The working alliance is hypothesized to be crucial for facilitating change during psychodynamic therapy. However, few studies have examined the session-by-session effects of the alliance on outcomes within this therapeutic approach. We aimed to test the effect of the client- and therapist-reported alliance on next-session problems/functioning in short-term psychodynamic therapy conducted in a university training clinic. A secondary aim was to test whether baseline personality functioning and adverse childhood experiences moderate the association between alliance and outcome. A total of 152 clients, receiving short-term psychodynamic psychotherapy from novice therapists, completed the Clinical Outcomes in Routine Evaluation-10 before each session. After each session, clients and therapists completed the Working Alliance Inventory-Short. Data were analyzed using continuous time structural equation modeling, which allows for relatively strong causal inferences despite the nonexperimental design. Improvement in the client-reported alliance significantly predicted a reduction of problems/dysfunction in the following session with a small effect size that increased to a large effect size after 7-8 sessions. The effect of problems/functioning on the client-reported alliance was also statistically significant. No associations were found between the therapist-reported alliance and outcome. The alliance effect varied considerably between therapist-client dyads and was stronger for clients reporting more adverse childhood experiences. In conclusion, the client-reported alliance was a predictor of outcome in the following session. Its effect on outcome peaked after 7-8 sessions. While this long-term effect aligns with the principles of psychodynamic therapy, it may also stem from the statistical model used. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Østergård et al. (Mon,) studied this question.