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The following is a summary of “Working alliance and its link to guidance in an internet-based intervention for depressive disorders: a secondary analysis of a randomized controlled trial,” published in the  September 2024 issue of Psychiatry by Haaf et al.

Guided Internet-based interventions (IBIs) are adequate than unguided ones, including the role of the therapist-client working alliance, and are poorly understood. 

Researchers conducted a retrospective study to analyze the trajectories of the working alliance and its relationship to therapeutic guidance via secondary analysis of a randomized controlled trial (RCT) comparing therapist-guided and unguided versions of the Selfapy IBI for depressive disorders.

They compared a therapist-guided version (with weekly calls) to an unguided version (n = 301, mean age 37 years, 83% female, mean BDI-II = 30.09). Using an intention-to-treat approach, to  investigate within- and between-group differences in the quality of the working alliance, estimated with the Working Alliance Inventory-Short Revised (WAI-SR) questionnaire at mid- and post-treatment via repeated measures ANOVA. Further, correlations and mediation analyses were performed to investigate the association between working alliance and outcomes and adherence parameters.

The results showed IBIs were successful in establishing a strong and positive alliance in both  groups, with similar ratings at mid-treatment but with elevated ratings in the guided group at post-treatment (Cohen’s d = -0.38). Post-treatment working alliance scores were discovered to be positively linked to symptom reduction at post-treatment (guided: r = .25, unguided r = .15) and follow-up (guided: r = .25, unguided: r = .17). In the unguided group, the establishment was mainly caused by the subscale task. Serial mediation analysis exhibited the relationship between guidance and outcomes at follow-up was reconciled by working alliance (b = 0.59; 95% CI: 0.14, 1.22) and a connection between working alliance and adherence (b = 0.15; 95% CI: 0.04, 0.34).

They concluded the importance of the working alliance in guided IBIs, providing new insights into its role and formation in unguided IBIs.

Source: frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1448823/full