Therapeutic Alliance Research

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Therapeutic Alliance Research

Baseline patient characteristics such as age and symptoms are predictors of therapeutic alliance. Religion, spirituality and attachment are also significant predictors, as well as interpersonal factors and treatment-related expectations. I found no best practices for exposing therapeutic alliance predictors in my research.

Below you will find a deep dive of my findings.


To complete your request, I looked for academic and medical research dated within the last two to three years and focused on predictors of the therapeutic alliance between patients and therapists. I searched journal publications including Wiley Online Library, ResearchGate and ProQuest. I found none that were from the last two to three years. However, I found several research papers from earlier years and included them in my findings. I found no resources about best practices for exposing them. Nevertheless, I have gathered relevant findings that I believe will be helpful for your project. I have presented my findings by order of importance and not chronologically for the sake of cohesion. Please continue below to see the results of my research.


The 2011 paper "Predictors of the Therapeutic Alliance in Group Therapy for Individuals with Treatment‐Resistant Auditory Hallucinations" highlighted several baseline client characteristics that function as good predictors of group therapeutic alliance for this patient population. These predictors were:

• Age
• Symptoms
• Insight
• Social functioning

No further details were given in the report's preview version, which is locked behind a paywall.

These baseline characteristics were also mentioned in the other research papers presented below.


The 2014 paper "Religion, Spirituality, and Attachment as Predictors of the Therapeutic Alliance" identified these three factors as significant predictors of therapeutic alliance. The paper investigated whether a patient's perception of how their therapists integrated religion and spirituality into their treatment affected their treatment outcomes. The researchers reported that they found the following as significant predictors of therapeutic alliance:

Client attachment to therapist
• Perception of how therapist addresses religious belief
• Perception of how therapist integrates spirituality and religion into treatment

Patients' perception of how their therapists addressed religious belief, as well as integrated spirituality and religious belief into treatment, were reported to affect treatment outcome. Also, adult attachment related to client attachment were both identified as significant predictors of working alliance.

The paper, however, gave no further information on how these predictors were exposed in the patient population investigated.

Attachment as a factor in therapeutic alliance is also addressed in the 2003 paper "Traumatic Brain Injury and Rehabilitation Outcomes: Does the Working Alliance Make a Difference?". The paper states that therapeutic alliance, also called working alliance, has three components: shared goals, shared tasks and attachment. Attachment was further defined as an "emotional bond between counselor and client", which is supported by a shared commitment toward treatment goals.

No further information about these predictors or best practices for exposing them were given in the preview version of the report.


The 2014 paper "The Development and Evaluation of a Five-Language Multi-Perspective Standardised Measure: Clinical Decision-Making Involvement and Satisfaction (CDIS)" mentions the following predictors of therapeutic alliance in passing: age, gender, symptom severity and type, and interpersonal factors. The paper also mentioned treatment-related factors as predictors:
Service contact frequency
Awareness of the need for treatment
Insight into one's own illness

The 2001 paper "The Relationship Between Patient Pretreatment Interpersonal Schemas and Therapeutic Alliance in Short-Term Cognitive Therapy" also mentioned interpersonal factors as predictors of therapeutic alliance. Specifically, the paper reported that positive interpersonal exchange in submissive situations was associated with therapeutic alliance while the same interpersonal factors in dominant situations were negatively associated with the alliance.

Finally, the 2012 paper "Interpersonal Predictors of Early Therapeutic Alliance in a Transdiagnostic Cognitive-Behavioral Treatment for Adolescents With Anxiety and Depression" highlights interpersonal and social factors as predictors of the patient-therapist bond. Also, within this specific patient population, i.e., adolescents with anxiety and depression, clinical factors were not strong predictors of therapeutic alliance. The paper reports that for adolescents with history of substance abuse, relationship and support from family and friends were predictors of therapeutic alliance.

No information regarding best practices for exposing therapeutic alliance predictors was given in the paper.


To wrap it up, research identifies the following factors as predictors for therapeutic alliance: baseline patient characteristics such as age and symptoms, religion, spirituality and attachment, interpersonal factors and treatment-related expectations. I found no best practices for exposing therapeutic alliance predictors in my research.