Stages of change and the working alliance in psychotherapy

This study investigated whether the working alliance mediates between the stages of change and symptom improvement. It also investigated whether progression to a higher stage of change was associated with an enhancement in working alliance and outcome scores. Fifty-six adult clients receiving counseling at a community mental health clinic completed measures after the first, fifth, and termination sessions. Using the Baron and Kenny (1986) and bootstrapping procedures, the working alliance was found to be a mediating variable. A multivariate analysis of variance indicated that clients who progressed from a lower stage to a higher stage reported stronger working alliances and more symptom improvement than those who did not progress. These results offer further support for the importance of a strong working alliance in psychotherapy.