Therapeutic Alliance: A Comparison Study between Adolescent Patients and Their Therapists

Abstract

The aim of this study was to examine the congruence of adolescent- and therapist-rated therapeutic alliance, and to explore which rating or combination of ratings would predict treatment outcome or premature termination. We also studied whether the alliance changes over the course of treatment and if the change is related to the outcome or dropout. This study comprised 58 adolescents clinically referred for psychotherapeutic interventions. The alliance (Working Alliance Inventory, patient/therapist ratings) and treatment outcomes (Beck Depression Inventory, Clinical Outcomes in Routine Evaluation—Outcome Measure) were measured at baseline and at 3-, 6-, and 12-month follow-ups. The alliance did not change significantly over the course of therapy, but adolescent and therapist ratings did not correlate. Low values in the early assessment of adolescent-rated alliance and discrepancy between the ratings were significant predictors of undesirable treatment outcome. Weak adolescent- or therapist-rated alliance later in treatment and change for the worse in adolescent-rated alliance was associated with treatment dropout. As adolescent-rated alliance predicts treatment outcome better than therapist-rated alliance, therapists should frequently use assessments of therapeutic relationship within the therapy and pay attention if the adolescent feels the alliance is weakening or his/her evaluation is contrary to the therapist’s.

Observer and client perceptions of therapist multicultural orientation in a jail setting.

“…It was also anticipated that clients who perceived their therapist as less responsive to opportunities for cultural discussion during sessions (i.e., the therapist missed more cultural opportunities) would report a weaker therapeutic alliance. Additionally, given that previous research suggests client ratings of therapeutic alliance or cultural processes during session have been unrelated to therapist- (Fuertes et al, 2006; Gergov et al, 2021; Polaschek and Ross, 2010; Soto et al, 2018) or observer ratings (e.g., Constantine, 2001; Flückiger et al, 2018; Luong et al, 2022; Polaschek & Ross, 2010; Ribeiro et al, 2021; Worthington et al, 2000), it was speculated that client and observer ratings of therapist cultural humility, missed cultural opportunities, and therapeutic alliance would be unrelated.…”