Assessing the Alliance–Outcome Association Adjusted for Patient Characteristics and Treatment Processes

A Meta-Analytic Summary of Direct Comparisons

Flückiger, Christoph
Del Re, A. C.
Wlodasch, Daniel
Horvath, Adam O.
Solomonov, Nili
Wampold, Bruce E.

Department of Psychology, University of Zurich
Faculty of Education, Simon Fraser University
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College
Modum Bad Psychiatric Center, Vikersund, Norway, and School of Education, University of Wisconsin–Madison

An overall comparison of zero-order alliance–outcome correlations with overall partial correlations was reported in based on the same set of data. The present analyses were not a part of a published article, online publication, or conference presentation. No other work using this data set is currently under review by another journal. This study was supported by the Swiss National Science Foundation (Grant PP00P1_163702) and the Foundation for Research in Science University of Zurich (Grant: STWF-19-018; for both PI: Christoph Flückiger). Additionally, Nili Solomonov was supported by National Institute of Mental Health Grant - T32 MH019132 (PI: George Alexopoulos).

Christoph Flückiger, Department of Psychology, University of Zurich, Binzmühlestrasse 14/04, 8050 Zürich, Switzerland [email protected]

Received November 4, 2019

revised January 14, 2020

Accepted January 15, 2020

Journal of Counseling Psychology 67(6):p 706-711, November 2020. | DOI: 10.1037/cou0000424

The alliance is widely recognized as a robust predictor of posttreatment outcomes. However, there is a debate regarding whether the alliance is an epiphenomenon of intake characteristics and/or treatment processes occurring over the course of treatment. This meta-analysis aimed to synthesize the evidence on this issue. We identified 125 effect sizes in 60 independent samples (6,061 participants) of studies that reported alliance−outcome correlations as well as parallel intake or process characteristics. We examined the impact of these potential confounds on the alliance−outcome correlations. We meta-analyzed the studies estimates by computing omnibus effects models as well as multivariate models. We identified 3 variable types that were used to adjust the alliance−outcome correlations: (a) intake characteristics (k = 35); (b) simultaneous processes, such as adherence or competence (k = 13); and (c) both intake and simultaneous processes (k = 24). We found moderate alliance−outcome correlations with or without adjustments for intake and simultaneous processes (range from r = .23 to r = .31). Our results provide robust empirical evidence for the assertion that the alliance−outcome association is an independent process-based factor. Findings suggest that alliance is positively related to outcome above and beyond the studied patient intake characteristics and treatment processes.