title: Levels and patterns of the therapeutic alliance in brief psychotherapy.
abstract: We examined the relevance of the level and pattern of the therapeutic alliance in 44 cases of three different, manualized 30-session treatments using patient ratings of the Working Alliance Inventory after each session. It was hypothesized that both high-alliance level and either a linear increase in alliance rating or a series of brief rupture-and-repair episodes would be found in successful treatments. We also hypothesized that a more global high-low-high pattern predicted in the literature would not be present. Consistent with the literature, higher alliance levels were found to be related to improved outcome. As predicted, we did not find a global, high-low-high pattern. Local rupture-and-repair patterns were found in 50% of the cases; linear trends were found in 66% of the cases. There was no relationship between outcome and either pattern. We found no differences among the treatments.
authors.affiliation: Beth Israel Medical Center, Department of Psychiatry & Behavioral Sciences, First Avenue at 16th Street, New York, New York 10003, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Stevens
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Muran
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Safran
authors.forename: Bernard S
authors.initials: BS
authors.lastname: Gorman
authors.forename: Arnold
authors.initials: A
authors.lastname: Winston
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010555:Personality Inventory; D010817:Physician-Patient Relations; D013811:Psychotherapeutic Processes; D011614:Psychotherapy, Brief / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome