Abstract
Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients' and therapists' estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument. We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size. Heterogeneity analyses (k=22, Cohen's d=-.46, 95% confidence interval=.31-1.1) produced a significant Q-statistic (Q=94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate. Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client's diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients' and therapists' estimations than do more general instruments that are applied to assess TA.
Highlights
The therapeutic alliance (TA) has been consistently shown to be one of the most important factors in psychotherapy, and a robust alliance-outcome link has been found across different therapy approaches [1]
Our inclusion criteria were as follows: (a) ratings of the TA from both client perspective and therapist perspective had to be reported, (b) studies had to include at least eight individual sessions of psychotherapy, (c) studies had to have a group design of at least 10 participants, (d) patients had to be 18 years of age or older, and (e) studies had to be published in English, (f) over 60% of the subjects had to be diagnosed with schizophrenia spectrum disorders, personality disorders, or substance misuse disorders according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria
With these limitations in mind, our meta-analysis suggests that clients with serious mental illness tend to have higher estimations of TA than do therapists, a finding that is often found among clients without such psychiatric disorders
Summary
The therapeutic alliance (TA) has been consistently shown to be one of the most important factors in psychotherapy, and a robust alliance-outcome link has been found across different therapy approaches [1]. Interpersonal conceptualizations view the therapeutic relationship as involving the ongoing negotiation of meanings between the therapist’s presence and the client’s subjective experience [3]. In this framework, the TA is a dyadic process in which clients and therapists mutually influence one another [3]. In exploring mean difference scores, it is important to note that a previous meta-analysis demonstrated that clients systematically rated their alliance higher than did their therapists (d = 0.63) [15]. The aim of the present meta-analysis was to assess the mean differences between clients’ and therapists’ estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument. Specific setting-related instruments seem to result in higher agreement between clients’ and therapists’ estimations than do more general instruments that are applied to assess TA
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
