Trajectories of Therapeutic Alliance in Couple Versus Individual Therapy: Three-Level Models

Abstract

Research concerning therapeutic alliance and outcome is prevalent but relies heavily on data from individual treatment. In this article, the authors present data from cases in which an individual was seen and cases in which a couple was seen in order to investigate differences in therapeutic alliance and its trajectory depending on case type, therapist experience, and therapist sex. Participants included 96 couples and 52 individuals with 15 therapists from a large Midwestern training clinic for couple and family therapy. Data include the use of the Working Alliance Inventory-Shortened Version, and three-level models were estimated using hierarchical linear modeling. The results highlight differences in the trajectories of individual and couple clients' therapeutic alliance, including evidence for a curvilinear trend in work scores for individual clients but not couple clients. The results also highlight differences in the sources of variation for couple cases versus individual cases. There is clearly complexity in the building of alliance with clients in general, and even more so with couple clients.

Pre‐therapy relationship adjustment, gender and the alliance in couple therapy

“…In a notable exception, a recent study by Bartle‐Haring et al. ( ) found that women's alliance scores increased from session two to session six while men's alliances remained relatively stable. Yet this study did not test whether these trajectories were significantly different for men and women.…”

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

“…For example, some studies compared alliance strength, either observed or self-reported, at two (Escudero, Friedlander, Varela, & Abascal, 2008;Glebova, Foster, Cunningham, Brennan, & Whitmore, 2012;Knobloch-Fedders, Pinsof, & Mann, 2007;Symonds & Horvath, 2004) or three (Friedlander, Escudero, Horvath, et al, 2006) discrete points in time. Other studies tracked alliances over time within cases (Anker, Owen, Duncan, & Sparks, 2010;Bartle-Haring et al, 2012;Friedlander et al, 2014;Montesano, Feixas, Muñoz, & Compañ, 2014).…”

Using Attachment to Better Understand the Therapy Alliance: The Attachment Based Alliance Questionnaire

“…While Bordin's conceptualization and Pinsof's application of the alliance have been helpful in producing quality research in a couple therapy context, two concerns may merit the development of a new measure of the alliance in couple therapy. First, there are reservations about the factorial validity between the tasks and goals domains (Bartle‐Haring et al., ; Duncan et al., ; Knerr & Haring, ; Pinsof & Zinbarg, ). According to Pinsof and Zinbarg (), the definitions of tasks and goals are as follows: “Tasks refers to how much the client(s) and the therapist agree about and are comfortable with their respective therapy tasks.…”

“…Statistically, the two domains are also difficult to differentiate due to consistently high correlations between the tasks and goals domains (Bartle-Haring et al, 2012;Duncan et al, 2003;Horvath & Greenberg, 1989;Pinsof & Horvath, 1994;Smith, Msetfi, & Golding, 2010). Multiple studies have found high correlations between tasks and goals (range r = .95 to .99; Bartle-Haring et al, 2012;Smith et al, 2010). In 2008, Pinsof and colleagues attempted to address this concern by conducting further research on the CTASr-SF.…”