Therapeutic relationship in the treatment of geriatric depression with executive dysfunction

J Affect Disord. 2017 May:214:130-137. doi: 10.1016/j.jad.2017.03.006. Epub 2017 Mar 7.

Abstract

Background: The effects of therapeutic relationship (TR) in elder mental health are understudied. A greater understanding of TR in geriatric psychotherapy is particularly needed for treating late-life depression with executive dysfunction, which predicts poor response to antidepressant medication and presents unique clinical challenges.

Methods: Participants were older patients (N = 220) with major depression and executive dysfunction who received 12 weeks of problem-solving therapy or supportive therapy in a randomized control trial. Multilevel growth curve modeling and latent change scores were used to analyze TR dimensions of Understanding and Accepting at the patient level (individual patient ratings, N = 194) and therapist level (ratings of each therapist averaged across participants, N = 10).

Results: TR predicted reduction of depression in both treatment groups, while treatment×TR interactions were not significant. Patients treated by therapists with higher average Understanding (patient and therapist level) and Accepting (therapist level) ratings had greater decreases in depression. The patient level×therapist level interaction for Understanding approached statistical significance (p=.065), suggesting a synergistic effect on treatment outcome. Together, Understanding and Accepting predicted 21% of variance in depression level changes.

Limitations: TR was not assessed throughout the course of treatment (only after the first therapy session and at post-treatment) and did not include ratings from an objective evaluator.

Conclusions: Assessment of patient's experience of the TR and of therapist ability to foster Understanding and Accepting can play a significant role in the delivery of geriatric psychosocial interventions.

Keywords: Depression; Geriatrics; Growth curve modeling; Therapeutic relationship; Treatment outcomes.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Antidepressive Agents / therapeutic use
  • Depressive Disorder, Major / psychology*
  • Depressive Disorder, Major / therapy*
  • Executive Function*
  • Female
  • Humans
  • Male
  • Professional-Patient Relations*
  • Psychotherapy / methods*
  • Treatment Outcome

Substances

  • Antidepressive Agents