The alliance-outcome association in group interventions: A multilevel meta-analysis.

Abstract

Objective: The therapeutic alliance has been studied in group interventions, but its relationship to patient outcome is still controversial. This study systematically reviewed the association of both the member-leader and membergroup alliance with patient outcomes, and assessed the effects of several theoretically informed moderators. Method: A three-level meta-analysis was conducted on 57 studies to disentangle within-and between-study variability in the alliance-outcome association. Results: The overall effect size of the unconditional model was r = −.259 (95% CI: −.302, -.214; p < .001), whereas the correlation between alliance and outcome based on the three-level meta-analytic model was r = −.215 (95% CI: −.252, −.178; p < .001) indicating a medium effect. Meta-regressions of moderators showed that the alliance-outcome correlation was higher when patients reported on their alliance with the group/other members compared with when they rated the alliance with the leader. Outcome type, rating perspective, theoretical orientation, treatment length, and year of publication were significant moderators of the relationship between alliance and outcome. Conclusions: The current meta-analysis highlighted that the therapeutic alliance, especially with other group members, is a significant predictor of outcomes in group therapies even after controlling for several moderators and adopting more conservative statistical modeling. What is the public health significance of this article?Prior research has established that member-leader alliance is a predictor of outcome in group psychotherapy with a small effect. This meta-analysis provides a comprehensive analysis of the complex role of the alliance in group therapy, suggesting that the alliance with other group members or the group as a whole has a significantly larger association with outcome. This study provides support for the importance of the group context on the alliance-outcome relationship.

Therapists’ perceptions of online group therapeutic relationships during the COVID-19 pandemic: A survey-based study.

“…Thus, therapists who indicated that it was easier to foster group alliance, cohesion, and client self-disclosure in online therapy versus in-person group therapy, and who felt empathic and focused (i.e., with a high level of therapeutic presence) experienced the online group as more effective and satisfactory. These findings are parallel to those reported in process-outcome research that group cohesion and alliance are associated with better outcome in in-person group therapies (Burlingame et al, 2018; Lo Coco et al, 2022). Although previous research on online groups indicated that group members have positive perceptions of telemental health interventions (Gentry et al, 2019), to date there is limited research on group therapists’ perceptions of online group process during the pandemic.…”

“…The first group therapeutic factor comprises the therapist's ratings of the alliance, group cohesion, and client self-disclosure dimensions. These dimensions parallel some of the important relationship elements found in in-person group therapy (Alldredge et al, 2021;Burlingame et al, 2018;Johnson et al, 2005;Lo Coco et al, 2022). Prior research showed that the therapeutic alliance in videoconferencing therapy is commensurable to that reported in face-to-face settings across a range of clinical populations (Simpson et al, 2021;Thomas et al, 2021), although most of these studies focused on the client's experience of videoconferencing therapy (Gentry et al, 2019).…”

“…Group climate is an indicator of the atmosphere in a group, which comprises a participant’s perception of other members’ engagement with the group, avoidance of important or difficult topics, and conflict among group members (Tasca et al, 2006). The group alliance is a collaborative relationship between the therapist and other group members, comprising an emotional bond and an agreement on tasks and goals of therapy (Alldredge et al, 2021; Lo Coco, Tasca, et al, 2019; Lo Coco et al, 2022). To date, only few studies examined whether group processes differ between in-person and online groups, reporting somewhat lower levels of patient-rated therapeutic alliance among video teleconference participants or less cohesion within the group (Gentry et al, 2019).…”

Changes in group counseling engagement and conflict and growth in emotional cultivation for children and adolescents.

“…For two decades, researchers have examined group process and outcome at the session (i.e., time), group member (i.e., within-group), and group-as-a-whole (i.e., between-group) levels (e.g., Janis et al, 2016; Lo Coco et al, 2022; Moritz & Watson, 1998). Typically, this is done by distinguishing between-group and within-group of the dependent variable (e.g., Burlingame et al, 2013).…”

Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre

“…Researchers could consider examining how this type of integrated group intervention translates to an online therapy. Also, given that therapeutic alliance is a robust predictor of positive outcomes in psychotherapy (Lo Coco et al, 2022), future research should examine the relationship between attachment insecurity dimensions and therapeutic alliance factors, including alliance rupture and repair, in mixed-CID samples (Lo Coco, Tasca, Hewitt, Mikail, & Kivlighan, 2019).…”