How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis.

Abstract

Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome. Multilevel longitudinal analysis was used to investigate the following moderators of the alliance-outcome correlation: (a) research design (RCT or other), (b) use of disorder-specific manuals, (c) specificity of outcomes, (d) cognitive and/or behavioral therapy (CBT) or other types of treatments, (e) researcher allegiance, and (f) time of alliance assessment. RCT, disorder-specific manual use, specificity of primary and secondary outcomes, and CBT did not moderate the alliance-outcome correlation. Early alliance-outcome correlations were slightly higher in studies conducted by investigators with specific interest in alliance than were those in studies conducted by researchers without such an allegiance. Over the course of therapy, these initial differences disappeared. Apart from this trend, none of the variables previously proposed as potential moderators or mediators of the alliance-outcome relation, alone or in combination, were found to have a mediating impact.

Reciprocal influence model of working alliance and therapeutic outcome over individual therapy course.

“…However, the previous longitudinal reciprocal research (e.g., (Falkenström et al, 2014) investigating the effect of the working alliance typically Reciprocal Model of Working Alliance and Therapeutic Outcome 7 adopted a single alliance rating at the third session. Such an approach fails to recognize the change of the working alliance over time (Kivlighan & Shaughnessy, 2000;Kivlighan & Shaughnessy, 1995;Stiles et al, 2004) and ignores the enhancement of the working alliance-outcome link over time (Flückiger, Del Re, Wampold, Symonds, & Horvath, 2012;Martin et al, 2000). An examination exploring the reciprocal effects of the fluid working alliance and the fluid therapeutic outcome across the therapy course is thus needed.…”

Perceived Injustice and Adverse Recovery Outcomes

“…The working alliance describes warmth, trust, and a shared sense of the presenting problem, solution, and the therapeutic goals between a client and clinician (Corbière, Bisson, Lauzon, & Ricard, 2006;Horvath & Greenberg, 1989). A large body of evidence has identified the working alliance as one of the strongest predictors of outcomes in the rehabilitation of patients with persistent physical and mental health problems (Ahn & Wampold, 2001;Bennett, Fuertes, Keitel, & Phillips, 2011;Flückiger, Del Re, Wampold, Symonds, & Horvath, 2012;Miciak, Gross, & Joyce, 2012). Feelings of distrust and expressions of anger might present significant challenges to the development of a strong working alliance between the client and the clinician.…”

Couple-Based Psychosexual Support Following Prostate Cancer Surgery: Results of a Feasibility Pilot Randomized Control Trial

“…A manualised approach was sought in order to provide evidence which is considered robust by research funders and health service commissioners. Manuals are increasingly being used in clinical practice across therapeutic modalities, and are thereby contributing to the evidence base for therapeutic interventions (CritsChristoph et al, 2009;Fluckiger et al, 2012;Lusk & Melnyk., 2011;Weck et al, 2011). A recent paper indicates that therapists who use manuals are more positive about them than practitioners without such exposure (Forbat et al, 2015), which provides some assurance that while trials may struggle to claim untainted objectivity, manuals themselves may be an acceptable format of sharing approaches to treatment.…”