Clinical Neuropsychiatry (2016) 13, 6, 94-99 TherapisT variabiliTy in The Task/goal dimension of The early working alliance predicTs ouTcome in exposure and response prevenTion TreaTmenT for obsessive-compulsive disorder

Objective: The importance of a strong working alliance is assumed to be important in exposure and response prevention (ERP) treatment of obsessive-compulsive disorder (OCD). During the first sessions, the therapist aims to achieve agreement with the patient on the tasks and goals of therapy by formulating a treatment plan. The aims of the study were to explore the predictive role of therapistand patient variability in the early working alliance when using erp for ocd. Method: a total of 13 therapists gave individual erp treatment to 44 outpatients with ocd. The working alliance was measured after the second or third session with patient rated working alliance inventory-short (wai-s). we used two subscales from the wai-s (agreement on tasks/goals and therapeutic bond). Treatment outcome was measured using the yale-brown obsessive compulsive scale. Therapist variability in the working alliance was estimated by calculating each therapist’s mean wai-s scores and calculating how much each therapist’s mean deviated from the grand means. patient variability was estimated by calculating each patient’s score for the two wai-s components and how much this deviated from their therapist’s mean score on these factors. Results: Therapist variability in the task/goal dimension of the alliance predicted treatment outcome, while patient variability in the alliance did not. Therapeutic bond was not related to outcome. Conclusions: Therapists’ ability to establish agreement on tasks and goals of treatment in the first couple of therapy sessions could be vital in treating ocd with erp. further studies investigating the relationship between patient and therapist variability in the working alliance and treatment outcome using larger samples are needed.