The DOI matches its Crossref record; 118 of the 118 references it cites were found in a registry or an index.
Therapeutic alliance as a mediator of change: A systematic review and evaluation of research
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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“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]
In the citing paper
“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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Randomized Trial of a Generative AI Chatbot for Mental Health Treatment
Heinz, M. V., Mackin, D. M., Trudeau, B. M., Bhattacharya, S., Wang, Y., Banta, H. A., Jewett, A. D., Salzhauer, A. J., Griffin, T. Z., & Jacobson, N. C. (2025) · NEJM AI · doi:10.1056/aioa2400802 · Cited by 287
Therapeutic alliance and rapport modulate responses to psilocybin assisted therapy for depression
Murphy, R., Kettner, H., Zeifman, R., Giribaldi, B., Kartner, L., Martell, J., Read, T., Murphy-Beiner, A., Baker-Jones, M., Nutt, D., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.788155 · Cited by 250
The alliance in mental health care: conceptualization, evidence and clinical applications
Wampold, B. E., & Flückiger, C. (2023) · World Psychiatry · doi:10.1002/wps.21035 · Cited by 261
History repeating: guidelines to address common problems in psychedelic science
van Elk, M., & Fried, E. I. (2023) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253231198466 · Cited by 137
Treatment with psychedelics is psychotherapy: beyond reductionism
Gründer, G., Brand, M., Mertens, L. J., Jungaberle, H., Kärtner, L., Scharf, D., Spangemacher, M., & Wolff, M. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00363-2 · Cited by 126
Metadata
- Authors
- Baier, A. L., Kline, A. C., & Feeny, N. C.
- Affiliations
- Case Western Reserve University (US)
- Corresponding author
- Baier, Allison L.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 82
- Pages
- 101921
- ISSN
- 0272-7358 (ISSN-L)
- 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
- 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 › Clinical 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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