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(p. 24) Alliance in Adult Psychotherapy 

(p. 24) Alliance in Adult Psychotherapy
(p. 24) Alliance in Adult Psychotherapy

Christoph Flückiger

, A. C. Del Re

, Bruce E. Wampold

, and Adam O. Horvath

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date: 05 May 2021

The alliance continues to be one of the most investigated variables related to success in psychotherapy. In this chapter, the authors define and illustrate the alliance (also conceptualized as therapeutic alliance or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients for face-to-face psychotherapy as well as Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using three-level meta-analysis with random-effects. The overall alliance–outcome association for face-to-face psychotherapy was r = .278 (equivalent of d = .579). The correlation for internet-based psychotherapy was approximately the same (r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The chapter concludes with research limitations, diversity considerations, and therapeutic practices.

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