Alliance Scores Research Articles

A Dyadic Analysis of the Between‐ and Within‐System Alliances on Distress

This study examines the relationship between the therapeutic alliance and distress using the couple rather than the individual as the unit of analysis. One hundred and seventy-three couples receiving treatment for relational distress at two university clinics participated in this study. The actor-partner interdependence model was used to analyze the relationship of each partner's between- and within-system alliance scores and distress at session four. Results provide support for actor effects on relational distress for both male and female partners and for actor effects on psychological distress for female partners. Limited support was found for partner effects on distress. Furthermore, results indicate that the alliance between partners is a stronger predictor of improvement in early sessions in comparison with the alliance between the individual and the therapist.

The process of change in cognitive therapy for depression: predictors of early inter-session symptom gains.

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists' adherence to cognitive therapy techniques, the patients' facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists' adherence in treatment response.

Counsellor behaviours that predict therapeutic alliance: From the client's perspective

The therapeutic alliance has been shown to be a robust predictor of counselling outcome. However, the specific counsellor behaviours that relate to the alliance have not been clearly and consistently identified, and prior attempts to identify these variables have not been typically based on client-derived conceptualizations of the alliance. A total of 79 adult counselling clients participated in a study examining the relationship between 15 client-identified counsellor behaviours and the strength of the therapeutic alliance. Correlational analyses revealed that 11 of the 15 behaviours moderately to strongly correlated with the strength of the alliance, and hierarchical regression analyses found that three particular counsellor behaviours (making encouraging statements, making positive comments about the client, and greeting the client with a smile) accounted for 62% of the variance in alliance scores. The findings suggest that seemingly small, strengths-fostering counsellor micro-behaviours can play a key role in strengthening therapeutic alliances. Given the role that alliance plays in positive counselling outcomes, it is suggested that these behaviours be tactfully implemented early on in the counselling process.

The alliance in couple therapy: Partner influence, early change, and alliance patterns in a naturalistic sample.

The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence and gender and sought to identify couple alliance patterns that predicted couple outcomes. The authors examined the alliances and outcomes at posttreatment and follow-up of 250 couples seeking treatment for marital distress in a naturalistic setting. The Session Rating Scale was used to measure the alliance; the Outcome Rating Scale and Locke Wallace Marital Adjustment Scale were used to measure outcomes. Couples were White, Euro-Scandinavian, and heterosexual, with a mean age of 38.5 years and average number of years together of 11.8. On a subsample (n = 118) that included couples with 4 or more sessions, the authors investigated the relationship between the alliance and outcome controlling for early change, and patterns of alliance development were delineated. In the full sample, first-session alliances were not predictive of outcomes, but last-session alliances were predictive for both individuals and their partners. In the subsample, third-session alliances predicted outcome significantly above early change (d = 0.25) that exceeded the reliable change index. Couple alliances that started over the mean and increased were associated with significantly more couples achieving reliable or clinically significant change. Gender influences were mixed. Given the current findings suggesting a potential alliance impact over and above symptom relief as well as the importance of ascending alliance scores, continuous assessment of the alliance appears warranted.

Client attachment to therapist: Relation to client personality and symptomatology, and their contributions to the therapeutic alliance.

This study examined the relation of client attachment to the therapist to diverse facets of the therapeutic alliance, client personality, and psychopathological symptoms, as well as the relative importance of therapeutic attachments, personality, and symptomatology in predicting the alliance. Eighty clients in ongoing therapy completed measures of client attachment to therapist (CATS), personality (6FPQ), psychopathological symptoms (BSI), and therapeutic alliance (WAI-Short, CALPAS, HAQ). Secure and Avoidant-Fearful attachment to the therapist correlated positively and negatively, respectively, with total and subscale alliance scores. Preoccupied-Merger therapeutic attachment was unrelated to the alliance. Exploratory analyses suggested however that the relationship between Preoccupied-Merger attachment and the alliance was moderated by the extent to which clients were distressed. Clients' therapeutic attachments were unrelated to basic personality dimensions. Preoccupied-Merger attachment to the therapist correlated significantly with several symptom dimensions. Clients' therapeutic attachments emerged as superior and more consistent predictors, relative to client personality and symptomatology, of the therapeutic alliance.

How does tele-mental health affect group therapy process? Secondary analysis of a noninferiority trial.

Video teleconferencing (VTC) is used for mental health treatment delivery to geographically remote, underserved populations. However, few studies have examined how VTC affects individual or group psychotherapy processes. This study compares process variables such as therapeutic alliance and attrition among participants receiving anger management group therapy either through traditional face-to-face delivery or by VTC. The current study represents secondary analyses of a randomized noninferiority trial (Morland et al., in press) in which clinical effectiveness of VTC delivery proved noninferior to in-person delivery. Participants were male veterans (N = 112) with posttraumatic stress disorder (PTSD) and moderate to severe anger problems. The present study examined potential differences in process variables, including therapeutic alliance, satisfaction, treatment credibility, attendance, homework completion, and attrition. No significant differences were found between the two modalities on most process variables. However, individuals in the VTC condition exhibited lower alliance with the group leader than those in the in-person condition. Mean self-leader alliance scores were 4.2 (SD = 0.8) and 4.5 (SD = 0.4), respectively, where 5 represents strongly agree and 4 represents agree with positive statements about the relationship, suggesting that participants in both conditions felt reasonably strong alliance in absolute terms. Individuals who had stronger alliance tended to have better anger outcomes, yet the effect was not strong enough to result in the VTC condition producing inferior aggregate outcomes. Our findings suggest that even if group psychotherapy via VTC differs in subtle ways from in-person delivery, VTC is a viable and effective means of delivering psychotherapy.

Stages of change and the working alliance in psychotherapy

This study investigated whether the working alliance mediates between the stages of change and symptom improvement. It also investigated whether progression to a higher stage of change was associated with an enhancement in working alliance and outcome scores. Fifty-six adult clients receiving counseling at a community mental health clinic completed measures after the first, fifth, and termination sessions. Using the Baron and Kenny (1986) and bootstrapping procedures, the working alliance was found to be a mediating variable. A multivariate analysis of variance indicated that clients who progressed from a lower stage to a higher stage reported stronger working alliances and more symptom improvement than those who did not progress. These results offer further support for the importance of a strong working alliance in psychotherapy.

The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome.

The purpose of this study was to understand how the real relationship (RR) relates to important process and outcome variables from both the clients' and therapists' perspectives. Using a sample of 31 therapist/client dyads at a university counseling center, the authors examined the RR at the 3rd session of therapy and at termination. The results revealed that client adult attachment avoidance was negatively correlated with client RR, while client adult attachment anxiety was uncorrelated. Therapists' ratings of negative transference were negatively correlated with therapist-rated RR and were uncorrelated with client-rated RR. Hierarchical linear modeling analyses were conducted to predict postintervention outcome from client and therapist perceptions of the RR. Therapists' ratings of the RR accounted for a significant amount of variance in client posttreatment symptoms while controlling pretreatment symptoms. Client-rated RR total scores and client and therapist 3rd-session alliance scores were not significant predictors of postsymptom ratings. Implications of the usefulness of measuring the RR in psychotherapy are discussed, as are recommendations for future study.

The relationship of therapeutic alliance to outcome in wilderness treatment

The author examined therapeutic alliance in relation to a standardized measure of social and psychological outcomes for adolescents with behavioural, emotional and substance use diagnoses in a wilderness treatment programme. Client self-ratings of treatment outcome and therapeutic alliance were found to improve significantly. However, early alliance scores and change from early- to post-treatment alliance scores were not predictive of treatment outcomes as suggested in treatment literature. Questions concerning wilderness leader/therapist roles, wilderness effect and involuntary treatment related to alliance are raised. Methodological difficulties in completing this line of research are shared and implications for practice are discussed.

Presence mediates the impact of attitudes and behaviors on the quality of the working alliance in telepsychotherapy for panic disorder and agoraphobia

Event Abstract Back to Event Presence mediates the impact of attitudes and behaviors on the quality of the working alliance in telepsychotherapy for panic disorder and agoraphobia Genevieve Robillard1*, Stephane Bouchard1, T. Guitard1 and C. Lefebvre1 1 Université du Québec en Outaouais, Canada Many studies suggest that the therapeutic alliance is an important factor in the effectiveness of psychotherapy. A variety of measures is available to assess therapeutic alliance but they are all centered on the strength of the alliance felt between the therapist and client, not on actual behaviour performed to develop this alliance. The present study aims to assess how attitudes and behaviors of both the therapist and the client can influence the quality of therapeutic alliance while the therapy is being conducted in videoconference. A total of 55 telepsychotherapy sessions for the treatment of panic disorder and agoraphobia were videotaped and analysed. All participants were diagnosed with panic disorder and agoraphobia using the DSM-IV criteria. An independent clinician examined sessions 1, 5 and 12 and rated therapists and clients’ attitudes and behaviors relevant to the therapeutic alliance with an instrument previously developed in our Lab. The Working Alliance Inventory was completed by the therapists at the same therapy sessions. Results show that attitudes and behaviors do not correlate significantly with the therapeutic alliance, probably due to ceiling effects. However, the feeling of telepresence has a direct influence on the working alliance scores and appears to mediate the relationship between client’s behaviour and working alliance. Conference: Annual CyberTherapy and CyberPsychology 2009 conference, Villa Caramora, Italy, 21 Jun - 23 Jun, 2009. Presentation Type: Oral Presentation Topic: Oral Presentations Citation: Robillard G, Bouchard S, Guitard T and Lefebvre C (2009). Presence mediates the impact of attitudes and behaviors on the quality of the working alliance in telepsychotherapy for panic disorder and agoraphobia. Front. Neuroeng. Conference Abstract: Annual CyberTherapy and CyberPsychology 2009 conference. doi: 10.3389/conf.neuro.14.2009.06.089 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 23 Mar 2009; Published Online: 23 Mar 2009. * Correspondence: Genevieve Robillard, Université du Québec en Outaouais, Québec, Canada, genevieve_robillard@hotmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Genevieve Robillard Stephane Bouchard T. Guitard C. Lefebvre Google Genevieve Robillard Stephane Bouchard T. Guitard C. Lefebvre Google Scholar Genevieve Robillard Stephane Bouchard T. Guitard C. Lefebvre PubMed Genevieve Robillard Stephane Bouchard T. Guitard C. Lefebvre Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

A paediatric therapeutic alliance occurs with distance intervention

We investigated whether a distance therapeutic alliance occurs when children receive manualized, cognitive-behavioural treatment via telephone, in the absence of face-to-face contact. The therapeutic alliance scores were measured in 55 child-parent pairs. The mean total Working Alliance Inventory child scores were 236 (95% confidence interval [CI]: 232, 240) and the mean parent scores were 245 (95% CI: 242, 247). Parent scores were significantly higher than child scores, although the difference may not be clinically meaningful. This study provides evidence that a strong therapeutic alliance does occur between child-coach and parent-coach pairs when treatment is delivered from a distance by non-professionals. The term 'child' encompasses both children and adolescents.

Behavioral activation therapy for depressed cancer patients: Factors associated with treatment outcome and attrition.

Psychological interventions for cancer patients have included educational methods, supportive therapy, cognitive-behavioral therapy, relaxation training, problem-solving and social skills training, biofeedback, and hypnosis (Andersen, 1992; Baum & Andersen, 2001; Carlson & Butz, 2004; Evans et al., 2005). In studies assessing the efficacy of these interventions, there is substantial support that they effectively reduce symptoms of depression, anxiety, and pain (Antoni et al., 2001; Carlson & Butz, 2004; Goodwin et al., 2001; Hopko et al., in press; Moorey, Greer, Bliss, & Law, 1998; Trijsburg, van Knippenberg, & Rijpma, 1992). Conversely, there are a few studies in which psychosocial interventions have seemingly had minimal impact in reducing psychological distress (e.g., Cunningham et al., 1998; Edelman, Bell, & Kidman, 1999), and in a fairly recent review of the literature, it was concluded that although no intervention can be highly recommended for reducing depression in cancer patients, there is most empirical support for group therapy, education, structured counseling, cognitive behavioral therapy, communication skills training, and self-esteem building approaches (Newell, Sanson-Fisher, & Savolainen, 2002). Among the several limitations inherent to psychosocial treatment outcome research with cancer patients, very few studies have targeted patients with well-diagnosed clinical depression and little is known about the factors that most predict treatment outcome and attrition in this population. The present study addresses precisely these issues. In treatment outcome research focused on individuals with clinical depression, several factors have been associated with a negative (or limited) treatment response, including increased severity and chronicity of depression, earlier age of onset, family history of depression, presence of a personality disorder (but see Mulder, Joyce, & Luty, 2003), co-existent Axis I disorders, presence of psychotic symptoms, perceived social stigma, increased cognitive and/or social dysfunction, high levels of self-criticism, marital problems or being unmarried, decreased treatment expectations, and double depression (Duggan, Sham, Minne, Lee, & Murray, 1998; Earle, Smith, Harris & Longino, 1998; Enns, Cox & Pidlubny, 2001; Jarrett, 1995; Kung & Elkin, 2000; Mynors-Wallis & Gath, 1997; Robinson & Spiker, 1985; Sirey et al., 2001; Sotsky et al., 1991; Viinamaki et al., 2006). A recent study utilizing functional magnetic resonance imaging also revealed potential treatment outcome differences as a function of organic processes. Specifically, patients whose reactivity to emotional stimuli was low in the subgenual cingulate cortex and high in the amygdala demonstrated more attenuation of depressive symptoms following cognitive-behavioral therapy (Siegle, Carter, & Thase, 2006). Pertaining to treatment attrition, variables associated with an increased likelihood of prematurely terminating psychotherapy include lower socioeconomic status, reduced income and lower educational level, ethnic or racial minority status, and younger age (Grilo et al., 1998; Rabin, Kaslow, & Rehm, 1985; Roffman, Klepsch, Wertz, Simpson, & Stephens, 1993; Self, Oates, PinnockHamilton & Leach, 2005; Stratterfield, 1998). Patients presenting with co-existent psychiatric diagnoses also tend to exhibit higher attrition rates (Arnow et al., 2007; Frank et al., 2000; Issakidis & Andrews, 2004). More specific to treatment process, treatment expectations may impact attrition, with negative attitude towards treatment and a discontinuity between patients' personal beliefs and proposed treatment rationale increasing attrition rates (Rabin et al, 1985). Arnow et al. (2007) also reported that lower therapeutic alliance scores predicted earlier attrition in treatment. Finally, patients enrolled in cognitive-behavioral group therapy also appear more likely to discontinue treatment if they have higher pretreatment hopelessness scores and are more pessimistic about symptom control (Westra, Dozois & Boardman, 2002). …

How do therapists enhance family alliances? Sequential analyses of therapist-client behavior in two contrasting cases.

To identify alliance-related behavior patterns in more and less successful family therapy, the authors intensively analyzed two cases with highly discrepant outcomes. Both families were seen by the same experienced clinician. Results showed that participants' perceptions of the alliance, session impact, and improvement at three points in time were congruent with the families' differential outcomes and with observer-related alliance behavior using the System for Observing Family Therapy Alliances. In this measure, therapist behaviors contribute to the alliance and client behaviors reveal the strength of the alliance on four dimensions: Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family. In the poor outcome case, observer ratings and self-reported alliance scores revealed a persistently "split" alliance between family members; this family dropped out midtreatment. Only in the good outcome case did the clients follow the therapist's alliance-building interventions with positive alliance behaviors; sequential analyses showed that therapist contributions to Engagement significantly activated client Engagement behavior, and therapist Emotional Connection interventions significantly activated client Emotional Connection. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Patient versus therapist alliance: Whose perception matters?

Development of working alliance was examined for 25 opioid-abusing pain patients and their therapists. Patients participated in an eight-session intervention based on adherence strategies and employment of a supportive, psychoeducational approach; methadone was prescribed for pain. Treatment goals included opioid analgesic adherence and decreasing pain, functional interference, and substance abuse. Patients and therapists completed the Helping Alliance Questionnaire-II following each treatment session. At baseline, scores of patients and therapists indicated good alliance. Patient alliance grew significantly over time regardless of addiction severity and independent of treatment outcomes. In contrast, therapist alliance grew only for patients without substance abuse comorbidity and/or who had good outcomes. Patients' and therapists' alliance scores were consistent during sessions focused on emotional bonds but diverged during sessions that demanded behavior change, suggesting that therapists may have reacted negatively to patients' lack of progress. Whether therapists' reactions to poor performers impacted subsequent patient outcomes is unknown but should be investigated.

Alliance in two telephone-administered treatments: Relationship with depression and health outcomes.

The present study examined the relationship between therapeutic alliance and both depression and health outcomes in a randomized clinical trial of 2 telephone-administered treatments with 97 clients with multiple sclerosis (MS). The 16-week, manualized treatments compared were telephone-administered cognitive-behavioral therapy (T-CBT) and telephone-administered supportive emotion focused therapy (T-SEFT), an experiential treatment. Alliance scores were significantly higher in T-CBT compared with T-SEFT, and treatment moderated the relationship between alliance and outcome on some of the measures. Specifically, alliance predicted subsequent improvements in depression within the T-CBT condition, but not in T-SEFT, controlling for early symptom change. The authors found a similar trend for alliance and MS-related disability in T-CBT only. This is one of the first studies to examine the role of alliance in outcome for the emerging modality of telephone therapy and one of the few to relate alliance to health outcomes. The findings suggest that the therapist-client relationship is important to improvement in telephone therapy and that the role of alliance in outcome may vary by treatment approach.

Predictors of outcome and completion status in cognitive therapy for depression

The aim of this study was to investigate the relationship among therapy outcome, premature termination, and client interpersonal style and therapeutic alliance. Of the 94 clients who began cognitive therapy for the treatment of depression, 24 did not complete their agreed-on number of therapy sessions, had poorer outcomes and alliance scores, and were more likely to have an ambivalent interpersonal style. However, mediation of this relationship between interpersonal style and completion status by alliance was not significant. Therapy outcomes for all clients were better for clients with a secure interpersonal style than for those with an insecure interpersonal style, particularly avoidant. The association between interpersonal style and outcome was mediated by the therapeutic alliance.

Does the Quality of the Working Alliance Predict Treatment Outcome in Online Psychotherapy for Traumatized Patients?

Background The provision of online counseling and online therapy is steadily increasing. The results of a number of controlled trials investigating the efficacy of online approaches indicate that some of these new treatment alternatives might indeed be effective. Yet, little is known about how the therapeutic relationship (or working alliance) evolves over the Internet and whether it influences treatment outcome as it does in traditional face-to-face therapy. The working alliance has been defined as the extent to which a patient and a therapist work collaboratively and purposefully and connect emotionally.Objective The aim of the study was to investigate the quality and predictive relevance of the therapeutic alliance for patients receiving a short-term, Internet-based, cognitive-behavioral therapy program for posttraumatic stress reactions.Methods After rigorous screening for exclusion criteria of high dissociative tendencies, risk of psychosis, and suicidal tendencies, 48 patients, who had experienced a traumatic event in the past, were included in the online treatment study. The short form of the Working Alliance Inventory (WAI-S) was administered at the fourth treatment session. The relevance of the therapeutic relationship for treatment outcome was assessed in terms of residual gain from pretreatment assessment to the end of treatment. The revised Impact of Event Scale (IES-R) and the depression and anxiety subscales of the Brief Symptom Inventory (BSI) were used to assess treatment outcome.Results A total of 48 participants were included in the analysis. Overall, high alliance scores were found. In contrast to previous studies of conventional face-to-face therapy, there was only a low to modest association (.13 to .33) between the quality of the therapeutic relationship and treatment outcome.ConclusionHigh alliance scores indicate that it was possible to establish a stable and positive therapeutic relationship online. However, the therapeutic relationship was found to be a less relevant predictor of the therapy outcome than in face-to-face approaches. We discuss whether this finding can be attributed to methodological reasons such as the restricted range of alliance ratings obtained or the time of administration of the WAI-S, or whether the therapeutic relationship might be less relevant to the treatment outcome of online therapy approaches.

A therapeutic alliance can exist without face-to-face contact

We examined the therapeutic alliance in 64 parents who completed treatment with a non-professional telephone coach in a paediatric psychosocial and behavioural intervention study called Family Help. The mean total Working Alliance Inventory score was 242.7 (95% confidence interval [CI]: 240.2, 245.2). Overall, the total scores were very high regardless of coach/parental age or gender, socioeconomic class/educational level of the parent, severity or type of the child's mental health disorder or modality of treatment delivery. The results were compared with normative data reported from other studies, which suggested that the distance therapeutic alliance scores were at least similar to face-to-face therapeutic alliance scores. The present study provides evidence that a strong, positive therapeutic alliance can exist in the absence of face-to-face contact using non-professional telephone coaches.

Dropouts versus completers among chronically depressed outpatients

Background Premature termination is common among patients treated for depression with either pharmacotherapy or psychotherapy. Yet little is known about factors associated with premature treatment termination among depressed patients. Methods This study examines predictors of, time to, and reasons for dropout from the 12-week acute phase treatment of nonpsychotic adult outpatients, age 18–75, with chronic major depression who were randomly assigned to nefazadone alone (MED), cognitive behavioral analysis system of psychotherapy alone (CBASP) or both treatments (COMB). Results Of 681 randomized study participants, 156 were defined as dropouts. Dropout rates were equivalent across the three treatments. Among dropouts, those in COMB remained in treatment (Mean = 40 days) significantly longer than those in either MED (Mean = 27 days) or CBASP (Mean = 28 days). Dropouts attributed to medication side-effects were significantly lower in COMB than in MED, suggesting that the relationship with the psychotherapist may increase patient willingness to tolerate side-effects associated with antidepressant medications. Ethnic or racial minority status, younger age, lower income, and co-morbid anxiety disorders significantly predicted dropout in the full sample. Within treatments, differences between completers and dropouts in minority status and the prevalence of anxiety disorders were most pronounced in MED. Among those receiving CBASP, dropouts had significantly lower therapeutic alliance scores than completers. Limitations The sample included only individuals with chronic depression. Conclusions Predictors of dropout included baseline patient characteristics, but not early response to treatment. Ethnic and racial minorities and those with comorbid anxiety are at higher risk of premature termination, particularly in pharmacotherapy, and may require modified treatment strategies.

Association between Interpersonal Behaviour and Helping Alliance in Substance-Dependent Patients

This paper focuses on exploring the association between the patient’s perception of his own interpersonal behaviour on the one hand, and that of the therapist’s behaviour and of helping alliance on the other hand. A cross-sectional study was conducted, including 83 patients from substance dependence programs in The Netherlands. They completed the Helping Alliance Questionnaire (HAQ) and the Interpersonal Check List (ICL). Results indicate that the patient’s perception of the therapeutic alliance, and his perception of his own and of the therapist’s interpersonal behaviour are three separate domains, each playing their role in the context of the therapeutic relationship. Helping Alliance scores are predicted by both the patient’s (complaisance) and the therapist’s interpersonal behaviour (dominance). We conclude that patient’s cognitions about himself and about his therapist do contribute significantly to the perception of the therapeutic relationship. Limitations to the study are discussed, as well as some clinical implications.