A meta-analytic review of the relationships between the therapeutic alliance, empathy, and genuineness in individual adult psychotherapy.

Abstract

ACKNOWLEDGEMENTSI would like to thank my co-chairs for their individual contributions and guidance.Dr. Jesse Owen, thank you for your help exploring the many nuances in the therapeutic relationship literature and helping me apply this work to psychotherapy practice. Our talks helped me see the different facets of the therapeutic relationship and how perception means so much in therapy. I also want to thank you for your insight during advanced practicum and for introducing me to short-term dynamic therapy, which I continue to use and teach to others.Dr. Jeff Valentine, thank you for your instruction in meta-analysis and guidance that brought this project to completion. You were there at the beginning, when I was still wrestling with translating ideas about therapy relationships into a study-able dissertation question. I really enjoyed our talks, over tea and coffee, as this project gained momentum. Thank you for all your help with the study methodology and showing me how to communicate it in a succinct, meaningful way.I would also like to thank Dr. Stephanie Budge and Dr. Mark Hilsenroth for their comments and assistance as committee members. Your calm and humorous personalities made an otherwise stressful life event so much more bearable. I never expected to laugh so much during my proposal defense. Special thanks to AC Del Re for his help in creating and providing personal assistance with R-based meta-analysis software.I want to express my utmost thanks to my wife Miriam for her patience, support, and kind words throughout the full grad school process. You were there before this iv whole process started and you've been strong through all the ups and downs that have come as a result. It's difficult to fully credit Miriam's contribution in such a short space. This dissertation explored the relationship between the therapeutic alliance and perceptions of therapist empathy and genuineness through a systematic review and metaanalysis. Alliance, empathy, and genuineness are each integral parts of the therapeutic relationship. Prior meta-analyses demonstrated that alliance, empathy, and genuineness each had a moderate relationship to therapy outcome. No previous analysis has explored how therapist empathy and genuineness contribute to the therapeutic alliance. Studies for this analysis were obtained through a multi-part search strategy. Out of 2,141 obtained abstracts, 46 studies contained enough data for inclusion in the meta-analysis. Thirty-six studies reported alliance/empathy relationships, six studies reported alliance/genuineness relationships, and four studies reported both. Random effects meta-analyses revealed that therapeutic alliance was related to perceptions of therapist empathy with a mean r(k = 40) = .51 (95% CI = 0.43-0.59). Therapeutic alliance was related to perceptions of therapist genuineness with a mean r(k = 10) = .53 (95% CI = 0.40-0.65). Tests of publication bias indicated a low likelihood of publication bias affecting the strength and direction of the results. Potential moderating variables w...

Not Just Nonspecific Factors: The Roles of Alliance and Expectancy in Treatment, and Their Neurobiological Underpinnings

“…The working alliance is commonly defined as the emotional bond established in the therapeutic dyad, and the agreement between the two about the goals of therapy and the tasks necessary to achieve them (Bordin, 1979; Hatcher and Barends, 2006). Meta-analyses have consistently demonstrated that stronger alliance is associated with better treatment outcome across treatment modalities, both in various psychotherapies (based on a data from more than 30,000 patients; Flückiger et al, 2018) and in psychopharmacotherapy ( N = 1,065 patients; Totura et al, 2017).…”