Training Community-Based Psychotherapists to Maintain a Therapeutic Alliance: A Psychotherapy Practice Research Network Study

Clinical Impact Statement Question: Does training community-based psychotherapists to improve their interpersonal skills (to be reflective, to meta communicate, to attend to patient attachment, and to manage countertransference) strengthen their capacity to be more attuned or congruent with their patients? Findings: Training improved therapist's but not patient's therapeutic alliance ratings over six sessions of therapy. Compared to untrained therapists, trained therapists were more congruent with their patients in their alliance ratings over time. For trained therapists and their patients, agreement in positive alliance ratings in a previous session was related to better patient well-being in a subsequent session. Meaning: Training community-based psychotherapists in key interpersonal skills may improve their capacity to be attuned to their patients' experiences of the therapeutic relationship. Next Steps: We will code patient and therapist behaviors from video recordings to directly assess therapist interpersonal skills and therapeutic alliance ruptures. The goal of this study was to test the efficacy of training community-based psychotherapists who were part of a practice research network to be more attuned to their patients' experiences of the therapeutic relationship. We were particularly interested in the effect of therapist training on the congruence of alliance ratings with their patients. Forty psychotherapists who treated 117 patients were randomly assigned to receive either no training or training, whose learning objectives were to help therapists to develop and maintain a therapeutic alliance. The training included workshops and ongoing consultations to help the clinician to strengthen the therapeutic relationship with the use of mentalizing, attachment theory, countertransference management, and metacommunication. Therapeutic alliance and well-being outcomes were measured at each of six consecutive early psychotherapy sessions. We used the truth and bias model and response surface analysis within a multilevel modeling context to test hypotheses. There was a significantly faster rate of alliance growth in the training versus the no training condition when the alliance was rated by therapists, but not when rated by patients. Trained therapists experienced greater temporal congruence in alliance ratings with their patients compared to untrained therapists. Patient well-being outcomes improved in a session when trained therapists and their patients agreed in their positive alliance ratings in a previous session. This association not significant among untrained therapists. Training therapists in key interpersonally focused skills may lead them to be better attuned to their patients' experiences of the therapeutic relationship.