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The Effect of Working Alliance on Adherence and Outcome in Cognitive Remediation Therapy

Huddy, Vyv PhD; Reeder, Clare PhD; Kontis, Dimitris MD, PhD; Wykes, Til PhD; Stahl, Daniel PhD

The Journal of Nervous and Mental Disease: July 2012 - Volume 200 - Issue 7 - p 614–619
doi: 10.1097/NMD.0b013e31825bfc31
Original Articles

Cognitive remediation therapy (CRT) for schizophrenia has been effective in improving cognitive and global functioning outcomes. It is now important to determine what factors maximize benefit. The quality of relationship—or working alliance—between clients and therapists may be one such factor that improves outcome. To investigate this, 49 individuals with schizophrenia were recruited into a naturalistic study of the impact of CRT on work and structured activity outcomes. Participant’s cognitive skills, severity of symptoms, and social skills were assessed at baseline. Both client and therapist working alliance ratings were gathered early in therapy. After controlling for depression, clients who rated the alliance more favorably stayed in therapy longer and were more likely to improve on their main target complaint but notably not on working memory performance or self-esteem. Therapist’s ratings of the alliance were not associated with memory outcome. These findings indicate that working alliance is important for client satisfaction with therapy.

Institute of Psychiatry, Kings College London, London, England.

T.W. and D.S. are joint last authors.

Send reprint requests to Vyv Huddy, PhD, King’s College London, Institute of Psychiatry, Department of Psychosis Studies, PO Box 63, De Crespigny Park, Denmark Hill, London SE5 8AF, England. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.