - 454
• Main Authors: Wheaton, Michael G., Mcingvale, Elizabeth, Van Meter, Anna R., Björgvinsson, Thröstur
• Format: Journal Article
• Language: English
• Published: England Routledge 19.05.2023; Taylor & Francis Ltd
• Subjects: Cognitive-behavioral factors; cognitive-behavioral therapy (CBT); exposure and response prevention (EX/RP); Humans; intensive residential treatment; Intensive treatment; Neuroses; Obsessive compulsive disorder; Obsessive-compulsive disorder (OCD); Obsessive-Compulsive Disorder - therapy; Patient admissions; Ratings & rankings; Residential treatment; Residential Treatment - methods; Therapeutic Alliance; Therapeutic alliances; Treatment Outcome; working alliance; Obsessive-compulsive disorder (OCD); therapeutic alliance; intensive residential treatment; exposure and response prevention (EX/RP); working alliance; cognitive–behavioral therapy (CBT)
• ISSN: 1050-3307; 1468-4381
• DOI: 10.1080/10503307.2022.2138618

Intensive residential treatment (IRT) for obsessive-compulsive disorder (OCD) includes frequent meetings with a cognitive-behavioral therapist. We examined whether this therapeutic working alliance relates to IRT outcomes. Data came from a naturalistic sample of patients with OCD (n = 124) who received IRT at a specialty OCD clinic. Patients completed measures of OCD severity and well-being at admission and discharge. Both the patient and treating psychologist completed the Working Alliance Inventory-Short Form (WAI-SF). Alliance ratings were tested as predictors in models predicting outcomes (discharge scores adjusting for baseline and treatment duration) as well as logistic regression predicting treatment response (≥35% symptom reduction in OCD symptoms). Patient and clinician ratings of the quality of the alliance were weakly yet significantly correlated. Patient ratings of the alliance predicted outcomes, while therapist ratings did not. Moreover, greater discrepancy between patient and client ratings predicted worse outcomes. Patient ratings of the task dimension of the alliance uniquely related to responder status. Patient perceptions of the working alliance, particularly as pertaining to agreement on therapeutic tasks, related to success with IRT for OCD. Further study is needed test interventions to improve task alliance as a strategy to enhance treatment.