Effective therapists foster 'alliances'.

Effective therapists foster "alliances'

Researchers at the University of Pennsylvania in Philadelphia recently discovered that opiate-addicted men improve far more when drug counseling is combined with psychotherapy. They noticed, however, that the patients of some therapists did markedly better than the patients of others.

The scientists found that the most successful therapists are seen by patients as helpful during the first few treatment sessions. A "helping alliance,' or cooperative patient-therapist relationship, is the result. This sets the stage for a therapist to effectively use specific techniques, such as interpreting conflicts behind symptoms or identifying problem behaviors. Without a helping alliance, any number of therapy approaches are likely to fall flat, report Lester Luborsky and colleagues in the June ARCHIVES OF GENERAL PSYCHIATRY.

Clinicians have long assumed that a therapist's personal qualities play a role in the success or failure of psychotherapy, but "there is a remarkable lack of tested information on the topic,' say the investigators.

They randomly assigned 110 male opiate addicts to one of three treatments: drug counseling, psychoanalytically oriented psychotherapy with drug counseling, or cognitive therapy with drug counseling. Patients attended sessions once every week or two over a six-month period. Nine therapists-- three per treatment--participated, and all sessions were videotaped.

One month after completing treatment, patients in the two psychotherapy groups reported less drug use and criminal activity, higher rates of employment and better psychological functioning than those receiving only counseling. Improvement among the psychotherapy patients varied considerably, though, depending on the therapist.

The patients had similar backgrounds that did not account for the different outcomes, explain the researchers. But there was a strong relationship between improvement and a "helping alliance' measure obtained from both patients and therapists after the third therapy session. Psychoanalytic techniques, which stress working through inner conflicts, and cognitive methods, which focus on changing behaviors and moods, worked equally well for therapists who consistently formed a warm, supportive relationship with patients.

The sample needs to be expanded, note the researchers, and therapists who treat nonaddicted patients should also be studied. But for now, the data support the view that the therapist makes the therapy, rather than vice versa.