Therapeutic alliance in cognitive behavior therapy for schizophrenia: Association with history of sexual assault

Paul H. Lysaker, Louanne Davis, Samantha D. Outcalt, Marc Gelkopf, David Roe

Research output: Contribution to journalArticle

8 Scopus citations


History of sexual assault in schizophrenia has been suggested as a risk factor for psychosis and a graver course of illness. One possibility is that a history of this type of trauma affects responses to treatment by forming a barrier to a therapeutic alliance. To explore this possibility, we compared monthly ratings of therapeutic alliance for clients with schizophrenia with (n = 9) and without (n = 31) a history of sexual assault across 6 months of cognitive behavior therapy. Ratings were collected from clients and therapists and compared using a repeated measures analysis of variance controlling for level of positive symptoms. Results revealed that clients with a sexual trauma history produced lower overall rating of therapeutic alliance than clients without such a history. Therapist ratings of therapeutic alliance between both groups were not significantly different. Results suggest treatment may need to consider trauma histories as a barrier to therapeutic alliance.

Original languageEnglish (US)
Pages (from-to)456-462
Number of pages7
JournalCognitive Therapy and Research
Issue number5
StatePublished - Oct 1 2011



  • Cognitive behavior therapy
  • Recovery
  • Schizophrenia
  • Sexual assault
  • Therapeutic alliance
  • Trauma

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Clinical Psychology

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