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

Abstract

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. 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.

Interpersonal agency as predictor of the within-patient alliance effects on depression severity.

“…For instance, analyzing in-session rupture-repair episodes on the alliance also provided evidence of within-patient effects of alliance on outcome (Eubanks et al, 2018). Future studies might benefit from exploring how patients' interpersonal problems may have an effect on the association between alliance rupture-resolutions with outcome (Gómez Penedo, Zilcha-Mano, & Roussos, 2019).…”

“…Besides these baseline predictors, the intrinsic relational nature of the alliance suggests patients’ interpersonal problems as promising candidates to moderate the effects of alliance on therapy outcome (Gómez Penedo, Zilcha-Mano, & Roussos, 2019). Patients with certain interpersonal difficulties might benefit substantially from an improved alliance, whereas for patients with other interpersonal issues such change may not be as decisive (Constantino, Coyne, et al, 2017).…”

Latent profile analysis of interpersonal problems: Attachment, basic psychological need frustration, and psychological outcomes.

“…Empirically, scholars have begun to identify specific interpersonal profiles characterizing those with psychological disorders or personality disorders (Locke et al, 2018). In one study, two interpersonal problem profiles—cold interpersonal problems (too hostile) and overly nurturant interpersonal problems (too dependent)—were identified for patients with emotional disorders (Gómez Penedo et al, 2019). Taking both the interpersonal theoretical perspective and empirical evidence together, different interpersonal problem profiles might have differences in their levels of psychological outcomes.…”

“…Salzer et al (2011) described four interpersonal subtypes (Overly Nurturant, Intrusive, Socially Avoidant, and Nonassertive) for those with generalized anxiety disorder. Using cluster analysis and SSM, Gómez Penedo et al (2019) reported that cold interpersonal problems (too hostile) and overly nurturant interpersonal problems (too dependent) characterize patients with emotional disorders. Solomonov et al (2020) who used cluster analysis and SSM, reported that individuals with obsessive-compulsive personality disorder could be classified into two distinct interpersonal subgroups on opposite sides of the interpersonal problem circumplex: (a) “aggressive” (i.e., Vindictive-Domineering) and (b) “pleasing” (i.e., Submissive-Exploitable).…”

Propiedades psicométricas del Hopkins Symptom Checklist (HSCL-11) en Argentina: Un instrumento para monitoreo y feedback en psicoterapia

“…Uno de los ejemplos más difundidos es el del Outcome Questionnaire (OQ-45;Lambert et al, 1996;Lara, Cruz, Vacarezza, Florenzano, & Trapp, 2008), cuyo uso en países como Chile y Argentina es frecuente (p. ej., Barros et al, 2020;Gómez-Penedo, Zilcha-Mano, & Roussos, 2019;Roussos, Gómez-Penedo, & Muiños, 2018;Zilcha-Mano & Errázuriz, 2015). Dicho cuestionario se presenta como una medida psicométricamente rigurosa, que abarca los motivos de consulta más comunes de las personas que solicitan psicoterapia, y que es sensible a modificaciones en períodos breves, lo que facilita su uso para monitorear procesos de cambio.…”