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Cited by 441Psychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology ResearchCounseling Practices and Supervision

Therapeutic alliance as a mediator of change: A systematic review and evaluation of research

Baier, Allison L., Kline, Alexander C., Feeny, Norah C.·2020·Clinical Psychology Review
DOI 10.1016/j.cpr.2020.101921
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Abstract

The alliance-outcome relationship has been consistently linked to positive treatment outcomes irrespective of psychotherapy modality. However, beyond its general links to favorable treatment outcomes, it is less clear whether the alliance is a specific mediator of change and thus a possible mechanism underlying psychotherapy response. This systematic review evaluated research examining the alliance as a potential mediator of symptom change, reviewing study characteristics of 37 relevant articles examining the alliance-outcome relationship and the extent to which these studies met recommended criteria for mechanistic research. Alliance mediated therapeutic outcomes in 70.3% of the studies. We observed significant heterogeneity across studies in terms of methodology, including timing of alliance assessment, study design, constructs used in mediation models, and analytic approaches. Building on recent methodological advancements, we propose directions for future research examining the putative mediational role of alliance, such as greater uniformity in and attention to study design and statistical methodology. This review highlights the importance of alliance in therapeutic change and discusses how adhering to requirements for process research will improve our ability to more precisely estimate how and to what extent alliance drives therapeutic change.

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  • Processing relational patterns within therapeutic relationship allows patients to experience corrective emotional experiences that shift maladaptive interaction styles toward healthier, more reciprocal ones.

    “By processing these relational patterns, within the therapeutic relationship, patients can experience corrective emotional experiences that help shift maladaptive interaction styles toward healthier, more reciprocal ones (166–168).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [166]

  • Therapist-patient relationship is one of the strongest predictors of treatment success across psychotherapeutic approaches, including PAT.

    “Studies indicate that the therapist-patient relationship is one of the strongest predictors of treatment success across psychotherapeutic approaches, including PAT (166, 169–171).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [166]

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Authors
Baier, A. L., Kline, A. C., & Feeny, N. C.
Affiliations
Case Western Reserve University (US)
Corresponding author
Baier, Allison L.
ORCID
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2020-12
Volume
82
Pages
101921
ISSN
0272-7358 (ISSN-L)
DOI
10.1016/j.cpr.2020.101921
OpenAlex
W3087180323
Cited by
441
References
118
Citations by year
2026: 79 · 2025: 111 · 2024: 105 · 2023: 74 · 2022: 60 · 2021: 12
FWCI
2.89
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01 MH066348)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
Keywords
therapeutic relationship, psychotherapy outcome, symptom change, process research, mechanistic research, mediation analysis, psychotherapy response
MeSH terms
Therapeutic Alliance, Humans, Professional-Patient Relations, Psychotherapy, Research Design, Treatment Outcome

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