Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy

•Attempted to replicate findings of Lorenzo-Luaces, DeRubeis, and Webb (2014).•In CBT, alliance did not predict outcomes for patients with more prior episodes.•In CBT, alliance strongly predicted outcomes for patients with fewer prior episodes.•In psychodynamic therapy, alliance predicted outcome irrespective of prior episodes.•CBT-specific mechanisms may account for outcomes in more recurrent depression.

Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N = 282) at Week 5 of treatment. Overall, the alliance was a predictor of symptom change (d = 0.33). In SPSP, the alliance was a modest but robust predictor of change, irrespective of prior episodes (d = 0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d = 0.86), moderate for those with 1 prior episode (d = 0.49), and small for those with 2 + prior episodes (d = 0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.