The linear pattern of therapeutic alliance development: Exploring the relationship between alliance trajectories over time and the outcomes of systemic psychotherapy treatment for adaptation disorders

Abstract Objective This study aimed to determine the trajectories of therapeutic alliance development in individual systemic psychotherapy for adults with adaptation disorders and the differences in alliance development between groups with different treatment outcomes. Method The longitudinal quasi ‐ experiment included 20 patients undergoing individual outpatient psychotherapy treatment in private practice for over a year. Therapeutic alliance was evaluated three times, by the psychotherapist and the patient simultaneously. Treatment outcomes were estimated twice based on patient ratings. Their clinical significance was assessed using the Reliable Change Index, analysis of variance for independent groups and trend analysis. The analyses concerned global therapeutic alliance and its three dimensions: goals, tasks and bonds. Results The study supported the hypothesised linear trend. It also confirmed a greater increase in alliance quality over the course of treatment in patients whose therapy was more successful. Conclusion The results indicate that, in patients with adaptation disorders, alliance development in systemic therapy follows a stable linear trend. The linear change observed for global therapeutic alliance is paralleled by similar trends in goals, tasks and bonds. Strong alliance correlates with better treatment outcomes.