Association of patients’ pre-therapy strengths and alliance in outpatient psychotherapy: A multilevel growth curve analysis

Abstract

Objective Meta-analytic evidence showed robust associations between the alliance in psychotherapeutic dyads and treatment outcomes. Recent studies have indicated that facets of positive mental health are additionally relevant predictors of both the alliance and success of psychotherapy. However, the impact of patients’ pre-therapy strengths on the alliance at the beginning and during treatment has been scarcely examined. Method 428 patients (62.4% female, M age = 40.79), treated by 41 therapists, underwent cognitive behavioral therapy in a German outpatient training and research center. Alliance from patients’ perspectives was assessed at the beginning and during treatment. Data were analyzed with multilevel growth curve modeling. Results Alliance increased during psychotherapy, with a quadratic trajectory best representing this trend on average, p < .001. Pre-therapy strengths were positively related to alliance intercept, b = 0.0537, p < .001. No interaction was found between the included time variables and pre-therapy strengths in the prediction of the alliance slope. Conclusion Positive mental health facets should be considered in psychotherapy research and practice. Future studies may focus on the parallel development of patients’ strengths with other process factors in treatment.