Level of Posttraumatic Stress Disorder Symptoms, Social Support and Quality of the Therapeutic Alliance as Predictors of Therapy Course: A Mediational Model

Abstract

Background: Potential traumatic events can have severe consequences. No consensus has been achieved as to how several factors interact in influencing the therapy course of traumatised people. Aims: Firstly, investigated was if level of Posttraumatic Stress Disorder [PTSD] symptoms and social support before therapy, predicted therapy course. Secondly, investigated was if this relationship of level of PTSD symptoms and social support with therapy course was mediated by the quality of the therapeutic alliance. Methods: Several questionnaires were obtained from 130 clients who are being treated at Foundation Centrum ’45. To measure level of PTSD symptoms, the Dutch Zelfinventarisatielijst Posttraumatische Stressstoornis and the Harvard Trauma Questionnaire were used. The Resources Questionnaire was completed to obtain information about the level of social support someone experiences during stressful situations. The Outcome Rating Scale and the Session Rating Scale were routinely obtained to measure therapy course and quality of the therapeutic alliance respectively. Results: Level of PTSD symptoms and quality of the therapeutic alliance were found to influence therapy course. Social support did not prove to influence therapy course. Neither the level of PTSD symptoms nor the level of social support seemed to influence the quality of the therapeutic alliance. In this way, no mediating role for the quality of the therapeutic alliance was found. Conclusions: A first move has been made into the creation of clarity around the factors that influence the therapy course of people with PTSD symptoms. Indicated is that attention for the therapeutic alliance should be more integrated into therapy. More research is needed to find out why levels of PTSD symptoms influences therapy course, and what the exact role of social support is in the treatment process.