To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.

Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review.

Anxiety Disorders and Phobias: A Cognitive Perspective

During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control gro...

https://www.tandfonline.com/doi/pdf/10.1080/16506073.2017.1401115

Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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The alliance in adult psychotherapy: A meta-analytic synthesis.

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Cognitive Therapy: Basics and Beyond

This study developed a measure of the accuracy of therapists' interpretations based on the core contliclual relationship theme method and examined the relation of accuracy to the outcome of dynamic psychotherapy. Accuracy was assessed on therapists' interpretations from two early-intreatment sessions of 43 patients receiving moderate-length dynamic therapy. The results indicated that accuracy about the main wishes and responses from others that were expressed in the relationship themes was significantly related to outcome, even after the effects of general errors in treatment techniques and the quality of the helping alliance had been controlled for. Our hypothesis that accurate interpretations would have their greatest impact in the context of a positive helping alliance was not confirmed.

The accuracy of therapists' interpretations and the outcome of dynamic psychotherapy.

Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials

Long-term efficacy of psychotherapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials.

An empirical review of potential mediators and mechanisms of prolonged exposure therapy.

Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed outpatients randomized to the combined condition of a clinical trial, we examined ratings of adherence and alliance as predictors of subsequent session-to-session symptom change across early CT sessions. Results: Both adherence to Behavioral Methods/Homework and the therapeutic alliance significantly predicted session-to-session symptom change. In models in which patients’ medication regimen and prior symptom change were covaried, only Behavioral Methods/ Homework remained a significant predictor of subsequent symptom change. Conclusions: Our findings highlight the utility of Behavioral Methods/Homework in combined treatment for promoting early session-to-session symptom change.

The process of change in cognitive therapy for depression when combined with antidepressant medication: Predictors of early intersession symptom gains.

Andrew A. Cooper

Papers

The accuracy of therapists' interpretations and the outcome of dynamic psychotherapy.

Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials

Long-term efficacy of psychotherapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials.

An empirical review of potential mediators and mechanisms of prolonged exposure therapy.

The process of change in cognitive therapy for depression when combined with antidepressant medication: Predictors of early intersession symptom gains.