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69. The Impact of Client Attendance, Memory, and Symptoms on Therapeutic Alliance
Therapeutic alliance (TA) is an important but overlooked factor when examining treatment outcome in schizophrenia. We sought to examine how both client and therapist perceptions of TA may change during a particular type of cognitive skills therapy. Hypotheses were that therapist and client perceptions of TA would be related to improvements in cognition and symptoms. We also examined whether client attendance would make a difference in TA. One hundred-four adults with schizophrenia were enrolled in a three-month, compensatory cognitive skills group. Assessments of TA (Working Alliance Inventory-Short Revised, client and therapist versions), cognition (Penn Computerized Neurocognitive Battery), degree of therapist/patient contact, and symptoms (Positive and Negative Syndrome Scale) were conducted at baseline and post (3mo). Client and therapist TA were strongly related throughout treatment, and while the group improved in memory (d=0.52) and symptoms (d=0.48), therapist and client TA were not related to improvements in memory. Rather, client and therapist TA improved as symptoms improved. Also, client attendance was related to stronger perceptions of TA by the therapist but interestingly unrelated to client perceptions of TA. These findings highlight the importance of TA and suggest a strong TA can be developed in the context of symptom rather than cognitive improvement and despite less than optimal attendance.