Therapist Perspective of Therapeutic Alliance and Treatment Outcome in Systemic Psychotherapy

One of the most robust findings in psychotherapy outcome research has been the relationship of a strong therapeutic alliance with improvement in treatment. Most research, however, has measured therapeutic alliance from the client’s point of view, disregarding the therapist’s perspective of this phenomenon. In this naturalistic study of adults in systemic individual, couple, or family psychotherapy (N = 627), both client- and therapist-ratings of alliance were assessed for their associations with treatment outcomes. Multilevel modeling was employed to analyze data from the Marriage and Family Therapy Practice Research Network (MFT-PRN). Client-ratings of the therapeutic alliance and general functioning/relationship satisfaction at the start of treatment were both found to predict outcomes at the end of treatment. However, no association was found for the therapist’s rating of alliance, nor was the therapist’s rating found to moderate the relationship between client-ratings and therapy outcomes. Findings potentially highlight the asymmetric nature of the therapeutic relationship, with the client’s perspective of the alliance more salient for treatment outcomes, as well as the need for routine outcome monitoring to regularly assess therapeutic alliance strength.