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

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.