Effects of the therapist's statements on the patient's outcome and the therapeutic alliance: A systematic review

Abstract

This systematic review summarizes articles that examined the effects of the psychotherapist's statements on the outcome of the patient and the therapeutic alliance. The databases PsychINFO, PSYNDEX, PubMed, and PsychARTICLES were searched, and English peer‐reviewed articles were included. Participants should be adult patients with Diagnostic and Statistical Manual of Mental Disorders diagnosis who were receiving evidence‐based psychotherapy in an individual setting. Studies with a standardized, observer‐based measurement of the therapist's verbal utterances on the basis of verbatim transcripts of therapy sessions were included. Furthermore, there should be a standardized measurement of the symptom outcome or a measurement of the therapeutic alliance. The 10 included articles showed that supportive and exploratory statements and addressing aspects in the therapeutic relationship were perceived as positive regarding symptom outcome. Negative effects were particularly evident with controlling and challenging statements of the therapist. Regarding the therapeutic alliance, both positive and negative as well as nonsignificant results were obtained. The results of this review suggest that the question of which statements by therapists correlate positively or negatively with the outcome of therapy and the therapeutic alliance cannot be answered unequivocally and must be applied to more individual and specific situations.

Passing patients’ tests—But how? An analysis of therapists’ helping skills in response to patient testing.

“…With the first three skills, the probability of failing the patient’s test decreased over 95%, with interpretations over 83%. Recalling the findings of Pole et al (2008), Sammet et al (2006), and Silberschatz (2017) that passing tests is related to more positive therapy outcomes, the present results also reinforce the findings of the review by Kadur et al (2020), namely, that supportive and exploratory expressions by therapists are especially related to positive therapy outcomes. The content of this result also seems to be understandable, since in the present sample, mainly depressed patients with self-esteem conflicts were treated, and encouraging or interested reactions, especially to potentially “risky” actions such as tests, can also account for a disturbance of self-esteem in the patient.…”

“…With regard to therapy outcome, a systematic review by Kadur et al (2020) shows that supportive and explorative statements are negatively correlated and that strongly controlling and challenging statements are positively correlated with symptom burden. Regarding the therapeutic alliance, no clear correlations were found as to which statements were associated with a stronger or weaker alliance (Kadur et al, 2020).…”

Influencing Factors and Machine Learning-Based Prediction of Side Effects in Psychotherapy

“…On average, therapists who developed stronger alliances with their patients achieved better therapeutic results ( 32 ). According to Jennifer, Jonas, and Sylke ( 33 ), the negative effects of psychotherapy were particularly evident after a therapist had used controlling and challenging statements. In other words, failure to establish a strong therapeutic alliance between the therapist and the patient is a potential risk factor for treatment side effects.…”

Therapists and psychotherapy side effects in China: A machine learning-based study

“…Similarly, therapist factors may influence psychotherapy side effects. The therapist's inappropriate narratives could undermine the outcome of psychotherapy and the therapeutic alliance, particularly therapists' controlling and challenging statements ( Kadur et al., 2020 ). A NAPT study shows that patients experience more negative effects in psychological treatment when their treatment preferences are not satisfied ( Williams et al., 2016 ).…”