In April 2016 Manchester eScholar was replaced by the University of Manchester’s new Research Information Management System, Pure. In the autumn the University’s research outputs will be available to search and browse via a new Research Portal. Until then the University’s full publication record can be accessed via a temporary portal and the old eScholar content is available to search and browse via this archive.

Related resources

Search for item elsewhere

University researcher(s)

Academic department(s)

Faculty of Medical and Human Sciences' website

Causal modelling of the therapeutic alliance in randomized controlled trials of complex interventions in mental health

Goldsmith, Lucy

[Thesis]. Manchester, UK: The University of Manchester; 2015.

Access to files

FULL-TEXT.PDF (pdf)

Abstract

University of ManchesterLucy Pollyanna GoldsmithPhD MedicineCausal modelling of the therapeutic alliance in randomized controlled trials of complex interventions in mental health2015This thesis addresses one of the oldest debates in psychological therapies: whether the therapeutic alliance has a causal effect on outcome. This was previously unresolved due to the limitations of prior methodologies. The statistical profile of two methods (multiple imputation and structural equation modelling full information maximum likelihood) to deal with missing data in mediators including interactions were investigated using simulation studies. The simulation studies revealed that the methods worked well with simple models, but SEM FIML was biased for models including interactions and some multiple imputation models were biased for simulation studies including interactions and a categorical variable.The causal effect of the therapeutic alliance on outcome in mental health is investigated through analyses of the SoCRATES and FINE randomized controlled trials. This thesis finds that the therapeutic alliance has a causal effect in therapies for schizophrenia, but not in therapies for chronic fatigue syndrome. Further research is needed to investigate the reliability of these findings and to investigate the effects of therapeutic alliance in different disorders. Theoretical work is required in psychology to explore why the therapeutic alliance has a causal effect in some disorders but is irrelevant to the outcome in others.