Negative Indicators, Therapeutic Alliance, and Therapy Outcome

The present study measured the relationship among negative psychotherapy process indicators, therapeutic alliance, and outcome. A sample of 40 patients at a university psychological clinic were administered pre- and posttreatment questionnaires, and three excerpts from audiotaped sessions were rated for level of alliance and negative indicators. Results showed negative indicators and lower therapeutic alliance were significantly related, more so in long therapies (greater than 40 sessions). There was a significant relationship between negative indicators and outcome as rated by participants, but the relationship to symptomatic improvement was much weaker, appearing in the longlength group only. Pretreatment symptomatology was significantly related to some negative indicators in the medium-length group (20–40 sessions). The strong correlations between alliance and negative indicators suggest they may be tapping aspects of one underlying construct, the state of the therapist-patient relationship.