Accuracy of therapist perceptions of patients' alliance: Exploring the divergence

Abstract

Objective: The therapeutic alliance is a well-established predictor of psychotherapy outcome, yet much research has shown that therapists' and patients' views of the alliance can diverge substantially. Therapists systematically underestimate their patients' perceived level of alliance, and the correlation between therapist and patient estimates of patient alliance is only moderate. The present study explored the divergence between therapists' and patients' perspectives on patients' alliance experience, and its relations to therapists' concurrent work involvement and session process experiences. Method: Data from 98 patients treated by 26 therapists with psychodynamic psychotherapy were analyzed. Results: Therapist-patient divergence was significantly related to therapists' case-wise work involvement, but not to therapist's views of session process. The best predictor of therapist-patient divergence was therapists experiencing a “distressed practice” work involvement pattern. Conclusion: Although therapists' work involvement experiences are not commonly investigated, they can be a relevant predictor of therapy processes.