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Therapist Effects and the Impact of Early Therapeutic Alliance on Symptomatic Outcome in Chronic Fatigue Syndrome

Goldsmith, LP; Dunn, G; Bentall, RP; Lewis, SW; Wearden, AJ (2015) Therapist Effects and the Impact of Early Therapeutic Alliance on Symptomatic Outcome in Chronic Fatigue Syndrome. PLOS ONE, 10 (12). e0144623. ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0144623
SGUL Authors: Goldsmith, Lucy Pollyanna

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Abstract

Few studies have examined therapist effects and therapeutic alliance (TA) in treatments for chronic fatigue syndrome (CFS). Therapist effects are the differences in outcomes achieved by different therapists. TA is the quality of the bond and level of agreement regarding the goals and tasks of therapy. Prior research suffers the methodological problem that the allocation of therapist was not randomized, meaning therapist effects may be confounded with selection effects. We used data from a randomized controlled treatment trial of 296 people with CFS. The trial compared pragmatic rehabilitation (PR), a nurse led, home based self-help treatment, a counselling-based treatment called supportive listening (SL), with general practitioner treatment as usual. Therapist allocation was randomized. Primary outcome measures, fatigue and physical functioning were assessed blind to treatment allocation. TA was measured in the PR and SL arms. Regression models allowing for interactions were used to examine relationships between (i) therapist and therapeutic alliance, and (ii) therapist and average treatment effect (the difference in mean outcomes between different treatment conditions). We found no therapist effects. We found no relationship between TA and the average treatment effect of a therapist. One therapist formed stronger alliances when delivering PR compared to when delivering SL (effect size 0.76, SE 0.33, 95% CI 0.11 to 1.41). In these therapies for CFS, TA does not influence symptomatic outcome. The lack of significant therapist effects on outcome may result from the trial’s rigorous quality control, or random therapist allocation, eliminating selection effects. Further research is needed.

Item Type: Article
Additional Information: © 2015 Goldsmith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Corrections available at http://doi.org/10.1371/journal.pone.0157199 and http://doi.org/10.1371/journal.pone.0156120
Keywords: General Science & Technology, MD Multidisciplinary
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: PLOS ONE
Editors: Nater, UM
ISSN: 1932-6203
Dates:
DateEvent
19 November 2015Accepted
14 December 2015Published
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
G200212Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
UNSPECIFIEDDepartment of Healthhttp://dx.doi.org/10.13039/501100000276
URI: http://openaccess.sgul.ac.uk/id/eprint/108186
Publisher's version: https://doi.org/10.1371/journal.pone.0144623

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