The first session is the one that counts: An exploratory study of therapeutic alliance

Abstract

BackgroundThe controversy about whether psychotherapy outcome is the consequence of the techniques themselves, common factors or both is still current. The importance of common factors has been demonstrated, although it is also known that they alone are insufficient. At the present time, the contextual model grants heavy weight to the therapeutic alliance in the first sessions and seems to predict positive final results. Furthermore, monitoring sessions has demonstrated that this alliance improves.ObjectivesTo analyze the relationship between the therapeutic alliance and patient’s perceived improvement during the first five sessions of therapy, and find out whether the therapeutic alliance is maintained or unstable within that timeframe.MethodsThirty-four patients at a university psychological care service who had had at least five therapy sessions participated. Of these, 70.46% were women (Mage = 24.24, SD = 6.73). The patients filled out the Outcome Rating Scale and Session Rating Scale the week before each session. Data were analyzed by the Dual STATIS method.ResultsThe compromise matrix explained 77.36% of the variability. The position of the vectors and the distribution of the position of the patients on the graph show that as their perception increased, therapeutic alliance remained stable. Moreover, the position of the vectors shows that the therapeutic alliance was forged in the first session and remained stable during the following sessions.ConclusionThis exploratory study demonstrated the importance of the first session in establishing the therapeutic alliance, and for it to remain stable, regardless of whether the rest of the therapeutic process has variations or changes. Novel use of the STATIS method for analyzing measurements in the first five sessions, showed that beginning the therapeutic intervention with a strong alliance, produced the favorable, lasting effects necessary for development of the intervention.

“The early bird catches the worm”—Prediction of early response and its importance for treatment outcome in a naturalistic setting of cognitive behaviour therapy

“…The first sessions of therapy appear to be critical for both early response and therapeutic alliance building, regardless of treatment approach (Beard & Delgadillo, 2019; Fluckiger, Del Re, et al, 2020). Several studies across various therapeutic schools indicate that a strong initial therapeutic alliance correlates with enhanced early and long‐term treatment outcomes (Del Rio Olvera et al, 2022; Falkenström et al, 2013; Fluckiger, Del Re, et al, 2020; Kramer et al, 2009; Levy et al, 2015; Samstag et al, 2008; Wampold & Imel, 2015). Interestingly, a study on cognitive behavioural therapy for eating disorders revealed that early response was a more potent predictor of treatment outcome than the therapeutic alliance (Turner et al, 2015).…”

Psychotherapeutic approaches: hopefully, globally effective

“…In most psychotherapeutic endeavors, compassion and trust must be conveyed for clinical interventions to be maximally successful. The first moments of the first session may be exceptionally important ( 40 ). An example illustrating how even the smallest interaction may be important at this initial meeting involves how providers may best escort new patients from the waiting room to the treatment room after first greeting them.…”