Within‐patient perceptions of alliance and attunement: Associations with progress in psychotherapy

Abstract

The most frequently examined aspect of the therapeutic relationship is the working alliance, which reflects the conscious collaborative bond, and agreement on task and goal. In addition to the established importance of the working alliance, the therapists' attunement and responsiveness might reflect another important aspect of the therapeutic relationship that can be considered in relation to session‐by‐session progress over treatments. Emerging research suggests that the quality of the working alliance not only differs between patients but also within patients over time. However, little is known about the quality of the therapeutic relationship between and within patients in relation to progress in psychotherapy. We examined fluctuations of the working alliance measure (WAI) and the newly developed measure of the Patients' Experiences of Attunement and Responsiveness (PEAR) during treatment in a naturalistic sample of patients in an outpatient psychotherapy clinic. Multilevel modelling was used to examine the respective contribution of these measures to subsequent improvement in psychological functioning longitudinally. Results suggest that the within‐patient effect, instead of between‐patient effect, was significant for WAI (and did not reach significance for PEAR), indicating that the fluctuation of WAI was predictive of psychological functioning in the subsequent month. Based on these findings, therapists and their patients might benefit from regular tracking of the patient‐reported working alliance. The findings underscore the importance of the alliance, specifically at the within‐patient level. It also highlights the challenge for research to tap into other aspects of the therapeutic relationship that can help explain progress in therapy. Given the breadth and accessibility of the working alliance construct, more work is needed for researchers to examine the construct of attunement and responsiveness.

Validation of the Working Alliance Inventory- Short Form for Patient (WAI-S-P) in Peruvian Adults

“…Additionally, as supported by a systematic review, these results suggest that therapeutic alliance plays a crucial role in influencing the effectiveness of the change process even across diverse patients, disorders, and settings. 23 …”

“…This is especially relevant, since the therapeutic alliance is a predictor of better outcomes in therapy and a lower dropout rate. 15 , 16 , 22 , 23 As a second objective of the study, a network analysis was conducted to investigate the direct relationships between the therapeutic alliance and relevant sociodemographic variables, such as sex, age, and total session attendance. This complementary analysis seeks to take into account the differentiation of attributes that may influence trust and commitment in psychological interventions in Peruvian patients, which would help psychologists and psychiatrists to achieve better results in clinical practice.…”

“…Additionally, as supported by a systematic review, these results suggest that therapeutic alliance plays a crucial role in influencing the effectiveness of the change process even across diverse patients, disorders, and settings. 23 Previous research has found that sociodemographic aspects such as age and sex can play a significant role in the establishment of an adequate therapeutic alliance, particularly in the early stages of the sessions. For example, research with large samples has revealed significant differences according to sex in seeking psychological help, 24 as well as a higher positive response to psychological therapy in older adults compared to young individuals.…”