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Title: Treatment integrity, therapeutic alliance and outcome : an evaluation of the relationship in cognitive behaviour therapy and befriending for psychosis
Author: Hammond, Katherine.
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2004
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Background Outcome studies of CBT for psychosis have shown positive results from cognitive behaviour therapy and supportive treatments. It has been suggested that this results partly from the common, non-specific aspects of therapy. Although this is possible, in many studies, treatment integrity has not been adequately examined and it may be that the cross-contamination of treatments might account for some results obtained. This research examines treatment differences and relationships with outcome, for treatment integrity and working alliance, in early sessions of CBT and befriending for psychosis. Method This study used outcome and therapy data from sixty dyads involved in a randomised controlled trial of CBT and befriending. Observer ratings of adherence, competence and alliance were made from early treatment sessions. Treatment differences in adherence, competence and alliance were examined and their relationship with global and negative symptom change was explored. Results CBT was adherent to a cognitive model of psychosis and was characterised by competent administration of techniques. Befriending did not include specific cognitive therapy techniques. There were significant differences between CBT and befriending on measures of competence and adherence. Working alliance was high in both interventions with comparable levels of therapeutic `bond' between treatments. Significant treatment differences were observed in `task'and `goal' rated alliance with higher levels observed in the CBT group. Higher levels of goal rated alliance, insight oriented techniques and competently administered specific and non-specific CBT techniques differentiated those individuals who improved and those who did not. Conclusions Befriending and CBT were procedurally different interventions, with comparable levels of therapeutic bond. Higher task and goal alliance scores suggest that patients invested more in the CBT intervention. Factors that facilitate improvement may change over the course of therapy but in early therapy, aspects of working alliance and adherent and competent administration of techniques appear to be implicated in improvement. Further research in this area is required
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available