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Vol 22, No 3, Article 1, PDF

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Two models of the relationship between client-rated outcome and working alliance in a psychotherapy training context were tested on data from a sample of Swedish outpatient clients (n=24) in an attempt to determine whether the alliance influences the outcome, or whether it develops as an artefact of a previous outcome. In the first model, the alliance is influenced by the outcome (O->A).  In the second model, the outcome is influenced by the symptom level and were assessed at five time-points.  Structural equation methodology (path analysis) was applied to estimate the total, direct and indirect effects.  The result provided support for the (A->O) model, which was found to be stable in both high and low-quality alliance groups.  The results suggest that novices need to focus first on learning to use methodology and techniques that reduce the clients' symptoms.
Key Words: Alliance, psychotherapy outcome, WAI, OQ-45, structural equation modelling.                               

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