Intraindividual dynamics between alliance and symptom severity in long-term psychotherapy: Why time matters.

Abstract

Objective: The association between alliance and therapy outcome is one of the most investigated factors in psychotherapy research. However, even studies using advanced methods estimate effects over a specific time period (interval) between measurement occasions. Thus, it remains unknown how the magnitude and direction of effects depend on the considered time interval, resulting in limited comparability across studies. The current study examines the influence of time on the within-person relationship between alliance and symptom severity. Method: Alliance (WAI-SR) and symptom severity (SCL-K11) were assessed every fifth session in N = 650 patients receiving up to 100 weekly sessions (mode = 55; M = 41.03; SD = 27.23) of individual psychotherapy in a German outpatient clinic. Bivariate continuous-time (CT) structural equation modeling (SEM) was used to estimate within-person cross-and auto-effects. Results: Analysis revealed significant reciprocal within-person cross-effects with stronger relative effects of SCL-K11 on WAI-SR (a 21 ) than vice versa (a 12 ). CT analysis showed that both cross-lagged effects increased for longer time intervals with strongest effects for time intervals of about 40 sessions (a 21 = −.47; a 12 = −.19). Conclusions: Alliance and symptom severity showed a reciprocal relationship. Expanding current evidence, our analysis showed how the magnitude of these effects depends on the considered time interval. Applying CT-SEM on longitudinal data of the alliance outcome association complements current crosslagged panel analysis and allows to compare results of studies which are based on different time intervals between measurement occasions. Methodological, theoretical, and clinical implications are discussed. Public Significance StatementThis study shows that alliance predicts subsequent therapy success and vice versa in patients with longterm therapy. Moreover, our study suggests that these associations become stronger over the course of about 40 weekly sessions in patients with long-term treatment.

The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders – an umbrella review based on updated criteria

“…There is preliminary evidence from studies examining within‐patient effects that the alliance may have a causal role in improving outcomes 32 , including studies of PDT (in depressive disorders) 85 . Specifically for PDT, it has been documented that the temporal precedence of alliance predicting symptom change becomes stronger with time over the course of long‐term therapy 86 .…”

Working alliance and adherence mediate the effect of guidance in a web-based program for participants with mild to moderate depressive symptoms: A secondary mediation analysis

“…Measuring the alliance repeatedly throughout treatment might reveal more complex relationships between guidance, working alliance and outcome. Such studies might reveal whether the importance of working alliance varies throughout treatment, as has been done for face-to-face psychotherapies (e.g., Volz et al, 2021 ). Fourth, the study had dropout rates at post-treatment of 31.1 %.…”

The interplay between agency and therapeutic bond in predicting symptom severity in long-term psychotherapy.

“…From a theoretical perspective, agency and therapeutic bond might build up over the course of treatment as patient and therapist get to know each other and define their roles in the therapeutic process. Regarding the alliance, it was recently shown that associations between alliance and outcome are the strongest for time intervals of up to 40 sessions (Volz et al, 2021). To depict these processes, we thus intended to conduct our study in long-term treatments.…”