Therapeutic Alliance Mediates the Effect of Directive Treatment on Subsyndromal Depression for Asian and European American Students

The therapeutic alliance has long been advanced as a common factor for improving outcomes across psychotherapies. Directive therapies appear to lead to stronger therapeutic alliance, with some evidence suggesting that directive strategies are particularly effective for East Asian populations. In the present study, we examined the role of therapeutic alliance as a mediator of the effect of a brief directive intervention on depression and explored whether ethnicity and cultural values moderated this relationship. Eighty Asian and European American college students with subsyndromal depression were randomly assigned to a directive or nondirective treatment session. Depression was assessed at pretreatment and at 1-month and 6-month follow-up, and alliance was assessed immediately after the treatment session. As predicted, therapeutic alliance mediated the relationship between directive (vs. nondirective) treatment and reduced depression at both follow-up periods. However, ethnicity and cultural values did not moderate mediation effects at either time point. The results from this study provide support for the importance of the therapeutic alliance for European American and Asian American populations, even in a brief, one-session intervention. Because there were no ethnic or cultural differences in the mediating role of therapeutic alliance, this might suggest the universal importance of alliance across diverse clinical populations.