Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance.

TLDR

Although the therapeutic alliance consistently predicts psychotherapy outcomes, prior research has not distinguished between patient and therapist variability, and clinicians should monitor therapist contributions, provide feedback, and train therapists to strengthen alliances. The authors employed multilevel models on data from 331 patients and 80 therapists, adjusting for baseline functioning, to assess how patient and therapist variability in alliance predicted outcomes. Therapist variability in alliance predicted outcomes, while patient variability did not, and the authors discuss why therapist factors drive this effect.

Abstract

Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331 patients seen by 80 therapists (therapist average caseload was 4.1). Patients rated both the alliance and outcome and all models adjusted for baseline psychological functioning. The results indicated that therapist variability in the alliance predicted outcome, whereas patient variability in the alliance was unrelated to outcome. Reasons why therapist variability as opposed to patient variability predicted outcome are discussed. Clinical implications include therapists monitoring their contribution to the alliance, clinics providing feedback to therapists about their alliances, and therapists receiving training to develop and maintain strong alliances.