Alliance-Focused Training (AFT) as an integrative approach to improve therapists’ competencies in dealing with alliance ruptures and prevent negative outcome in psychotherapy for depression. A randomized controlled multicenter trial

• Applicant: Professorin Dr. Antje Gumz
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology ; General and Domain-Specific Teaching and Learning
• Term: since 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 504346851

Depressive disorders are among the most common disorders and constitute the leading cause for disability worldwide. Psychotherapy is recommended as one of the main evidence-based treatments. However, many patients with depression do not benefit enough and about 1/3 terminates psychotherapy prematurely. Factors closely linked to outcome and dropout, such as the therapeutic alliance, need to be addressed. Ruptures in the therapeutic alliance (i.e. periods of tension or breakdown) inevitably occur in the course of any psychotherapy. They constitute a high risk of premature treatment termination and poor therapy outcome. Therapists often fail to notice them or lack the skills to deal with them constructively. Despite the common occurrence of alliance ruptures and the serious implications resulting from failures to resolve them, the curricula of psychotherapy training do not systematically address the topic as of yet. The alliance-focused training (AFT) is a promising approach to enhance therapists’ skills in dealing with alliance ruptures, independent of psychotherapeutic orientation, using video recordings of therapy sessions and role play as central elements. Previous research including an own pilot study (funded by the Heigl Foundation) emphasizes the potential of the approach. However, evidence from large-scale trials is missing. The project intends to investigate the effectiveness of AFT (vs. psychotherapy training as usual, TAU) for depressed patients (planned n=232) and their trainee therapists (Cognitive-behavioral, CBT or Psychodynamic psychotherapy, PDT; planned n=116) in a randomized controlled multicenter trial, stratified by cooperating center (n=11 psychotherapy training institutes), treatment approach (CBT vs. PDT), and comorbid personality disorder. Therapy sessions (50 min.) will take place once a week, post-assessment will be performed after 20 weeks and 1st follow-up after 35 weeks. The two hierarchically ordered primary hypotheses are: In AFT compared to TAU, a stronger reduction of self-rated depressive symptoms (first primary endpoint) and a lower rate of patient dropout (second primary endpoint) is expected after 20 weeks. Secondary outcome parameters are: other measurement points of self-rated depressive symptoms and dropout, observer-rated depressive symptoms; self-rated anxiety, somatic complaints, personality structure and interpersonal problems, and quality of life for patients, as well as therapeutic competence and higher satisfaction with supervision for therapists. In addition, evidence-based mediators will be investigated. The proposed project focuses on one of the most prevalent disorders, is dedicated to a topic highly relevant to everyday practice, and uses a randomized-controlled multi-center design including 11 training institutes throughout Germany. Thus, the results have great potential to substantially contribute to an evidence-based psychotherapy training and improved outcomes for patients with depression.

• DFG Programme: Clinical Trials
• Co-Investigators: Professor Dr. Frank Jacobi; Professorin Dr. Ulrike Willutzki