It takes two to heal: Trait-like and state-like contributions to the therapeutic bond and their association with therapeutic change

OBJECTIVE: The therapeutic alliance is a strong predictor of treatment outcome. Recent research emphasizes distinguishing between trait-like and state-like alliance. This study used the Social Relations Model (SRM) to analyze the variance attributable to the different trait and state components. Specifically, we focused on the bond component of the alliance and examined the extent to which SRM elements - Perceiver effect (evaluating relationships consistently), Target effect (being consistently perceived by others), and Relationship effect (influences specific to the dyad) contribute to the bond variance, and their associations with treatment outcome. METHOD: Bond ratings of 118 patients with major depressive disorder receiving psychodynamic psychotherapy, and three treatment-agents (therapists, case managers and interviewers) were analyzed, using the Working Alliance Inventory. Outcomes were assessed using the Hamilton Rating Scale for Depression. RESULTS: Variance partitioning of the elements showed that the perceiver effect accounted for the largest proportion of bond rating variance for patients and treatment-agents. The relationship effect (of patients and treatment-agents) emerged as a significant predictor of treatment outcome. CONCLUSION: Applying SRM across psychotherapy advances understanding of trait/state-like bond contributions to outcomes. Our findings underscore the potential of the unique relationship to capture processes of change, beyond stable patients' and therapists' characteristics.