Working Alliance Ratings Research Articles

Working Alliance, Risk, and Recidivism: A Community-Based Corrections Analysis

The relationship between the working alliance and rates of recidivism for individuals on probation or parole has been underexplored, and what information has been reported provides inconsistent findings. This study sought out to explore this relationship further by examining the degree to which client perceptions ( N = 145) of the working alliance were related to, and predicted, general and violent recidivism measured as reconviction. Results revealed that working alliance ratings were not significantly different between clients who recidivated and those who did not and did not predict future recidivism. Results also revealed that client age and risk predicted subsequent recidivism, while client perceptions of the working alliance did not. Implications for supervising officers in community corrections and recommendations for future research are discussed.

Using web-based, guided self-help to bridge the waiting time for face-to-face out-patient treatment for bulimic-spectrum disorders: randomised controlled trial.

Although effective treatments for bulimic-spectrum eating disorders exist, access is often delayed because of limited therapist availability and lengthy waiting lists. Web-based self-help interventions have the potential to bridge waiting times for face-to-face treatment and overcome existing treatment gaps. This study aims to assess the effectiveness of a web-based guided self-help intervention (everyBody Plus) for patients with bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who are waiting for out-patient treatment. A randomised controlled trial was conducted in Germany and the UK. A total of 343 patients were randomly assigned to the intervention 'everyBody Plus' or a waitlist control condition. The primary outcome was the number of weeks after randomisation until a patient achieved a clinically relevant improvement in core symptoms for the first time. Secondary outcomes included eating disorder attitudes and behaviours, and general psychopathology. At 6- and 12-month follow-up, the probability of being abstinent from core symptoms was significantly larger for the intervention group compared with the control group (hazard ratio: 1.997, 95% CI 1.09-3.65; P = 0.0249). The intervention group also showed larger improvements in eating disorder attitudes and behaviours, general psychopathology, anxiety, depression and quality of life, compared with the control group at most assessment points. Working alliance ratings with the online therapist were high. The self-help intervention everyBody Plus, delivered with relatively standardised online guidance, can help bridge treatment gaps for patients with bulimic-spectrum eating disorders, and achieve faster and greater reductions in core symptoms.

Therapist and client perceptions of the working alliance: Codevelopment, linear growth, variability, and client functioning.

Using longitudinal client and therapist working alliance ratings, previous research examined how alliance: average value, linear growth, variability, stability (autocorrelation), and partner responsiveness were associated with client outcome. However, no research simultaneously examined all of these dimensions. Omitting important variables in analyses could lead to overestimation of related effects. Therefore, the purpose of this study was to examine these effects simultaneously. Therapists (N = 45) and clients (N = 236) rated alliance after every session (N = 10,720) and clients completed a measure of psychological distress after every eighth session. We used dynamic structure equation modeling to model longitudinal ratings using the longitudinal actor-partner interaction and location-scale models. Across sessions, there were significant linear growth and significant variability in client and therapist alliance ratings. The variability indicates multiple "V" patterns, which have been associated with alliance ruptures. Both actor effects were significant, showing session-to-session stability for client and therapist alliance. In addition, client-partner effect was significant, indicating higher-than-usual client alliance in a session predicting an increase in therapist alliance in the subsequent session. Growth in neither client-rated nor therapist-rated working alliances was significantly associated with client improvement. Lower variabilities (fewer fluctuations) in both client- and therapist-rated working alliances were associated with better outcomes. Higher therapist-actor and partner effects were associated with client improvement, but client-actor and partner effects were not associated with client improvement. Average working alliances were not associated with client improvement. Implications for practice and research were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Retraction of Kivlighan et al. (2016).

Reports the retraction of "Working alliance, real relationship, session quality, and client improvement in psychodynamic psychotherapy: A longitudinal actor partner interdependence model" by Dennis M. Kivlighan Jr., Clara E. Hill, Charles J. Gelso and Ellen Baumann (Journal of Counseling Psychology, 2016[Mar], Vol 63[2], 149-161). The following article is being retracted (https://doi.org/10.1037/cou0000134). This retraction is at the request of coauthors Kivlighan, Hill, and Gelso after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Baumann was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2015-57048-001.) We used the Actor Partner Interdependence Model (APIM; Kashy & Kenny, 2000) to examine the dyadic associations of 74 clients and 23 therapists in their evaluations of working alliance, real relationship, session quality, and client improvement over time in ongoing psychodynamic or interpersonal psychotherapy. There were significant actor effects for both therapists and clients, with the participant's own ratings of working alliance and real relationship independently predicting their own evaluations of session quality. There were significant client partner effects, with clients' working alliance and real relationship independently predicting their therapists' evaluations of session quality. The client partner real relationship effect was stronger in later sessions than in earlier sessions. Therapists' real relationship ratings (partner effect) were a stronger predictor of clients' session quality ratings in later sessions than in earlier sessions. Therapists' working alliance ratings (partner effect) were a stronger predictor of clients' session quality ratings when clients made greater improvement than when clients made lesser improvement. For clients' session outcome ratings, there were complex three-way interactions, such that both Client real relationship and working alliance interacted with client improvement and time in treatment to predict clients' session quality. These findings strongly suggest both individual and partner effects when clients and therapists evaluate psychotherapy process and outcome. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Retraction of Gerstenblith et al. (2022).

Reports the retraction of "The triadic effect: Associations among the supervisory working alliance, therapeutic working alliance, and therapy session evaluation" by Judith A. Gerstenblith, Kathryn V. Kline, Clara E. Hill and Dennis M. Kivlighan Jr. (Journal of Counseling Psychology, 2022[Mar], Vol 69[2], 199-210). The following article is being retracted (https://doi.org/10.1037/cou0000567). This retraction is at the request of coauthors Kivlighan and Hill after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Gerstenblith and Kline were not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2021-88607-001.) Several theorists (Bandura, 1969; Hackney & Goodyear, 1984; Searles, 1955) suggest parallels between the relationship in supervision and the relationship in therapy. We examined supervisor and therapist trainee ratings of supervisory working alliance (SWA) in 1 week predicting client-rated therapeutic working alliance (TWA) and client-rated therapy session evaluation (TSE) in the following week as well as TWA and TSE ratings in 1 week predicting SWA ratings in the following week. Our data included 663 weeks of therapy nested within 28 trainees nested within 15 supervisors, disaggregated into differences between supervisors, differences within supervisors, and differences within trainees. At the between-supervisor level, when supervisors' trainees rated the SWA higher on average compared with other supervisors' trainees' average SWA ratings, their clients' average TWA rating was higher. In contrast, when supervisors rated the SWA higher on average compared with other supervisors' average SWA ratings, their trainees' clients' average TSE rating was higher but the average TWA rating was lower. At the within-supervisor level, when trainees rated a higher SWA on average compared with other trainees' average SWA ratings with the same supervisor, their clients' average TSE rating was higher. The theoretical prediction of parallel relationships in supervision and therapy was supported, but only for between-supervisor and within-supervisor differences in SWA. We found no evidence that week-to-week changes in SWA or client-rated TWA or TSE reflected parallel relationships. We provide suggestions for further research, including exploring the mechanisms through which supervision relates to the therapy process and outcome. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Empathy, working alliance, treatment expectancy and credibility in video and face-to-face psychotherapeutic first contact

Objective Video-based therapy has been used increasingly since the onset of the COVID-19 pandemic. Yet, video-based initial psychotherapeutic contact can be problematic due to the limitations of computer-mediated communication. At present, little is known about the effects of video first contact on important psychotherapeutic processes. Method: Forty-three individuals (n video = 18, n face-to-face = 25) were recruited via an outpatient clinic waiting list and were randomly assigned to video or face-to-face initial psychotherapeutic sessions. Participants rated treatment expectancy before and after the session, and the therapist’s empathy, working alliance, and credibility after the session and several days later. Results: Empathy and working alliance ratings of patients and therapists were high and did not differ between the two communication conditions after the appointment or at follow-up. Treatment expectancy increased to a similar extent for the video and face-to-face modalities from pre to post. Willingness to continue with video-based therapy increased in participants who had video contact, but not in those with face-to-face contact. Conclusion: This study indicates that crucial processes related to the therapeutic relationship can be initiated via video, without prior face-to-face contact. Given the limited nonverbal communication cues in video appointments, it remains unclear as to how such processes evolve. Trial registration: German Clinical Trials Register identifier: DRKS00031262..

Retraction of Kivlighan et al. (2017).

Reports the retraction of "Congruence and discrepancy between working alliance and real relationship: Variance decomposition and response surface analyses" by Dennis M. Kivlighan Jr., Kathryn Kline, Charles J. Gelso and Clara E. Hill (Journal of Counseling Psychology, 2017[Jul], Vol 64[4], 394-409). The following article (https://doi.org/10.1037/cou0000216) is being retracted. This retraction is at the request of coauthors Kivlighan, Hill, and Gelso after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Kline was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2017-15328-001.) We examined how congruence and discrepancy in clients' and therapists' ratings of the working alliance (WA) and real relationship (RR) were related to client-rated session quality (SES; Session Evaluation Scale). Ratings for 2517 sessions of 144 clients and 23 therapists were partitioned into therapist-level, client-level, and session-level components and then analyzed using multilevel, polynomial regression and response surface analysis. For both clients and therapists, at all levels of analysis (except the therapist level for therapist ratings), SES was highest when combined WA and RR ratings were high, and lowest when combined ratings were low. For client ratings, discrepancy between WA and RR, at the client and session levels, was associated with greater session quality. Some clients perceived greater session quality when, across all sessions, WA was stronger than RR and other clients perceived greater session quality when RR was stronger than WA. Within clients, session quality was highest when some sessions had a stronger WA than RR whereas other sessions had a stronger RR than WA. These findings are compatible with a responsiveness framework, therapists varied the balance of WA and RR to suit situational demands or needs of different clients. When therapists rated WA and RR the opposite pattern of results emerged; clients perceived greater session quality when therapists' WA and RR ratings, for a session were high and consistent (i.e., no discrepancy between WA and RR). In addition, across all sessions, clients perceived greater session quality when WA and RR ratings were high and consistent. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpersonal guilt and the working alliance in psychotherapy: The moderating role of childhood experience.

Interpersonal guilt often encompasses pathogenic beliefs that imply omnipotent responsibility for others and concerns about abandoning, humiliating or threatening others. This study sought to examine how interpersonal guilt may influence patients' and therapists' ratings of early working alliance and the potential moderating effect of perceived adverse parenting in childhood. Ninety-five patients and their 19 therapists in an outpatient psychotherapy clinic rated their early working alliance after the first and the fifth session in treatment. We conducted separate moderation analyses for patient and therapist-reported working alliance and controlled for psychological distress at baseline. Results suggest that perceived adverse parenting in childhood significantly moderated the effect of interpersonal guilt on the working alliance in such a way that for patients reporting very low levels of perceived adverse experiences, the interpersonal guilt beliefs had a positive effect on working alliance, whereas for those with very high levels of perceived adverse experiences, interpersonal guilt had a negative effect on working alliance. This same pattern of moderation was found for patient- and therapist-reported working alliance at session 1 and therapist-reported working alliance at session 5. Thus, although the effect of interpersonal guilt on the working alliance depends somewhat on the perspective of the working alliance rating (patient or therapist), it mainly depends on developmental experiences of the patient.

The triadic effect: Associations among the supervisory working alliance, therapeutic working alliance, and therapy session evaluation.

Several theorists (Bandura, 1969; Hackney & Goodyear, 1984; Searles, 1955) suggest parallels between the relationship in supervision and the relationship in therapy. We examined supervisor and therapist trainee ratings of supervisory working alliance (SWA) in 1 week predicting client-rated therapeutic working alliance (TWA) and client-rated therapy session evaluation (TSE) in the following week as well as TWA and TSE ratings in 1 week predicting SWA ratings in the following week. Our data included 663 weeks of therapy nested within 28 trainees nested within 15 supervisors, disaggregated into differences between supervisors, differences within supervisors, and differences within trainees. At the between-supervisor level, when supervisors' trainees rated the SWA higher on average compared with other supervisors' trainees' average SWA ratings, their clients' average TWA rating was higher. In contrast, when supervisors rated the SWA higher on average compared with other supervisors' average SWA ratings, their trainees' clients' average TSE rating was higher but the average TWA rating was lower. At the within-supervisor level, when trainees rated a higher SWA on average compared with other trainees' average SWA ratings with the same supervisor, their clients' average TSE rating was higher. The theoretical prediction of parallel relationships in supervision and therapy was supported, but only for between-supervisor and within-supervisor differences in SWA. We found no evidence that week-to-week changes in SWA or client-rated TWA or TSE reflected parallel relationships. We provide suggestions for further research, including exploring the mechanisms through which supervision relates to the therapy process and outcome. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Role of Personality in Early Alliance Formation in the Context of Clinical Supervision of Psychotherapists in Training

The literature suggests that working alliance is an important predictor of clinical supervision outcomes. However, little is known about the individual factors that influence the development and maintenance of the working alliance. This study aims to explore the role of supervisor and trainee personality traits in the development of early working alliances, as well as supervisor and trainee concordance rates in the context of clinical supervision. This study used the NEO-PI-3 measure to assess personality traits and the Working Alliance Inventory-Supervisor and Trainee Versions (WAI) measures to assess working alliance ratings. Results suggest that supervisors rate the strength of their alliances as significantly stronger than trainees (p < .05). While no trainee personality traits were found to predict their perception of the early alliance, the openness domain was found to be significantly associated to supervisor’s self-reported ratings of alliance. Implications of these findings are discussed.

The Role of Personality in Early Alliance Formation in the Context of Clinical Supervision of Psychotherapists in Training

The literature suggests that working alliance is an important predictor of clinical supervision outcomes. However, little is known about the individual factors that influence the development and maintenance of the working alliance. This study aims to explore the role of supervisor and trainee personality traits in the development of early working alliances, as well as supervisor and trainee concordance rates in the context of clinical supervision. This study used the NEO-PI-3 measure to assess personality traits and the Working Alliance Inventory-Supervisor and Trainee Versions (WAI) measures to assess working alliance ratings. Results suggest that supervisors rate the strength of their alliances as significantly stronger than trainees (p &lt; .05). While no trainee personality traits were found to predict their perception of the early alliance, the openness domain was found to be significantly associated to supervisor’s self-reported ratings of alliance. Implications of these findings are discussed.

The working alliance in blended versus face-to-face cognitive therapy for depression: A secondary analysis of a randomized controlled trial

IntroductionWe explored the working alliance as measured by both clients and therapists. The working alliance has been known to predict the outcome of psychotherapy and is often considered an important common factor. This study raised the question of how to conceptualize the working alliance in the blended format. MethodsThis was an exploratory study derived from a randomized controlled trial comparing bCBT and face-to-face cognitive behavioural therapy (ftf CBT) on depression. The change in depressive symptoms was measured with the Patient Health Questionnaire (PHQ-9) and the working alliance was measured using the Working Alliance Inventory. AnalysesCorrelation coefficients were calculated for the working alliance as reported by clients and therapists, working alliance was then examined at item and dimension level (task, bond, goal). Linear regression models were applied to investigate the predictive value of the working alliance on treatment outcome. Interaction between the level of working alliance and treatment condition was also considered. ResultsClient and therapist working alliance ratings correlated at r = 0.44 and clients rated the working alliance higher than therapists (x̄clients = 48.6, x̄therapists = 44.6). ftf CBT and bCBT had comparable joint working alliance ratings (x̄ftf = 46.4, x̄bCBT = 46.8). Items had little deviation apart from item 4 with high positive values. The level of working alliance from the total sample did not significantly predict outcome based on the client's perspective. Contrarily, seen from the therapist's perspective, it did (b = 0.00, p = .044). Using the mean from these predictors as a composite variable, was also significant (b = 0.00, p = .039, R2adj = 0.07). There was no significant interaction with treatment condition. DiscussionClients and therapists may lay emphasis on different aspects of the working alliance. The finding that therapist-rated working alliance was better than client working alliance at predicting outcome went against common findings; this pattern may be specific to bCBT. ConclusionClients rated the working alliance slightly higher than therapists on average. Clients and therapists as well as treatment conditions had different profiles on dimension deviations. Therapist ratings of the working alliance appeared to better predict treatment outcome than client ratings. Joint working alliance predicted outcome using client and therapist composite means. The working alliance was equally strong in ftf CBT and bCBT. The absence of interaction with treatment condition indicated that the working alliance was equally predictive of outcome in ftf CBT as in bCBT.

The Relationship Between Working Alliance and Symptom Improvement in Cognitive Therapy for Posttraumatic Stress Disorder

Background: Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings.Objective: To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavioral treatment for posttraumatic stress disorder (PTSD).Methods: Ratings of working alliance were made by both the patient and therapist after sessions 1, 3, and 5 of a course of Cognitive Therapy for PTSD (CT-PTSD). Autoregressive, cross-lagged panel models were used to examine whether working alliance predicted PTSD symptom severity at the next assessment point and vice versa. Linear regressions tested the relationship between alliance and treatment outcome.Results: Both patients' and therapists' working alliance ratings after session 1 predicted PTSD symptom scores at the end of treatment, controlling for baseline scores. At each assessment point, higher therapist working alliance was associated with lower PTSD symptoms. Crossed-lagged associations were found for therapist-rated alliance, but not for patient-rated alliance: higher therapists' alliance ratings predicted lower PTSD symptom scores at the next assessment point. Similarly, lower PTSD symptoms predicted higher therapist working alliance ratings at the next assessment point. Ruminative thinking was negatively related to therapists' alliance ratings.Conclusions: Working alliance at the start of treatment predicted treatment outcome in patients receiving CT-PTSD and may be an important factor in setting the necessary conditions for effective treatment. For therapists, there was a reciprocal relationship between working alliance and PTSD symptom change in their patients during treatment, suggesting that their alliance ratings predicted symptom change, but were also influenced by patients' symptom change.

RETRACTED ARTICLE: Examining therapy dynamics and session outcome using differential equations model and multilevel data disaggregation

We, the Editors and Publisher of the journal Psychotherapy Research, have retracted the following article: Xu Li & Dennis M. Kivlighan Jr (2020) Examining therapy dynamics and session outcome using differential equations model and multilevel data disaggregation, Psychotherapy Research, 30:5, 604-621, DOI: 10.1080/10503307.2019.1649730 Since publication, concerns had been raised about informed consent. The University of Maryland College Park Institutional Review Board investigated and they found that some data included in the publication were obtained from therapy clients who had either not been asked to provide consent or who had withdrawn consent for their data to be included in the study research. The investigation concluded that this article should be retracted. The authors agree with the retraction of this article. We have been informed in our decision-making by our editorial policies and COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

Opening the Career Counseling Black Box: Behavioral Mechanisms of Empathy and Working Alliance

Many individuals who struggle with career decisions seek professional guidance from career counselors. However, little is known about how to ensure that career guidance sessions are of high quality. Vital factors for a successful counseling process include a positive working alliance and empathy of the counselor. This study investigates how counselors’ behaviors, measured with a behavioral coding instrument, related to positive working alliances and empathy. We introduce a video-based instrument that measures microbehaviors and skills during career counseling sessions. Psychometric analyses were conducted on the basis of 53 video recordings. Double-coded sessions ( N = 18) showed excellent interrater reliabilities for the coded microbehaviors. By using a multitrait-multimethod approach, we established construct validity with another coding instrument, whereas criterion validity was established with respect to counselors’ empathy and working alliance ratings. We discuss theoretical implications of using video-based methods in career sessions to advance process research and present practical applications in terms of assessing quality assurance in career interventions.

Clients’ and counselors’ agreement in working alliance ratings, counselor attachment anxiety and avoidance, and counselor experience level.

Clients’ and counselors’ agreement in working alliance ratings, counselor attachment anxiety and avoidance, and counselor experience level.

Keep calm and alert and carry on: therapist calmness and fatigue in relation to session process

ABSTRACTWe examined whether therapist calmness and fatigue were associated with session process. Data were collected from 15 therapists and 51 clients over 1172 sessions at a university training clinic providing psychodynamic psychotherapy. Therapists rated their levels of calmness and fatigue before and after each session; clients and therapists rated session quality and working alliance after each session. Multilevel modeling was used to examine therapist pre-session calmness and fatigue, and pre- to post-session change in calmness and fatigue, in relation to post-session ratings of session quality and working alliance. Higher therapist pre-session calmness and increase of therapist calmness from pre- to post-session were associated with better client- and therapist-rated session quality and working alliance. Therapist pre-session fatigue was not associated with client-rated session quality or working alliance. However, a decrease in therapist fatigue was associated with better client-rated session quality and better therapist-rated session quality and working alliance. Thus, therapists who felt fatigued at the beginning of sessions could still have good sessions as perceived by clients. In contrast, therapists who entered session not feeling calm were less effective. Strategies to enhance therapist calmness and to reduce therapist fatigue should be investigated.

Readiness to Change as a Predictor of Treatment Engagement and Outcome for Partner Violent Men

Resistance to change has been long recognized as a barrier to successful intervention for partner violent individuals. Using archival data from a community-based intimate partner violence (IPV) intervention program, the current study investigated readiness to change as a predictor of treatment engagement and outcome in cognitive behavioral therapy (CBT) for IPV, and examined whether court referral status, antisocial personality characteristics, and borderline personality characteristics moderate these associations. During program intake, male IPV perpetrators (N = 195) provided structured interview data on demographics and referral source, and self-report data on readiness to change, borderline personality traits, and antisocial personality traits. During group CBT, participants and their therapists completed measures of the working alliance, and the therapists completed ratings of compliance with behavior change homework assignments. Criminal recidivism data were gathered from public records for 2 years after scheduled completion of treatment. Readiness to change significantly predicted client ratings of the working alliance, but not therapist ratings of the working alliance, CBT homework compliance, or criminal recidivism. Court referral status moderated predictive associations between readiness to change and working alliance ratings, and borderline and antisocial characteristics moderated predictive associations between readiness to change and working alliance as well as criminal recidivism. Interestingly, readiness to change is a stronger predictor of positive treatment response for court- versus self-referred individuals and for those with either very low or very high levels of borderline and antisocial characteristics. Hence, strategies to enhance motivation to change may be particularly be important for IPV perpetrators with these characteristics.

Congruence and discrepancy between working alliance and real relationship: Variance decomposition and response surface analyses.

We examined how congruence and discrepancy in clients' and therapists' ratings of the working alliance (WA) and real relationship (RR) were related to client-rated session quality (SES; Session Evaluation Scale). Ratings for 2517 sessions of 144 clients and 23 therapists were partitioned into therapist-level, client-level, and session-level components and then analyzed using multilevel, polynomial regression and response surface analysis. For both clients and therapists, at all levels of analysis (except the therapist level for therapist ratings), SES was highest when combined WA and RR ratings were high, and lowest when combined ratings were low. For client ratings, discrepancy between WA and RR, at the client and session levels, was associated with greater session quality. Some clients perceived greater session quality when, across all sessions, WA was stronger than RR and other clients perceived greater session quality when RR was stronger than WA. Within clients, session quality was highest when some sessions had a stronger WA than RR whereas other sessions had a stronger RR than WA. These findings are compatible with a responsiveness framework, therapists varied the balance of WA and RR to suit situational demands or needs of different clients. When therapists rated WA and RR the opposite pattern of results emerged; clients perceived greater session quality when therapists' WA and RR ratings, for a session were high and consistent (i.e., no discrepancy between WA and RR). In addition, across all sessions, clients perceived greater session quality when WA and RR ratings were high and consistent. (PsycINFO Database Record

Counselors’ attachment anxiety and avoidance and the congruence in clients’ and therapists’ working alliance ratings

Objective: To determine how counselors’ attachment anxiety and avoidance related to congruence between counselors’ and clients’ Working alliance (WA) ratings. Congruence strength was defined as the regression coefficient for clients’ WA ratings predicting counselors’ WA ratings. Directional bias was defined as the difference in level between counselors’ and clients’ WA ratings. Method: Twenty-seven graduate student counselors completed an attachment measure and they and their 64 clients completed a measure of WA early in therapy. The truth-and-bias analysis was adapted to analyze the data. Results: As hypothesized counselors’ WA ratings were significantly and positively related to clients’ WA ratings. Also as hypothesized, counselors’ WA ratings were significantly lower than their clients’ WA ratings (directional bias). Increasing counselor attachment anxiety was related to increasing negative directional bias; as counselors’ attachment anxiety increased the difference between counselors and clients WA ratings became more negative. There was a significant interaction between counselor attachment anxiety and congruence strength in predicting counselor WA ratings. There was a stronger relationship between client WA ratings and counselor WA ratings for counselors low versus high in attachment anxiety. Conclusion: Counselors’ attachment anxiety is realted to their ability to accurately percieve their clients’ WA.