Stability of therapeutic alliance and its relationship to outcome in short-term inpatient psychiatric care

The relationship of therapeutic alliance to patient and treatment characteristics and to outcome, was studied in a sample of 106 patients consecutively admitted to a short-term psychiatric ward. The main finding was that a better therapeutic alliance at discharge was related to a greater improvement in symptoms during treatment. A multivariate model for prediction of outcome revealed a significant contribution from therapeutic alliance at discharge but not from alliance at admission or from changes in alliance during treatment. Improvement in alliance was seen in 41.5% of the patients, no change in 28.3% and a deterioration in 30.2%. Patients who improved their alliance did not differ from the others in background characteristics, but were more often subject to psychopharmacological treatment and were more often treated in a basic activation group. Patients with a stable poor alliance more often stated physically oriented target complaints at admission while patients with a stable satisfactory alliance more often presented interpersonally related complaints. It is concluded that further research in the field would benefit from a closer description of the change in the alliance and its relationship to treatment characteristics and outcome.