Congruence and discrepancy between working alliance and real relationship: Variance decomposition and response surface analyses.

Abstract

We examined how congruence and discrepancy in clients' and therapists' ratings of the working alliance (WA) and real relationship (RR) were related to client-rated session quality (SES; Session Evaluation Scale). Ratings for 2517 sessions of 144 clients and 23 therapists were partitioned into therapist-level, client-level, and session-level components and then analyzed using multilevel, polynomial regression and response surface analysis. For both clients and therapists, at all levels of analysis (except the therapist level for therapist ratings), SES was highest when combined WA and RR ratings were high, and lowest when combined ratings were low. For client ratings, discrepancy between WA and RR, at the client and session levels, was associated with greater session quality. Some clients perceived greater session quality when, across all sessions, WA was stronger than RR and other clients perceived greater session quality when RR was stronger than WA. Within clients, session quality was highest when some sessions had a stronger WA than RR whereas other sessions had a stronger RR than WA. These findings are compatible with a responsiveness framework, therapists varied the balance of WA and RR to suit situational demands or needs of different clients. When therapists rated WA and RR the opposite pattern of results emerged; clients perceived greater session quality when therapists' WA and RR ratings, for a session were high and consistent (i.e., no discrepancy between WA and RR). In addition, across all sessions, clients perceived greater session quality when WA and RR ratings were high and consistent. (PsycINFO Database Record

Research on the alliance: Knowledge in search of a theory

“…A moderate (ES ≈ 0.26) but very robust positive link has been well documented (Horvath et al, 2011;Horvath & Symonds, 1991;Flückiger et al, 2017;Martin, Garske, & Davis, 2000). Over the last two decades, the investigation of this link has become more nuanced, identifying sources of contributions to the alliance (Baldwin, Wampold, & Imel, 2007;Del Re et al, 2012;Kivlighan, Kline, Gelso, & Hill, 2017), investigating these links in specific populations, and identifying some differences across racial and diagnostic lines (Flückiger et al, 2013).…”

“…Gelso and colleagues have continually developed and refined this theory, recently constructing and validating an instrument to measure the RR (Real Relationship Inventory (Client version): Kelley, Gelso, Fuertes, Marmarosh, & Lanier, 2010). With the availability of the RRI, there are now empirical studies addressing the links among RR, the alliance, and therapy outcome (e.g., Kivlighan et al, 2017).…”

What happens when the therapist leaves? The impact of therapy transfer on the therapeutic alliance and symptoms

“…On the one hand, there is evidence for a linear trend of alliance development displaying a consistent strengthening of the alliance over the course of treatment (e.g., Fitzpatrick, Iwakabe, & Stalikas, ; Rubel, Lutz, & Schulte, ; Sauer, Lopez, & Gormley, ). On the other hand, some studies describe a nonlinear U‐shaped trend or rupture‐resolution processes (e.g., Gelso & Carter, ; Horvath & Luborsky, ; Kivlighan Jr, Kline, Gelso, & Hill, ; Rubel, Bar‐Kalifa, et al, ; Safran & Muran, ). Both patterns of alliance development have received attention and lend support to the impact of the selection of the time point of assessment during treatment and the consideration of individual differences in alliance development.…”

“…On the one hand, there is evidence for a linear trend of alliance development displaying a consistent strengthening of the alliance over the course of treatment (e.g., Fitzpatrick, Iwakabe, & Stalikas, 2005;Rubel, Lutz, & Schulte, 2015;Sauer, Lopez, & Gormley, 2003). On the other hand, some studies describe a nonlinear U-shaped trend or rupture-resolution processes (e.g., Gelso & Carter, 1994;Horvath & Luborsky, 1993;Kivlighan Jr, Kline, Gelso, & Hill, 2017;Rubel, Bar-Kalifa, et al, 2018a;Safran & Muran, 2000).…”

The Therapeutic Alliance Over 10 Sessions of Therapy for Borderline Personality Disorder: Agreement and Congruence Analysis and Relation to Outcome

“…To examine session-and patient-level agreement as predictors of outcome, we fitted multilevel polynomial regression models (Kivlighan, Kline, Gelso, & Hill, 2017;Shanock, Baran, Gentry, Pattison, & Heggestad, 2010) separately for each group, with OQ-45 as the dependent variable and the following predictors at each level (session and patients): WAI-P, WAI-T, WAI-P 2 , WAI-P×WAI-T, and WAI-T 2 . All WAI variables were centered to the scale midpoint before inclusion in the model.…”