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The Effect of Therapeutic Alliance on Dropout in Cognitive Processing Therapy for Posttraumatic Stress Disorder
Author(s) -
Sijercic Iris,
Liebman Rachel E.,
Stirman Shan Wiltsey,
Monson Candice M.
Publication year - 2021
Publication title -
journal of traumatic stress
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.259
H-Index - 134
eISSN - 1573-6598
pISSN - 0894-9867
DOI - 10.1002/jts.22676
Subject(s) - alliance , dropout (neural networks) , psychology , clinical psychology , posttraumatic stress , psychotherapist , psychological intervention , cognitive processing therapy , randomized controlled trial , therapeutic effect , cognitive behavioral therapy , psychiatry , cognition , medicine , machine learning , political science , computer science , law
Abstract A substantial number of individuals who undergo cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) drop out before receiving a full course of treatment. Therapeutic alliance, defined as the working relationship between the therapist and client, is a dynamic process within therapy that may change over time. Research suggests that therapeutic alliance is associated with dropout in various treatments. However, no studies have yet examined the association between therapeutic alliance and dropout in CPT, and few studies have examined therapeutic alliance longitudinally over the course of treatment. Examining alliance in CPT through different methods may increase clinicians’ understanding of how to tailor interventions to prevent treatment dropout. The present study examined the association between therapeutic alliance and treatment dropout among 169 participants in a randomized implementation effectiveness trial. In total, 33.1% of clients dropped out over the course of CPT, and nearly half of these individuals dropped out during the first six sessions. Continuous‐time survival analysis results indicated that mean ratings of alliance significantly predicted treatment dropout, Wald χ 2 (1, N = 167) = 4.08, Exp(β) = .64, p = .043, whereas initial alliance, late alliance, and change in alliance over treatment did not. These findings suggest that overall therapeutic alliance is an important predictor of dropout from CPT.