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The alliance in adult psychotherapy: A meta-analytic synthesis


Flückiger, Christoph; Del Re, A C; Wampold, Bruce E; Horvath, Adam O (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy: Theory, Research, Practice, Training, 55(4):316-340.

Abstract

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Abstract

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:06 Faculty of Arts > Institute of Psychology
Dewey Decimal Classification:150 Psychology
Scopus Subject Areas:Social Sciences & Humanities > Clinical Psychology
Health Sciences > Psychiatry and Mental Health
Language:English
Date:December 2018
Deposited On:30 Oct 2018 16:44
Last Modified:29 Jul 2020 07:59
Publisher:Psychologists Interested in the Advancement of Psychotherapy
ISSN:0033-3204
Additional Information:This article is adapted, by special permission of Oxford University Press, by the same authors in J. C. Norcross & M. J. Lambert (Eds.). (2018), Psychotherapy relationships that work (3rd ed.). New York: Oxford University Press.
OA Status:Green
Publisher DOI:https://doi.org/10.1037/pst0000172
PubMed ID:29792475
Project Information:
  • : FunderSNSF
  • : Grant ID100012-116370
  • : Project TitleL'artiste romantique en représentation: Léopold Robert (1794-1835) et sa correspondance d'artiste

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