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We examined 40 psychotherapies, some delivered in combination with pharma-cotherapy, which were all conducted by cognitive behavioral or psychodynamically oriented therapists in a general hospital center for the treatment of light to moder-ate depressive disorders. Our goal was to examine the relationship between early outcome (defined as change in Beck Depression Inventory scores between sessions 2 and 15) and early therapy alliance (as measured at sessions 1 to 5 by the Working Alliance Inventory). We also wanted to concurrently examine the effect of initial depressive symptomatology (BDI at session 2) on early outcome. For the entire sample, both early alliance and initial depressive symptomatology were found to significantly correlate with outcome, the latter more strongly so. However, after di-viding the patient sample into subgroups based on different initial levels of depres-sion, early outcome for patients with depression of intermediate severity was found to be better predicted by early alliance than by initial depression. These results sug-gest that there may be a patient subgroup for whom a good early alliance optimally mitigates the self-perpetuating action of initial depression.

The Competing Influences of Initial Depressive Symptomatology and Early Alliance on Early Outcome: A Preliminary Study