title: Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review.
abstract: Alliance, empathy, and genuineness are each integral parts of the therapeutic relationship. No previous meta-analysis has explored the extent to which therapist empathy and genuineness contribute to the therapeutic alliance.
  
  
  
  In this meta-analysis, a multifaceted search strategy yielded 53 studies. Forty studies reported alliance/empathy relationships, eight studies reported alliance/genuineness relationships, and five studies reported both.
  
  
  
  Random effects meta-analyses revealed that therapeutic alliance was significantly related to perceptions of therapist empathy with a mean r = 0.50 (95% CI = 0.42, 0.57). Therapeutic alliance was also significantly related to perceptions of therapist genuineness with a mean r = 0.59 (95% CI = 0.45, 0.71). Tests of publication bias indicated a low likelihood of publication bias affecting the strength and direction of the results. Potential moderating variables were explored, including rater perspective, measure of therapeutic relationship variables, and client race/ethnicity.
  
  
  
  Therapeutic alliance has a moderate relationship with perceptions of therapist empathy and genuineness. Of note, there may be reason to believe that when rated by the same person, these constructs have significant overlap and lack discreteness. Future directions for study of the therapeutic relationship are discussed. Implications for practice are provided.
authors.affiliation: a Department of Educational and Counseling Psychology , University of Louisville , Louisville , KY , USA.
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Nienhuis
authors.affiliation: b Department of Counseling Psychology , University of Denver , Denver , CO , USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Owen
authors.affiliation: c Counseling and Human Development at the University of Louisville , USA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Valentine
authors.affiliation: a Department of Educational and Counseling Psychology , University of Louisville , Louisville , KY , USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Winkeljohn Black
authors.affiliation: a Department of Educational and Counseling Psychology , University of Louisville , Louisville , KY , USA.
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Halford
authors.affiliation: d Department of Clinical Psychology , Xavier University , Cincinnati , OH , USA.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Parazak
authors.affiliation: e Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Budge
authors.affiliation: f Adelphi University, I A P S, Derner Institute , Garden City , NY , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hilsenroth
mesh_terms: D000328:Adult; D004645:Empathy; D006801:Humans; D011613:Psychotherapy; D012938:Social Perception; D000078462:Therapeutic Alliance
keywords: alliance; philosophical/theoretical issues in therapy research; process research