Adherence to Interventions in Integrative Treatment: Associations With Therapeutic Alliance and Early Outcomes

ABSTRACT Background Early response in psychotherapy has received considerable attention over the past decades. However, limited evidence exists on how specific interventions are used in integrative treatments and how they relate to early therapeutic alliance and symptom change. This study investigates the impact of cognitive interventions within an integrative treatment approach in a naturalistic clinical setting. Methods Ninety‐three patients diagnosed with emotional disorders completed the Outcome Questionnaire (OQ.45) and Alliance Negotiation Scale (ANS) after the first four sessions of psychotherapy. Meanwhile, therapists completed the Comparative Psychotherapy Process Scale (CPPS) to measure cognitive interventions in the same time‐frame. To analyse the effects of cognitive interventions, we conducted hierarchical linear models (HLM) with a three‐level structure (i.e., repeated measures nested within patients nested within therapists), disaggregating between‐ and within‐patient effects of interventions and including cross‐level interactions of those components. Results The models showed no significant main effects of cognitive interventions on neither the between‐patient nor the within‐patient component of early alliance or early outcomes. However, there was a significant cross‐level interactive effect of the between‐ and within‐patient cognitive technique effects on early alliance. In the context of a generally high level of use of cognitive interventions, negative deviations in their use were beneficial for the alliance. When predicting early outcomes, the same interactive effect was non‐significant ( p = 0.06). Conclusion Therapist's flexibility appears to be an important factor for the development of the therapeutic alliance which, in turn, can also help to achieve better psychotherapy outcomes. Training and clinical implications are discussed.