Abstract
This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. A summary of how the concept of alliance has evolved over time and the more popular alliance measures used in literature to assess the level of alliance are presented. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. In our opinion, with regard to the relationship between the therapeutic alliance and outcome of psychotherapy, future research should pay special attention to the comparison between patients’ and therapists’ assessments of the therapeutic alliance. This topic, along with a detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects.
Highlights
The main aim of this paper is to propose a historical excursus of the most relevant literature which has investigated the relationship between the therapeutic alliance and outcome in psychotherapy.A challenge by Eysenck (1952), who claimed that the efficacy of psychotherapy had not been demonstrated and that any improvements were the result of so-called spontaneous remission, stimulated significant developments in the study of outcomes in psychotherapy
This viewpoint was more recently confirmed by Strupp (2001), who showed that the outcome of a psychotherapeutic process is often influenced by so-called nonspecific factors, namely, the personal characteristics of the therapist and the positive feelings that arise in the patient – feelings which can lead to the creation of a positive therapeutic climate from an emotional and interpersonal perspective
Outcome research analyses the results of the therapy, whereas process research investigates the various aspects of the therapeutic process, which can be measured during the course of therapy regardless of outcome
Summary
The main aim of this paper is to propose a historical excursus of the most relevant literature which has investigated the relationship between the therapeutic alliance and outcome in psychotherapy. Research into the relationship between the process and outcome of psychotherapy has frequently attempted to explain the non-specific factors theorized by Strupp and Hadley (1979) which can have a significant impact on the outcome of different treatments This viewpoint was more recently confirmed by Strupp (2001), who showed that the outcome of a psychotherapeutic process is often influenced by so-called nonspecific factors, namely, the personal characteristics of the therapist and the positive feelings that arise in the patient – feelings which can lead to the creation of a positive therapeutic climate from an emotional and interpersonal perspective. Outcome research analyses the results of the therapy, whereas process research investigates the various aspects of the therapeutic process, which can be measured during the course of therapy regardless of outcome This process is what takes place between, and within, the patient and therapist during the course of their interaction (Orlinsky and Howard, 1986). It allows the patient to follow the therapist and use his or her interpretations
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