A meta-analytic examination of client–therapist perspectives of the working alliance

Tryon, Georgiana Shick; Blackwell, Sasha Collins; Hammel, Elizabeth Felleman

doi:10.1080/10503300701320611

Cited by 211 publications

(78 citation statements)

References 80 publications

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“…However, therapists were not often observed delivering the types of active, directive, intensive intervention strategies which are common in EB treatment for this population. The positive perceptions of therapeutic alliance are consistent with other studies (Tryon et al 2007). Clients (youths and caregivers) generally rated the alliance more positively than did the therapist, which is consistent with Bickman’s current research suggesting that counselors may not be accurate in their judgment of their clients’ perception of the therapeutic alliance.…”

Section: What Do We Know Already About Usual Care?supporting

confidence: 91%

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care

Garland

Bickman

Chorpita

2010

Adm Policy Ment Health

205

206

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Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice.

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Section: What Do We Know Already About Usual Care?supporting

confidence: 91%

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care

Garland

Bickman

Chorpita

2010

Adm Policy Ment Health

205

206

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show abstract

“…Importantly, only psychiatrist-rated alliance was assessed. Previous psychotherapy research has suggested that therapist-rated and patient-rated WAs are significantly but only moderately correlated (Guadiano & Miller, 2006, r =.38; Tryon, Blackwell, & Hammel, 2007, r =.36). Furthermore, in psychotherapy, patient-reported alliance is thought to predict outcomes more robustly than therapist-assessed alliance (Constantino, Castonguay, & Schut, 2002).…”

Section: Discussionmentioning

confidence: 94%

Pharmacotherapy for social anxiety disorder: Interpersonal predictors of outcome and the mediating role of the working alliance

Cohen

Drabick

Blanco

et al. 2017

Journal of Anxiety Disorders

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Social anxiety disorder (SAD) is highly prevalent and associated with high levels of impairment and distress. Therapies for SAD leave many patients symptomatic at the end of treatment, and little is known about predictors or mechanisms of treatment outcome. Given the interpersonal dysfunction fundamental to SAD, this study investigated whether prominent interpersonal features of SAD (submissive behavior, childhood maltreatment, suppression of anger, and depression) predicted attrition and response to pharmacotherapy and whether the working alliance mediated these relationships. This is the first study to examine the role of the working alliance in pharmacotherapy for SAD. One hundred thirty-eight treatment-seeking individuals with a primary diagnosis of SAD received 12 weeks of open treatment with paroxetine. Higher levels of depression predicted greater severity of SAD at the end of treatment, and higher levels of submissive behavior and childhood emotional maltreatment predicted a greater probability of attrition from treatment. The psychiatrist-assessed working alliance mediated response to pharmacotherapy for individuals who reported a history of emotional maltreatment. These results identify variables that predict pharmacotherapy outcome and emphasize the importance of the working alliance as a mechanism of treatment response for those with a history of emotional maltreatment. Implications for person-specific treatment selection are discussed.

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“…Therapist and patient alliance ratings likely carry distinct information because of the inherent asymmetry in the psychotherapy relationship (Markin et al, 2014). Supporting this theoretical point, research has shown that therapist and patient alliance ratings are only moderately correlated with one another, despite their comparable associations with outcome (Horvath et al, 2011; Tryon, Blackwell, & Hammel, 2007). Thus, to understand better how the alliance relates to clinical processes and outcomes, it seems important to investigate patient-therapist (a) discrepancies/similarities in their perceptions of their alliance (i.e., level of agreement on alliance quality at one particular time point) and (b) divergences/convergences in their perceptions of their alliance (i.e., degree of change in agreement on alliance quality over time).…”

mentioning

confidence: 94%

“…We argue that the discrepancy or divergence between patients' and therapists' alliance ratings may approximate part of the dynamic interplay that occurs during psychotherapy (Swift & Callahan, 2009; Tryon et al, 2007). For example, differences in perceived alliance quality, at one time or gradually over time, may reflect a lack of mutual clarity or shared understanding of the therapy goals, which could impede change.…”

mentioning

confidence: 95%

Convergence in patient–therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment

Laws

Constantino

Sayer

et al. 2016

Psychotherapy Research

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Objective This study tested whether discrepancy between patients' and therapists' ratings of the therapeutic alliance, as well as convergence in their alliance ratings over time, predicted outcome in chronic depression treatment. Method Data derived from a controlled trial of partial or non-responders to open-label pharmacotherapy subsequently randomized to 12 weeks of algorithm-driven pharmacotherapy alone or pharmacotherapy plus psychotherapy (Kocsis et al., 2009). The current study focused on the psychotherapy conditions (N = 357). Dyadic multilevel modeling was used to assess alliance discrepancy and alliance convergence over time as predictors of two depression measures: one pharmacotherapist-rated (Quick Inventory of Depressive Symptoms-Clinician; QIDS-C), the other blind interviewer-rated (Hamilton Rating Scale for Depression; HAMD). Results Patients' and therapists' alliance ratings became more similar, or convergent, over the course of psychotherapy. Higher alliance convergence was associated with greater reductions in QIDS-C depression across psychotherapy. Alliance convergence was not significantly associated with declines in HAMD depression; however, greater alliance convergence was related to lower HAMD scores at 3-month follow-up. Conclusions The results partially support the hypothesis that increasing patient-therapist consensus on alliance quality during psychotherapy may improve treatment and longer-term outcomes.

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A meta-analytic examination of client–therapist perspectives of the working alliance

Cited by 211 publications

References 80 publications

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care

Pharmacotherapy for social anxiety disorder: Interpersonal predictors of outcome and the mediating role of the working alliance

Convergence in patient–therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment

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