I’m used to seeing many expert opinions on psychotherapy converge on the view that the type of therapy doesn’t make much difference (at least as far as the evidence can tell us). I.e. it doesn’t seem to matter much whether you choose CBT or IPT or whatever. The therapeutic alliance, on the other hand, does matter. Therapeutic alliance means something like “How well you get on with your therapist” (plus some related things).
I had a fleeting thought that perhaps the therapeutic alliance might be neglected. E.g. maybe there’s a novel intervention which involves training therapists really heavily on how to improve the therapeutic alliance, and skimping on (or entirely ignoring?) traditional therapeutic methods.
I suspect that this fleeting thought is probably not correct.
Firstly, a quick look at google scholar found loads of meta-analyses. One of them started with “The alliance continues to be one of the most investigated variables related to success in psychotherapy”.
Secondly, the intervention that I imagined (training therapists to focus on the alliance) arguably already exists. Rogerian therapy (also known as person-centred therapy) is one of the main forms of therapy, and it arguably focuses heavily on the alliance (I’m glossing over a bunch of nuances about Rogerian therapy).
Thirdly, the effect size seems to be small, as far as I can tell (having not looked into this carefully). Arnow & Steidman 2014 stated that “Overall, meta-analytic findings reveal that the magnitude of the alliance-outcome relationship is modest, accounting for 5-8% of the variance in outcome.”
So it actually seems that the alliance is getting loads of attention relative to its importance, I suspect. If I looked into this more carefully, it’s possible I could change my mind again, but I suspect I won’t look into it more carefully.
I always read therapeutic alliance as advice for the patient, where one should try many therapists before finding one that fits. I imagine therapists are already putting a lot of effort on the alliance front
Perhaps an intervention could be an information campaign to tell patients more about this? I feel it’s not well known or to obvious that you can (1) tell your therapist their approach isn’t working and (2) switch around a ton before potentially finding a fit
My intuition says that people are probably already following the heuristic “if you don’t like your therapist, try to get another one”. I also haven’t given much thought to the patient’s/client’s perspective on the therapeutic alliance.
How likely is this to be a real effect vs a confound? I imagine if I feel like therapy is working, I’m much more likely to like my therapist (similarly I’m more likely to like a physical trainer if I’m getting healthier, I’m more likely to like my teacher if I feel like I’m learning more, etc)
It’s also helpful because the wording of my post was meant to convey that “expert opinions tend to believe that the therapeutic alliance matters” (and not necessarily that I’m confident that that’s the case).
One of the papers that I referenced did flag that most of the studies are observational rather than experimental, which does validate your concern. (I think it was Arnow & Steidman 2014 which said this; I don’t know if a more recent paper sheds more light on this).
I’m not planning to look into this topic in any depth, but perhaps someone more knowledgeable can give a more definitive answer.
I’m used to seeing many expert opinions on psychotherapy converge on the view that the type of therapy doesn’t make much difference (at least as far as the evidence can tell us). I.e. it doesn’t seem to matter much whether you choose CBT or IPT or whatever. The therapeutic alliance, on the other hand, does matter. Therapeutic alliance means something like “How well you get on with your therapist” (plus some related things).
I had a fleeting thought that perhaps the therapeutic alliance might be neglected. E.g. maybe there’s a novel intervention which involves training therapists really heavily on how to improve the therapeutic alliance, and skimping on (or entirely ignoring?) traditional therapeutic methods.
I suspect that this fleeting thought is probably not correct.
Firstly, a quick look at google scholar found loads of meta-analyses. One of them started with “The alliance continues to be one of the most investigated variables related to success in psychotherapy”.
Secondly, the intervention that I imagined (training therapists to focus on the alliance) arguably already exists. Rogerian therapy (also known as person-centred therapy) is one of the main forms of therapy, and it arguably focuses heavily on the alliance (I’m glossing over a bunch of nuances about Rogerian therapy).
Thirdly, the effect size seems to be small, as far as I can tell (having not looked into this carefully). Arnow & Steidman 2014 stated that “Overall, meta-analytic findings reveal that the magnitude of the alliance-outcome relationship is modest, accounting for 5-8% of the variance in outcome.”
So it actually seems that the alliance is getting loads of attention relative to its importance, I suspect. If I looked into this more carefully, it’s possible I could change my mind again, but I suspect I won’t look into it more carefully.
I always read therapeutic alliance as advice for the patient, where one should try many therapists before finding one that fits. I imagine therapists are already putting a lot of effort on the alliance front
Perhaps an intervention could be an information campaign to tell patients more about this? I feel it’s not well known or to obvious that you can (1) tell your therapist their approach isn’t working and (2) switch around a ton before potentially finding a fit
I haven’t looked much into it though
My intuition says that people are probably already following the heuristic “if you don’t like your therapist, try to get another one”. I also haven’t given much thought to the patient’s/client’s perspective on the therapeutic alliance.
How likely is this to be a real effect vs a confound? I imagine if I feel like therapy is working, I’m much more likely to like my therapist (similarly I’m more likely to like a physical trainer if I’m getting healthier, I’m more likely to like my teacher if I feel like I’m learning more, etc)
Good question.
It’s also helpful because the wording of my post was meant to convey that “expert opinions tend to believe that the therapeutic alliance matters” (and not necessarily that I’m confident that that’s the case).
One of the papers that I referenced did flag that most of the studies are observational rather than experimental, which does validate your concern. (I think it was Arnow & Steidman 2014 which said this; I don’t know if a more recent paper sheds more light on this).
I’m not planning to look into this topic in any depth, but perhaps someone more knowledgeable can give a more definitive answer.