Original ArticlesNegative Symptoms and Poor Insight as Predictors of the Similarity Between Client and Therapist Ratings of Therapeutic Alliance in Cognitive Behavior Therapy for Patients With SchizophreniaLysaker, Paul H. PhD*†; Davis, Louanne W. PsyD*†; Buck, Kelly D. CNS*; Outcalt, Samantha PhD*†; Ringer, Jamie M. PsyD*†Author Information *Roudebush VA Medical Center, Indianapolis, IN; and †Indiana University School of Medicine, Indianapolis, IN. Supported by the VA Rehabilitation Research and Development Service. Send reprint requests to Paul Lysaker, PhD, Roudebush VA Medical Center (116H), 1481 West 10th St, Indianapolis, IN 46202. E-mail: [email protected]. The Journal of Nervous and Mental Disease: March 2011 - Volume 199 - Issue 3 - p 191-195 doi: 10.1097/NMD.0b013e31820c73eb Buy Metrics Abstract Recent studies have found that clients with schizophrenia rate therapeutic alliance more highly than therapists. Unclear is whether there are clinical characteristics which predict the degree of difference in client and therapist ratings. To explore this, we correlated client and therapist ratings of therapeutic alliance with baseline assessments of positive negative, and disorganized symptoms and awareness of need for treatment. Participants were 40 adults with schizophrenia enrolled in a 6-month program of cognitive behavior therapy. Results indicated that clients produced higher ratings of therapeutic alliance than therapists and that therapist and client general ratings were more disparate when clients had fewer negative symptoms and better insight. Higher overall client ratings of therapeutic alliance were linked to lower levels of positive, negative, and disorganized symptoms and better awareness of need for treatment. Higher overall therapist ratings were linked only to lower levels of disorganized symptoms among clients. © 2011 Lippincott Williams & Wilkins, Inc.