OBJECTIVES Working alliance is considered an important determinant of outcome of psychotherapy. Patients with posttraumatic stress disorder (PTSD) following childhood abuse (CA-PTSD) may have challenges in building interpersonal relationships, including working alliance. Phase-based treatment provides an opportunity to strengthen alliance prior to trauma-focused treatment. This study aimed to compare the development of working alliance among patients with CA-PTSD in three variants of prolonged exposure (PE) therapy: standard PE, intensive PE (iPE), and skill training in affective and interpersonal regulation + prolonged exposure (STAIR + PE). We also examined the effect of alliance on treatment outcome and dropout. METHOD Self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (Blevins et al., 2015) and patient-rated Working Alliance Inventory (Tracey & Kokotovic, 1989) were assessed in a clinical trial. We analyzed data from 138 adult patients (76.1% female; 42% non-Western). Analyses were performed using mixed-effects models. RESULTS Patients established a satisfactory alliance early in treatment, which increased over time. For PE and STAIR + PE, a larger decrease in PTSD symptom severity was related to a higher alliance in the subsequent session, but not the other way around. In STAIR + PE, a higher alliance in Phase 1 was related to lower PTSD symptoms in Phase 2. In all conditions, a higher initial working alliance was related to a lower chance of treatment dropout. CONCLUSION In the treatment of CA-PTSD, all three variants of prolonged exposure foster positive development of the working alliance. Across conditions, working alliance did not precede symptom decline. Therapists should strive for a strong alliance at the beginning of treatment as this reduces the likelihood of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

中文翻译：

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与儿童虐待相关的创伤后应激障碍的暴露治疗工作联盟。


目标 工作联盟被认为是心理治疗结果的重要决定因素。童年虐待后患有创伤后应激障碍 (PTSD) 的患者 (CA-PTSD) 可能在建立人际关系（包括工作联盟）方面面临挑战。分阶段治疗提供了在针对创伤的治疗之前加强联盟的机会。本研究旨在比较 CA-PTSD 患者在三种长期暴露 (PE) 疗法中工作联盟的发展情况：标准 PE、强化 PE (iPE) 以及情感和人际调节技能培训 + 长期暴露 (STAIR +体育）。我们还研究了联盟对治疗结果和退出的影响。方法 在临床试验中评估了《精神疾病诊断和统计手册》第五版的自我报告 PTSD 检查表（Blevins 等人，2015 年）和患者评价的工作联盟清单（Tracey & Kokotovic，1989 年）。我们分析了 138 名成年患者（76.1% 女性；42% 非西方人）的数据。使用混合效应模型进行分析。结果 患者在治疗早期就建立了令人满意的联盟，并随着时间的推移而不断增加。对于 PE 和 STAIR + PE，PTSD 症状严重程度的较大下降与后续疗程中较高的联盟相关，但反之则不然。在 STAIR + PE 中，第一阶段较高的联盟与第二阶段较低的 PTSD 症状相关。在所有情况下，较高的初始工作联盟与较低的治疗退出率相关。结论 在 CA-PTSD 的治疗中，所有三种长期接触的变体都促进了工作联盟的积极发展。在各种情况下，工作联盟并不先于症状下降。 治疗师应该在治疗开始时努力建立强有力的联盟，因为这可以减少中途退出的可能性。 （PsycInfo 数据库记录 (c) 2024 APA，保留所有权利）。