Interpersonal profiles in emotional disorders predict the importance of alliance negotiation for early treatment outcome

Objective: The aim of this study was to identify differential baseline profiles of interpersonal problems in patients with emotional disorders and investigate their ability to predict the extent to which alliance is important for early treatment outcome in therapy. Method: Ninety-six patients diagnosed with emotional disorders were admitted to psychotherapy at an independent practice center. After the first session, participants completed the Inventory of Interpersonal Problems and, after each of the first four sessions, the Alliance Negotiation Scale and the Outcome Questionnaire. We characterized the interpersonal problems of the sample using the circular statistics and the structural summary methods. Based on evidence of heterogeneity between patients, we conducted cluster analysis to identify differential profiles of interpersonal problems. We tested whether the identified profiles can predict the strength of the association between alliance negotiation and early treatment outcome using hierarchical linear models. Results: A two-cluster solution showed the best fit for the data. One cluster was characterized by Cold interpersonal problems (too hostile) and the other by Overly Nurturant interpersonal problems (too dependent). The identified profiles were significant predictors of the early alliance negotiation–outcome association. Overly Nurturant patients showed greater early improvements in outcome in the face of a stronger alliance negotiation. Conclusions: Results support the importance of personalized approaches using patients’ interpersonal profiles to determine the importance of alliance negotiation for early treatment outcome. Findings should be replicated in randomized controlled trials using strategies to manipulate alliance negotiation. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

What is the public health significance of this article?—Individual differences in interpersonal problems of patients with emotional disorders reveal two distinct interpersonal clusters: Cold and Overly Nurturant. Early in treatment, patients belonging to the Overly Nurturant profile benefit more from a strong alliance negotiation than do patients belonging to the Cold profile. These findings may have important implications for personalized psychotherapy for optimizing treatment outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved)