Alliance in individual psychotherapy.

Abstract

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as "alliance," "therapeutic alliance," "helping alliance," or "working alliance" were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25-.30. The statistical probability associated with the aggregated relation between alliance and outcome is p < .0001. The data collected for this meta-analysis were quite variable (heterogeneous). Potential variables such as assessment perspectives (client, therapist, observer), publication source, types of assessment methods and time of assessment were explored.

Assessing therapeutic change in patients with severe dissociative disorders: the progress in treatment questionnaire, therapist and patient measures

“…The PITQ-p also demonstrated statistically stronger relationships with measures of emotional dysregulation and psychological quality of life than the PITQ-t. These findings are consistent with research indicating a stronger relationship between patients’ reports (vs. therapist reports) of alliance and treatment outcome (Horvath et al, 2011), and underscore the salience of querying patients’ perceptions about their progress in treatment.…”

“…Lambert, 2015) resulted in improved outcomes for patients demonstrating difficulties in making or sustaining treatment gains. A meta-analysis of 201 therapeutic alliance studies comprising over 14,000 treatments (Horvath, Del Re, Flückiger, & Symonds, 2011) found that patient-reported alliance data were generally more strongly predictive of therapeutic outcome than therapist-reported data. These findings prompted the first and second authors to develop a patient version of the PITQ.…”

The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness

“…This relationship has previously been established as an important predictor of outcome in psychotherapy [1,2], and has been viewed as one of the most important 'common factors' that explain the success of professional interventions when the specific factors connected to the design and theory of these interventions does not suffice to explain the outcome [3]. Services of support and treatment that is directed toward persons with SMI take place within a wealth of organizational contexts such as psychiatric inpatient care, community mental health services and support provided in people's homes [4].…”

Climbing above the forest and the trees: three future directions in addiction treatment research

“…Behavioral outcome research also includes a successive hierarchy of contrast conditions assumed to control for non-specific therapy effects [1]. Very often, this process continues until the treatment fails in contrast to another specific treatment [2] or, worse yet, in an effectiveness study where the method is pitted against usual care [3][4][5][6]. In meta-analyses that do not account for variation in control group magnitude, the end result is a small effect size [7].…”

“…I agree that the field of behavioral intervention research needs to move beyond a hyper-focus on standardized empirically supported treatments. However, as therapist factors overall account for only 3-7% of the variance in client outcomes [3,4], will studying the therapeutic context be sufficient to boost the effects of addiction treatments? Instead, perhaps the way beyond this long-held debate is to focus upon [1] specific techniques predicting outcomes, [3] stand-alone technologies and [4] broadening the focus to include cost-effectiveness.…”