Expectations regarding psychotherapy and therapeutic alliance in women with depression : a study in two different cultural contexts

Abstract

The objective of the present study is to determine the relationship between psychotherapy expectations and early therapeutic alliance (first and third session) in women with depression in different cultural contexts (Chile and Germany), exploring the association between these variables and specific cultural variables such as dependent/interdependent self-construal, traditional/egalitarian sex role ideology, and the rigidity/laxness of social and familial norms. The sample consists of two groups of patients receiving psychotherapy, one in Chile and another in Germany. The first group is made up by 46 women diagnosed with depression, while the other consists of 30 female participants with the same diagnosis. The participants' age ranges between 20 and 50 years. The Chilean participants were contacted at Psicomédica, an outpatient mental health center in Santiago. They were receiving treatment which followed different theoretical psychotherapeutic approaches, once a week. The German women were recruited at the General and Psychosomatic Medicine Clinic (Heidelberg University Hospital), where they received inpatient treatment with a psychodynamic approach in two weekly sessions. The participants' level of depression was measured with the Beck Depression Inventory BDI-I (Beck, Ward, Mendelson, Mock & Erbaugh, J., 1961) both in Chile and Germany (Hautzinger, Bailer, Worall & Keller, 1994 [BDI-I]), before the first session. Also, a clinical interview was implemented in Chile, the MINI International Neuropsychiatric Interview (Lecubrier, Sheehan, Weiller, Amorim, Bonora, Sheehan, Janavs & Dunbar, 1997), while in Germany the Patient Health Questionnaire of Depression PHQ-D (Spitzer, Kroenke & Williams 1999) was used. Patient expectations were measured with the Patient Expectations Evaluation PATHEV (Schulte, 2005) in Chile and Germany, before beginning the psychotherapeutic process. Cultural variables were measured with the same questionnaire battery in both countries: the Multidimensional Cultural Variables Questionnaire for Chile (Olhaberry, Crempien, Biedermann, Cruzat, Martínez, V., Martínez, F. & Krause, 2011 [CMVC]) and the 9 Battery of Multidimensional Cultural Variables (Freund, Zimmermann, Pfeiffer, Conradi, Hunger, Riedel, Boysen, Schwinn, Rost, Cierpka, & Kämmerer, 2010 [HKFB]) for Germany. The therapeutic alliance was measured with the Working Alliance Inventory, WAI (Santibañez, 2001), in Chile and WAI-SR (Wilmers, Munder, Leonhart, Herzog, Plassmann, Barth, & Linster, 2008) in Germany, after the first and third sessions. Concerning the results of the comparison, significant differences between Chile and Germany were found in specific cultural variables (dependent and interdependent self-concept, social norms, sexual role ideology) and the therapeutic alliance as measured in sessions 1 and 3 (A1 and A3). In Chile, a positive association was observed between expectations and the alliance of session 1 (A1) but not with that of session 3 (A3). In Germany, expectations displayed a positive association with the alliance of session one (A1) and that of session three (A3). Regarding the relationship between cultural variables and the alliance, a positive association between independent self construal and A1 was found in Chile. In Germany, a positive association was observed between interdependent self-construal and A1; in addition, the egalitarian sex role ideology displayed a positive association with A1. Based on the results analyzed in both countries, it can be concluded that no significant association is present in the relationship between expectations and cultural variables. Likewise, no significant association was found in Chile and Germany between depression levels and expectations, nor was a link discovered between specific cultural variables and depression levels and the therapeutic alliance (A1 and A3).