The relationship between alliance and outcome: Analysis of a two-person perspective on alliance and session outcome.

Abstract

Objective Better alliance is known to predict better psychotherapy outcomes, but the interdependent and interactive effects of both therapist- and patient-reported alliance levels have yet to be systematically investigated. Method Using Actor-Partner Interdependence Model analysis we estimated actor, partner, and two types of interactive effects of alliance on session outcome in a sample of 241 patient-therapist dyads across 30 sessions of cognitive-behavioral and alliance-focused therapy. Results Findings suggest that the most robust predictors of session outcome are within-treatment changes in patient reports of the alliance, which predict both patient and therapist report on outcome. Within-treatment changes in therapist reports of the alliance, as well as differences between patients and between therapists in their average ratings of alliance levels across treatment, predict outcome as reported by the specific individual. Although alliance was found to be a significant predictor of outcome in both treatments, for therapist-reported alliance and outcome it had a stronger effect in alliance-focused therapy than in cognitive-behavioral therapy. Additionally, dyads with the highest pooled level of alliance from both partners fared best on session outcome. Conclusions The results are consistent with a two-person perspective on psychotherapy, demonstrating the importance of considering the interdependent and interactive nature of both patient and therapist alliance levels on session outcome.

Associations between clinicians' emotional responses, therapeutic alliance, and patient suicidal ideation

“…This finding is in line with previous reports of minimal or no contribution of the clinician‐rated alliance to treatment outcomes (Huppert et al, ; Zilcha‐Mano et al, ). Furthermore, this highlights the relevance of dyadic conceptualizations of the alliance (i.e., alliance convergence) in relation to the treatment process and outcome (Atzil‐Slonim et al, ; Coyne, Constantino, Laws, Westra, & Antony, ; Zilcha‐Mano et al, ).…”

Psychometrische Überprüfung des Helping Alliance Questionnaire (HAQ) in unterschiedlichen Versorgungssettings

“…Effektstärken sind deshalb kaum interpretierbar. Kritisch diskutiert werden muss auch die Frage, ob die "Erfolgszufriedenheit" wirklich ein bedeutender Prädiktor für Outcome-Parameter ist [42][43][44]. Dass es Zusammenhänge gibt, zeigt sich auch in den untersuchten Stichproben: Die Korrelationen mit Indikatoren des Therapieergebnisses liegen allesamt im mittleren bzw.…”

Facilitative interpersonal skills performance test: Psychometric analysis of a German language version

“…Using multi-level or one-with-many methodologies, these studies were able to differentiate the prognostic effect of therapists' and patients' contributions to the relationship (i.e., to separate betweentherapist and within-therapist variability). In two recent studies, Zilcha-Mano et al (Zilcha-Mano & Errázuriz, 2017;Zilcha-Mano et al, 2016) have uncovered heretofore unknown and indirect influences of therapists' ratings on the alliance-outcome relationship via clients in later sessions.…”