Clinical trial NCT03453957: Therapeutic Alliance Tensions and Repair in Psychotherapy Practices
Official title: Therapeutic Alliance Tensions and Repair in Psychotherapy Practices: A Psychotherapy Practice Research Network (PPRNet) Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Psychotherapy
Therapeutic Alliance
Keywords: Practice based research
Lead sponsor: University of Ottawa
Sponsor class: OTHER
Collaborators: name: Canadian Institutes of Health Research (CIHR)
First posted: 2018-03-05
Enrollment: 81
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This will be a 2-arm, parallel, prospective, single-blind cluster RCT with 1-1 allocation comparing: (a) therapists who receive the professional development intervention to identify and repair alliance tensions at the study outset versus (b) therapists who receive the intervention after participation is complete (no training control). Therapists will be randomized to study condition and patients will be clustered within therapists. Randomization will control for: (a) the effect of therapist variables (age, gender, theoretical orientation, experience, differing initial skill level) on competence, therapeutic alliance, or patient outcomes; (b) potential biases caused by pre-treatment patient variables (symptom severity, co-morbidity, chronicity, psychoactive medications); and (c) treatment or study factors (e.g. frequency of sessions, time to complete the study sessions, treatment received after the study sessions). Patients will be blind to therapist study arm allocation.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This study evaluates a professional development program intended to improve the relationship or alliance between therapists and patients/clients who are receiving psychotherapy in the community. Half of the participating therapists will receive training to detect and improve alliance with new patients while half will not. The professional development training is expected to improve therapists effectiveness in identifying and correcting alliance tensions which will, in turn, improve therapeutic outcomes for patients/clients.

Detailed description: Psychotherapy is the treatment of choice for many mental disorders, yet there is a gap between research and practice. Research indicates that: the therapist-patient alliance is important to reduce patient symptoms, alliance tensions are detrimental to patients, and those therapists who identify and repair alliance tensions can improve patient outcomes. In this study we will use state of the art research to train community-based therapists in evidence-based interventions to identify and repair alliance tensions. Trained therapists and their patients will be compared to therapists who provide usual care to their patients. Improvement in therapists' skills in identifying and repairing alliance tensions and how this is associated with better patient mental health outcomes will be measured. Trained therapists will be interviewed to identify the best ways of improving the training and disseminating the findings to psychotherapists across Canada. Research to improve practicing therapists' ability to identify and repair therapeutic alliance tensions will result in better mental health outcomes for patients.

Eligibility criteria: Therapist

Inclusion Criteria:

* regulated health professional
* in good standing with a Canadian provincial regulatory college
* scope of practice includes psychotherapy
* ability to add 3 or more new, English speaking clients to caseload over 6 to 9 months
* ability to obtain timely permission to conduct research from therapist's employing institution or health group when applicable

Exclusion Criteria:

* none

Patient/Client

Inclusion Criteria:

* 18 years of age or older
* will participate in psychotherapy sessions in English
* will see the study-affiliated therapist for a minimum of 6 sessions in the next 6 months

Exclusion Criteria:

* already seeing another therapist
* diagnosed with a neurocognitive disorder
* diagnosed with a psychotic disorder
* expressed suicidal behaviour in the past six months as assessed by their participating therapist

Primary outcomes:
measure: Mean tension resolution rating scale
timeFrame: 6 therapy sessions over 6 weeks up to 6 months depending on the frequency of therapy
Secondary outcomes:
measure: Generalized Anxiety Disorder 7-item scale (GAD-7) change from baseline
timeFrame: baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy
measure: Patient Health Questionnaire 9-item scale (PHQ-9) change from baseline
timeFrame: baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy
Other outcomes:
Locations:
city: Ottawa
country: Canada
facility: University of Ottawa
state: Ontario
city: Toronto
country: Canada
facility: Mt. Sinai Hospital
state: Ontario
Study officials:
affiliation: University of Ottawa
name: Giorgio Tasca, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References: