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The Role of Alliance in the Relationship Between Therapist Competence and Outcome in Brief Psychodynamic Psychotherapy

Despland, Jean-Nicolas Prof.*; de Roten, Yves PhD*; Drapeau, Martin Prof.†‡§; Currat, Thierry MD*; Beretta, Véronique MPs*; Kramer, Ueli PhD*

The Journal of Nervous and Mental Disease: May 2009 - Volume 197 - Issue 5 - p 362-367
doi: 10.1097/NMD.0b013e3181a20849
Original Article

Therapist competence is a key variable for psychotherapy research. Empirically, the relationship between competence and therapeutic outcome has shown contradictory results and needs to be clarified, especially with regard to possible variables influencing this relationship. A total of 78 outpatients were treated by 15 therapists in a very brief 4-session format, based on psychoanalytic theory. Data were analyzed by means of a nested design using hierarchical linear modeling. No direct link between therapist competence and outcome has been found, however, results corroborated the importance of alliance patterns as moderator in the relationship between therapist competence and outcome. Only in dyads with alliance change over the course of treatment was it clear that competence is positively related to outcome. These findings are discussed with regard to the importance for outcome of therapist competence and alliance construction processes.

*Department of Psychiatry-CHUV, Institute for Psychotherapy, University of Lausanne, Lausanne, Switzerland; Departments of †Counselling Psychology and ‡Psychiatry, McGill University, Montreal, Canada; and §Institute of Community and Family Psychiatry, S.M.B.D. General Hospital, Montreal, Canada.

Supported by the Swiss FN grant 3200BO-100706/1 and was presented at the European Meeting of the Society for Psychotherapy Research (SPR) in Madeira, PT, March 22 to 24, 2007.

Send reprint requests to Ueli Kramer, PhD, IUP-DP-CHUV, Bâtiment des Cèdres, Site de Cery, CH-1008 Prilly-Lausanne, Switzerland. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.