The Role of Client Preference for Therapeutic Alliance in Retention in Therapy

This study used a delay discounting model to examine the decisions around and preferences for different levels of therapeutic alliance and different lengths of therapy for therapeutically motivated participants. Overall, the level of bond was predicted to impact participants’ decisions about therapy duration with an overall preference for a stronger bond even if it meant lengthening treatment. A total of 105 participants completed an online delayed discounting questionnaire designed to assess at what indifference point in the therapeutic bond clients were willing to switch to a longer therapy. All participants were either currently attending therapy or waiting to attend therapy, and were primarily White and female with an average age of 34.92 years. A series of nonparametric tests were statistically significant for each of the hypotheses (ps < .001) except for 2c. Specifically, findings indicated that participants switched to the longer treatment duration in order to pursue a stronger therapeutic bond when they were offered a short therapy program with an unbonded or neutral therapeutic bond (1a and 1b), and that people needed higher therapeutic alliances to justify switching to longer therapy programs as their durations increased (8–12 weeks; 2a and 2b). Also, contrary to our predictions, people preferred a longer therapy with a lower bonded therapist over a shorter therapy duration with the highest bonded therapist possible (1c), and people discounted the same amount of therapeutic alliance when switching to the 8- and 12-week programs (2c). These results suggest that therapeutic alliance influences retention, but participants’ motivation to attend therapy may also be a contributing factor. These findings are important for clinicians to consider when forming relationships with their clients, as previous literature has been mixed on the relationship between alliance and retention.