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

Abstract

A reciprocal influence model of the working alliance and the therapeutic outcome was examined in a sample of clients (n ϭ 638) seen by novice therapists. Past researchers have found a relation between the working alliance and symptom improvement and this relation has been interpreted as the alliance leading to such symptom change. The current study was an examination of whether the alliance does indeed lead to symptom change, or whether symptom change leads to subsequent alliance change, or whether each is related to the other in a reciprocal way over time. By modeling the longitudinal development of the working alliance and the symptomatic severity over the individual therapy course, we found support for the reciprocal model being superior to the unidirectional models. The ideas of relationship as strategy and relationship as outcome along with the reciprocal pattern revealed in the findings were discussed with respect to the theoretical and clinical implications. We also discussed the limitations of the study and provided suggestions for future research.

One size does not fit all: Examining heterogeneity and identifying moderators of the alliance–outcome association.

“…The finding regarding the ability of between-patients alliance to predict outcome is consistent with meta-analyses demonstrating the ability of early alliance to predict outcome Horvath et al, 2011). The finding regarding the nonsignificant association between the between-therapists alliance and outcome is consistent with studies in which only the patient alliance level predicted outcome (e.g., Huppert et al, 2014;Xu & Tracey, 2015), but inconsistent with studies that found that the therapist alliance level contributed significantly to outcome (e.g., Baldwin et al, 2007;Kivlighan et al, 2015). It is interesting to speculate on the reasons for the nonsignificant between-therapists effect in the present study.…”

Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study

“…Improvements with respect to patient expectancies on outcome foster collaborative aspects of the working alliance (Falkenstrom et al, 2013) and reciprocally influence each other (Xu and Tracey, 2015). Johansson et al (2011) described “expectancy–alliance–outcome” as a general mediational chain.…”

Aliança terapêutica, vinculação parental e sintomatologia de pacientes adultos que iniciam psicoterapia

“…Estudos recentes reforçam a compreensão de um modelo de relação causal recíproca, ao invés de unidirecional. Ou seja, a AT parece ser preditora de diminuição de sintomas ao mesmo tempo em que a mudança nos sintomas parece afetar a AT, o que consequentemente tem relação com os resultados da terapia (Falkenström, Granström & Holmqvist, 2013;Xu & Tracey, 2015). Nesse sentido, considera-se que um delineamento transversal não foi sensível à complexa relação destas variáveis, sendo necessária uma investigação longitudinal para compreender as interações e variações ao longo do tratamento.…”