The association of alliance, the bond with the treatment team, and group cohesion with self-esteem and quality of life in day clinic treatment of depression

• The effect of relationships emerging in a day clinic treatment setting was studied. • The bond with the therapist was associated with more change in quality of life. • Group cohesion was associated with more change in self-esteem. • The bond with the treatment team was not associated with treatment outcome. • The patient group seems to be a promising adjunct in the treatment of depression. In day clinic treatment, patients engage not only with their psychotherapists, but also with fellow patients and other members of the treatment team. Given that interpersonal difficulties are a core component in the treatment of depression, these additional relationships could be of special relevance. However, compared to alliance little is known how other relationships experienced during treatment relate to outcome. Thus, the aim of the analysis was to examine the potentially beneficial association of different types of relationships with outcome in day clinic treatment of depression. The relationships were assessed with the Inpatient and Day-Clinic Experience Scale (IDES) including the subscales bond with the psychotherapist, bond with the treatment team, and group cohesion. Treatment outcome was assessed by the Rosenberg Self-Esteem Scale (RSE), and the European Health Interview Survey - Quality of Life (EUROHIS-QOL). For both outcome measures, residual gain scores were computed, and a path analysis was conducted. Whereas higher levels of group cohesion were associated with more increase in self-esteem, a stronger bond with the psychotherapist was associated with more increase in quality of life. For the bond with the treatment team no significant association with treatment outcome was observed. The results highlight distinct associations of different types of relationships with treatment outcome in depression. Limitations such as the limited sample size, high number of male patients, and high staff turnover are discussed. Future research should further explore the association of different therapeutic relationships with outcome as well as the associated mechanisms of action.