Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Apr;82(2):349-54.
doi: 10.1037/a0035554. Epub 2014 Jan 20.

Therapeutic alliance in face-to-face and telephone-administered cognitive behavioral therapy

Colleen Stiles-Shields  1 , Mary J Kwasny  1 , Xuan Cai  1 , David C Mohr  1
Affiliations
Randomized Controlled Trial

Therapeutic alliance in face-to-face and telephone-administered cognitive behavioral therapy

Colleen Stiles-Shields et al. J Consult Clin Psychol. 2014 Apr.

Abstract

Objective: Telephone-administered therapies have emerged as an alternative method of delivery for the treatment of depression, yet concerns persist that the use of the telephone may have a deleterious effect on therapeutic alliance. The purpose of this study was to compare therapeutic alliance in clients receiving cognitive behavioral therapy (CBT) for depression by telephone (T-CBT) or face-to-face (FtF-CBT).

Method: We randomized 325 participants to receive 18 sessions of T-CBT or FtF-CBT. The Working Alliance Inventory (WAI) was administered at Weeks 4 and 14. Depression was measured during treatment and over 1 year posttreatment follow-up using the Hamilton Rating Scale for Depression and Patient Health Questionnaire-9.

Results: There were no significant differences in client or therapist WAI between T-CBT or FtF-CBT (Cohen's f² ranged from 0 to .013, all ps > .05). All WAI scores predicted depression end of treatment outcomes (Cohen's f² ranged from .009 to .06, all ps < .02). The relationship between the WAI and depression outcomes did not vary by treatment group (Cohen's f² ranged from 0 to .004, ps > .07). The WAI did not significantly predict depression during posttreatment follow-up (all ps > .12).

Conclusions: Results from this analysis do not support the hypothesis that the use of the telephone to provide CBT reduces therapeutic alliance relative to FtF-CBT.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Ham-D indicates Hamilton Depression Rating Scale; TICS, Telephone Interview for Cognitive Status; PHQ-9, Patient Health Questionnaire-9; WAI-C, Working Alliance Inventory, Client version.
See this image and copyright information in PMC

References

    1. Arnow BA, Steidtmann D, Blasey C, Manber R, Constantino MJ, Klein DN, Kocsis JH. The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression. Journal of Consulting and Clinical Psychology. 2013 doi: 10.1037/a0031530. - PMC - PubMed
    1. Beck JS. Cognitive Therapy: Basics and Beyond. Guilford Press; New York, NY: 1995.
    1. Beckner V, Vella L, Howard I, Mohr DC. Alliance in two telephone-administered treatments: relationship with depression and health outcomes. Journal of Consulting and Clinical Psychology. 2007;75(3):508–512. doi: 10.1037/0022-006X.75.3.508. - PubMed
    1. Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice. 1979;16(3):252–260. doi: 10.1037/h0085885.
    1. Corson K, Gerrity MS, Dobscha SK. Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1. American Journal of Managed Care. 2004;10:839–845. - PubMed

Publication types