Therapist-Patient Alliance, Patient-Therapist Alliance, Mutual Therapeutic Alliance, Therapist-Patient Concordance, and Outcome of CBT in GAD

By Langhoff, Christin; Baer, Thomas et al. | Journal of Cognitive Psychotherapy, April 1, 2008 | Go to article overview

Therapist-Patient Alliance, Patient-Therapist Alliance, Mutual Therapeutic Alliance, Therapist-Patient Concordance, and Outcome of CBT in GAD


Langhoff, Christin, Baer, Thomas, Zubraegel, Doris, Linden, Michael, Journal of Cognitive Psychotherapy


The therapeutic alliance is seen as an important dimension in any type of psychotherapy. But patient, therapist, or observers can have different views on the therapeutic alliance. The question is which perspective best represents the therapeutic alliance, and what are the differences between these alternative views. In the present study, the therapist-patient alliance (TPA, the view of the therapist), patient-therapist alliance (PTA, the view of the patient), and mutual therapeutic alliance (MTA, the view of an observer) were measured simultaneously in cognitive behavior therapy of patients suffering from generalized anxiety disorder. Additionally, the concordance between patient and therapist ratings (TPC) was calculated. Cognitive behavior therapists attained high positive scores in all perspectives for all dimensions of the therapeutic alliance, such as empathy, cooperation, transparency, focusing, and assurance of progress. Correlations were consistently higher for ratings between therapist and patient than between observer and patient. A relation with outcome (Hamilton Anxiety Scale) was only found for observer ratings. It was concluded that cognitive behavior therapists can achieve good alliances with their patients. Different perspectives on the therapeutic alliance should be distinguished and taken into account separately in studies on the therapeutic process and outcome.

Keywords: therapeutic alliance; therapist-patient relationship; generalized anxiety disorder; cognitive behavior therapy

The relationship between the therapist and patient is one of the primary areas of psychotherapy research. The therapeutic alliance has been investigated in various psychotherapeutic orientations and settings (Barber, 2000; Castonguay, 1996; Cottraux et al., 1995; Frieswyk et al., 1986; Gaston, 1991, 1998; Hartley & Strupp, 1983; Hintikka, Laukkanen, Marttunen, & Lehtonen, 2006; Hogduin, De Haan, & Schaap, 1989; Keijsers, Scraap, Hoogduin, & Lainmors, 1995; Krupnick, 1996; Loeb et al., 2005; Luborsky, McLellan, Woody, O'Brien, & Auerbach, 1985; Malik, Bentler, Alimohamed, Gallagher-Thompson, & Thompson, 2003; Newman & Strauss, 2003; Orlinsky, Grawe, & Parks, 1994; Vogel, Hansen, Stiles, & Gotestam, 2006). More recent studies have examined the working alliance even in online psychotherapy (Knaev-elsrud & Maercker, 2006).

The scientific literature suggests that the quality of the therapeutic alliance is positively related to treatment outcome and can even lead to therapeutic changes by itself. In a meta-analysis of 25 studies, Horvath and Symonds (1991) found a moderate overall effect size of .26 for the impact of the quality of the therapeutic alliance on treatment efficacy. Similarly, Martin, Garske, and Davis (2000) reported an effect size of .22 on the basis of 79 studies. However, there are also studies that did not find significant correlations between the quality of the therapeutic alliance and treatment outcome (DeRubeis, 1990; Feeley, DeRubeis, & Gelfand, 1999). This may be due to discrepant concepts of the therapeutic alliance (Dill-Standiford, Stiles, & Rorer, 1988; Horvath, 2000; Wolfe & Goldfried, 1988; Zimmer, 1983).

Different psychotherapeutic schools have different concepts of the therapeutic alliance. In psychoanalysis, transference and countertransference are held to be indispensable treatment factors (Freud, 1958), and in client-centered psychotherapy the therapeutic alliance is seen as the primary treatment element (Rogers, 1958; Schmidt-Traub, 2003; Truax & Carkhuff, 1967). Behavior therapy, in contrast, is sometimes suspected to neglect the therapeutic alliance and to be rather mechanical and less personal. There is empirical evidence that cognitive behavior therapists are more active (Greenwald, Kornblith, Hersen, Bellack, & Himmelhoch, 1981; Hardy & Shapiro, 1985; Sloane, Staples, Cristol, Yorkston, & Whipple, 1975; Stiles, Shapiro, & Firth Cozens, 1988) and more directive (Brunik & Schroeder, 1979) than other psychotherapists, but they, nevertheless, do also reach high levels of emotional support, empathy, and unconditional positive acceptance towards the patient (Keijsers, Scraap, & Hoogduin, 2000; Sloane et al. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Therapist-Patient Alliance, Patient-Therapist Alliance, Mutual Therapeutic Alliance, Therapist-Patient Concordance, and Outcome of CBT in GAD
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.