4.3 Article

Does the Working Alliance Mediate the Effect of Routine Outcome Monitoring (ROM) and Alliance Feedback on Psychotherapy Outcomes? A Secondary Analysis From a Randomized Clinical Trial

期刊

JOURNAL OF COUNSELING PSYCHOLOGY
卷 66, 期 2, 页码 234-246

出版社

AMER PSYCHOLOGICAL ASSOC
DOI: 10.1037/cou0000320

关键词

client feedback systems; common factors; mediation; routine outcome monitoring; working alliance

资金

  1. Liaison Committee for Education, Research and Innovation in Central Norway [46056812 (653510 IPH)]
  2. Tiller Mental Health Center
  3. St. Olavs University Hospital
  4. Department of Research and Development, Norwegian University of Science and Technology

向作者/读者索取更多资源

Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM system that provides session-by-session feedback on clients' well-being and the alliance. Adult individuals (N = 170) referred for hospital-based outpatient mental health treatment were randomized to individual psychotherapy either with the PCOMS ROM system, or without (treatment as usual [TAU]). Treatment was provided by the same therapists (N = 20) in both conditions. A multilevel mediation model was developed to test if there was a significant indirect effect of ROM on client impairment at posttreatment through the alliance at 2 months' treatment controlled for first-session alliance. Alliance ratings increased more from session 1 to 2 months' treatment in the ROM than TAU condition, and alliance increase was associated with less posttreatment impairment. A significant indirect effect of ROM on treatment outcomes through alliance increase (p = .043) explained an estimated 23.0% of the effect of ROM on outcomes. The results were consistent with a theory of the alliance as one mechanism through which ROM works.

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