Background: No consensus has been reached about what leads to meaningful treatment change in traumatized refugees and asylum seekers. It is reasonable that the quality of the therapeutic alliance with refugees and asylum seekers in trauma treatment is related to treatment change. Aims: The first part of this study compared the evaluations of the therapeutic alliance by refugees and asylum seekers with the evaluations by other groups of patients. The second part of this study examined if the quality of the therapeutic alliance predicts change in psychological well-being. Methods: Seventy-three patients (19 refugees and asylum seekers, 19 Dutch veterans, and 34 patients of the post-war generation) of the day clinic of Foundation Centrum ’45 evaluated their state of psychological well-being and the therapeutic alliance every week by completing the Outcome Rating Scale and the Session Rating Scale. Results: The results suggest that the therapeutic alliance in therapy with refugees and asylum seekers is of poorer quality compared to the other treatment groups. Furthermore, this study provides some evidence that a weak alliance predicts a worsening in psychological well-being. Conclusion: The results of the study underline the importance of therapeutic alliance when working with traumatized refugees and asylum seekers. There is a need for further studies, with larger samples sizes and a longer follow-up period, to the therapeutic alliance in relation to treatment change in this group of patients
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