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.

Keywords:

• alliance
• strengths
• resource activation
• process research
• cognitive behavioral therapy
• multilevel modeling

Acknowledgements

We like to thank all patients and therapists who were involved in this study. We are grateful to Professor David E. Orlinsky for his extremely valuable comments to the final draft of this manuscript.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Ethical statement

JSV, SA, M-KA, LT, MMM, TO, TT, and UW contributed to the study design. JSV and UW implemented the study at the outpatient training and research center. JSV, M-KA, LT, and MMM searched for and discussed relevant literature. JSV and SA edited study data and conducted all statistical analyses. JSV wrote the initial draft of the manuscript. All authors read and approved the final version of the manuscript. Ethics approval for the study was provided by the Ethics Committee of the Witten/Herdecke University (Germany) in April 2015, approval no. 40/2015. All participants provided written informed consent.

Supplemental Data

Supplemental data for this article can be accessed https://doi.org/10.1080/10503307.2022.2146543

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This research did not receive any special grant from funding agencies in the public, commercial or non-profit sectors.