Early therapeutic alliance and trajectories of change across in-person therapy and teletherapy with couples

OBJECTIVE: Teletherapy has demonstrated outcomes comparable to in-person treatment, yet less is known about how early therapeutic processes and change trajectories unfold across modalities in couple therapy. This study examined whether early alliance predicts outcomes and change trajectories and whether these associations differ by modality and initial distress. METHOD: Data were drawn from 266 different-sex couples at university-based training clinics (2020-2024). Alliance was assessed via the Session Rating Scale (SRS) and functioning via the Outcome Rating Scale (ORS), using dyadic models and latent growth curve analyses. RESULTS: Early alliance predicted outcomes for female but not male partners, with no significant differences across modalities. Greater attendance predicted better outcomes; higher initial distress predicted poorer outcomes, with stronger effects for women in in-person therapy. ORS scores followed a nonlinear trajectory characterized by rapid early improvement followed by stabilization.. In teletherapy, higher alliance was associated with a gradual rate of early improvement. Partner distress reduced improvement for female partners. CONCLUSION: Early change was characterized by rapid gains followed by stabilization across both modalities. However, alliance predicted outcomes for female but not male partners, and partner distress constrained improvement among female partners, underscoring the importance of dyadic processes in couple therapy.