Existential Isolation as a Mediator of the Alliance–Outcome Association in Naturalistic Psychotherapy

Presenter: Kailin Huang

Faculty Sponsor: Michael James Constantino

School: UMass Amherst

Research Area: Psychology and Behavioral Sciences

Session: Poster Session 6, 4:15 PM - 5:00 PM, Concourse, B15

ABSTRACT

Objective. Existential isolation (EI) reflects an individual’s subjective lack of experiential connection with others. When higher, EI is associated with more maladaptive relational and clinical experiences. Moreover, higher EI is a risk factor for poorer outcomes among individuals engaging in psychotherapy. Conversely, EI may be an important during-treatment relational experience that, if improved, could be therapeutic. Supporting this idea, one study demonstrated a mediational pathway in which higher patient-reported therapy alliance quality predicted better treatment outcomes through lower EI (Storey et al., 2022). However, that study was limited by its focus on men only, cross-sectional design, and reliance on retrospective recall. Addressing these limitations, the present study will replicate and extend Storey et al.’s (2022) work by examining, in temporal sequence, whether lower EI mediates the association between higher patient-rated alliance quality and better posttreatment outcome in the context of a current course of naturalistic psychotherapy for adults with diverse gender identities. Method. Data for this novel secondary analysis will derive from a community-based outpatient psychotherapy trial for adults (Constantino et al., 2021). The present effective sample will include 157 patients and 44 therapists. Patients rated their EI, alliance, and symptomatic/functional impairment across up to 16 weeks of therapy. Analytic Plan. I will use multilevel structural equation modeling to test the indirect effect of early alliance quality on posttreatment symptomatic/functional impairment level through EI (assessed after the early alliance period and before posttreatment). Implications. Results will help determine whether reduced EI is a candidate mechanism of the alliance-outcome association in naturalistically administered psychotherapy.

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