doc with medA study published in the current issue of Psychotherapy and Psychosomatic sheds new light on the role of patient-doctor relationship in antidepressant drug treatment. Previous studies have shown that in psychotherapy alliance is a predictor of symptomatic change, even while accounting for the temporal precedence between alliance and symptoms. However, the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result, rather than the cause, of symptomatic change. Results showed that the effect of alliance on outcome, while controlling for prior symptomatic levels, was significant and restricted to the middle phase of treatment (week 4, p = 0.005), when most of the reductions in symptoms were observed. Exploratory analyses of the differences between placebo and medication conditions suggest that the differences between the patients in their average alliance levels predicted a greater reduction in symptoms in the placebo compared to the medication conditions (p = 0.008).
The findings suggest an effect of alliance on outcome in psychopharmacology, which is not merely the result of previous symptomatic levels. This effect may be more robust in conditions that do not include active treatment (placebo), possibly serving as a compensatory effect.

Source: Journal of Psychotherapy and Psychosomatics
Full bibliographic information:
Zilcha-Mano S, Roose SP, Barber JP, Rutherford BR. Therapeutic Alliance in Antidepressant Treatment: Cause or Effect of Symptomatic Levels? Psychother Psychosom 2015;84:177-182