Relationships among client and counselor agreement about the working alliance, session evaluations, and change in client symptoms using response surface analysis.

Abstract

Two studies explored how counselor and client agreement on the therapy alliance, at the beginning of treatment, influenced early session evaluations and symptom change. Unlike prior studies that operationalized alliance convergence as either a profile similarity correlation or a difference score, the present study used polynomial regression and response surface analysis to examine agreement. Study 1 explored the impact of working alliance congruence on session depth and smoothness at the 3rd session of treatment with 36 client-counselor dyads. Results revealed that session smoothness was greater when clients' and therapists' perceptions of the working alliance were in agreement and high compared with when they were in agreement and low. In addition, clients rated sessions less smooth when their ratings of the alliance were lower than their therapists' ratings of the alliance, and they rated sessions as more smooth when their ratings of the alliance were higher than their therapists' ratings of the alliance. The authors did not find a significant relationship with session depth. In Study 2, the authors explored the impact of working alliance congruence, at the 3rd session of therapy, on symptom change for 63 client-counselor dyads. Results revealed that as the therapist and client have more positive agreement on the perceived alliance at the beginning of the treatment, there is greater symptom change. The authors also found that the consequences of alliance disagreement are the same regardless of who rated the alliance higher than the other. Implications and recommendations for future research are discussed.

Therapist-reported alliance: Is it really a predictor of outcome?

“…It follows that taking a more active approach may improve therapists’ attunement to fluctuations in the alliance. These suggestions are also consistent with previous findings showing that therapists who rated themselves as generally forming stronger real relationships also rated poorer treatment progress (Kivlighan, Gelso, Ain, Hummel, & Markin, 2014), and with findings showing that patients rated sessions less smooth when their ratings of the alliance were lower than their therapists’ ratings of the alliance, and they rated sessions as more smooth when their ratings of the alliance were higher than their therapists’ ratings of the alliance (Marmarosh & Kivlighan, 2012). …”

“…Similar patterns of inconsistent results were reached when focusing on other aspects of the therapeutic relationship, such as the real relationship (Gelso et al, 2012; Markin, Kivlighan, Gelso, Hummel, & Spiegel, 2014). Additionally, although some studies showed that agreement between therapist and patient on the therapeutic alliance can predict outcome (Bachelor, 2013; Kivlighan, 2007; Marmarosh & Kivlighan, 2012; Rozarmin et al, 2008), others failed to find a significant association between differences in therapist and patient alliance levels and outcome (Fitzpatrick, Iwakabe, & Stalikas, 2005) or dropout (Meier & Donmall, 2006). …”

Convergence in patient–therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment

“…Theoretically, this might reflect an ongoing negotiation of the therapeutic relationship that becomes more attuned as the relationship evolves; that is, whatever the state of the relationship, the participants are able to read it more similarly whether it is thriving or in rupture. Second, and also consistent with limited prior research (Marmarosh & Kivlighan, 2012), we hypothesized that alliance perspective discrepancy measured in early therapy would be associated with less depression reduction (or, conversely, that greater alliance perspective similarity would be associated with greater depression reduction). Third, we predicted that convergence in patient-therapist alliance ratings over the course of therapy would be associated with greater depression reduction.…”

“…A small literature has used both patient and therapist data together when considering alliance discrepancy/similarity at a particular time point and divergence/convergence over time. For example, one study examined patient-therapist alliance rating similarity at the third session of psychotherapy for 63 therapy dyads from counseling clinics (Marmarosh & Kivlighan, 2012); the authors found that more similarity was related to greater symptom improvement. This finding, though, was specific to therapy dyads with higher-rated alliances, suggesting an interaction between early alliance levels and patient-therapist perceptual similarity of their alliance.…”

Do I fit with my group? Within-member and within-group fit with the group in engaged group climate and group members feeling involved and valued.

“…Unfortunately, PSIs are conceptually ambiguous, discard important fit information, and are not sensitive to rater differences (Edwards & Parry, 1993;Marmarosh & Kivlighan, 2012). Therefore, Edwards and Parry (1993) advocated polynomial re gression and response surface analysis to as sess person-group fit as an alternative to PSIs.…”