The therapeutic alliance has consistently been associated with improved client outcomes across numerous psychotherapy outcome studies. Previous systematic reviews have, however, evaluated the univariate association of the alliance with client outcome. The present meta-analytic review examines the association of the alliance with improved client outcomes after accounting for the presence of therapist empathy, client attachment styles, and client expectations. Across 23 independent studies, the alliance, adjusted for the presence of the other variables, remained as the most robust predictor of improved outcomes r = .258 (SE = .01, p < .001), with a 95% confidence interval of r = .18 to r = .33. After accounting for therapeutic alliance, therapist empathy was a small but statistically significant predictor of improved outcomes. These findings provide the first attempt at synthesizing multivariate estimates of the contribution of the alliance with improved outcomes when in the presence of empathy, client attachment style, and client expectations. The findings presented here suggest the superordinate nature of the alliance as a variable that exists on a separate conceptual level from the other variables evaluated.
College and Department
David O. McKay School of Education; Counseling Psychology and Special Education
BYU ScholarsArchive Citation
Soto, Alberto, "A Meta-Analytic Review of the Association of Therapeutic Alliance, Therapist Empathy, Client Attachment Style, and Client Expectations with Client Outcome" (2017). All Theses and Dissertations. 6493.
therapeutic alliance, empathy, attachment style, client expectations, psychotherapy, psychotherapy outcomes