Confidence in the therapist and confidence in the treatment predict symptomatic improvement week by week in therapy: A latent curve modeling approach.

Abstract

Previous research suggests that common relationship factors are composed of two overarching factors, "Confidence in the therapist" and "Confidence in the treatment." The aim of this naturalistic processoutcome study was to investigate the reciprocal relationships between these two constructs and patients' symptom level across treatment. The sample consisted of 587 patients who were admitted to an inpatient program and treated with psychotherapy for a range of mental health disorders, such as chronic depression, anxiety disorders, and eating disorders. Our data consisted of weekly measures of symptomatic distress (Patient Health Questionnaire) and the common relationship factors were measured weekly using a newly developed scale. Latent curve modeling with structured residuals was used to investigate the between-and within effects of week-to-week changes in the two components as predictors of subsequent symptom level. An increase in both relationship factors predicted a decrease in subsequent levels of symptoms at the withinpatient level, and the other way around, but the two relationship factors did not systematically relate to one another at the within-patient level over the course of treatment. Our findings indicate that patients' perceptions of the therapist as a person and their appraisal of the treatment, are important, different predictors of therapeutic change. Furthermore, they support prior research demonstrating a reciprocal relationship between common relationship factors and symptomatic distress and add to existing common factor theory by exploring the role of two central relationship dimensions and using a method which examines reciprocal relationships and within-patient effects simultaneously. Public Significance StatementThis study suggests that patients' appraisal of their confidence in the therapist and confidence in the treatment contributes to psychotherapeutic change above and beyond early symptom change. Thus, patients' perception of the therapist as a person, and patients' perceptions of the treatment, is important, different predictors of therapeutic change.

Psychotherapist variables that may lead to treatment failure or termination—A qualitative analysis of patients’ perspectives.

“…Still, it is serious when patients get the impression that confidentiality is at risk. Previous research has shown that patients’ trust in the psychotherapist and the treatment are important factors for treatment success (Finsrud, Nissen-Lie, Ulvenes, et al, 2022; Finsrud, Nissen-Lie, Vrabel, et al, 2022). Being professional also includes taking the lead and having a concrete plan for both individual sessions and the whole treatment while also being transparent about this.…”

Emotional and cognitive processes in psychotherapy are associated with different aspects of the therapeutic relationship.

“…For our main analyses, we applied a multivariate version of the latent curve model with structured residuals (LCM-SR; see Curran et al, 2014; Melsom et al, 2023). This multivariate model is an extension of the bivariate LCM-SR used in other process studies (see e.g., Melsom et al, 2022; Finsrud, Nissen-Lie, Ulvenes, et al, 2022, for detailed description and graphical presentation of the bivariate LCM-SR), but expanded to include three variables in the analyses. The LCM-SR is a model that is particularly suited to address our research questions of how different treatment processes and symptom distress evolve over time and how they are associated with each other .…”

“…This line of thinking is in accordance with Frank’s (Frank & Frank, 1993) ideas of therapy being effective partly due to the therapist’s ability to present a meaningful “myth” and remedy for the patient’s problems. Both Confidence in the therapist and Confidence in the treatment have been found to predict symptom change at a within-patient level week by week in therapy (Finsrud, Nissen-Lie, Ulvenes, et al, 2022). Together, these two factors make up a parsimonious model of the therapeutic relationship that seemingly captures two basic evaluations patients make about the therapeutic relationship throughout treatment.…”

“…Although a variety of relationship factors have shown to predict therapy outcome above and beyond various patient characteristics, early processes, and prior symptom change (e.g., Finsrud, Nissen-Lie, Ulvenes, et al, 2022; Flückiger, Del Re, et al, 2020; Flückiger, Rubel, et al, 2020; Zilcha-Mano et al, 2014), the associations between relationship factors and other change processes, such as rumination and emotional clarity, have not been extensively explored. Such studies might lead to increased understanding of how relationship factors are beneficial in therapy.…”