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Relation between working alliance and outcome in psychotherapy: A meta-analysis
Abstract
Results of 24 studies (based on 20 distinct data sets) relating the quality of the working alliance (WA) to therapy outcome were synthesized using meta-analytic procedures. A moderate but reliable association between good WA and positive therapy outcome was found. Overall, the quality of the WA was most predictive of treatment outcomes based on clients' assessments, less so of therapists' assessments, and least predictive of observers' report
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In the citing paper
“consistent with research suggesting the clinical utility of non-specific treatment factors and the simple provision of support; see Horvath and Symonds, 1991; Klein et al., 2003”
From Initial RCT of a distress tolerance treatment for individuals with substance use disorders (2012) · cites this paper as Horvath and Symonds, 1991
In the citing paper
“Moreover, studies show that therapist assessments of working alliances are less reliable than patient assessments [51].”
From "It's not a life of war and conflict": experienced therapists' views on negotiating a therapeutic alliance in involuntary treatment (2019) · cites this paper as [51]
In the citing paper
“The therapeutic alliance is a well-established predictor of positive treatment outcomes across a range of psychotherapeutic modalities (158–160), including psychoanalytic psychotherapy (161) and the treatment of personality disorders such as PN (162, 163).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [162]
In the citing paper
“The results of several psychotherapy meta-analyses have shown a moderate but reliable association between a good therapeutic alliance and a positive psychotherapy outcome, and sometimes this link is more important than the type of psychotherapy used (Horvath and Symonds, 1991; Martin et al., 2000; Shirk and Karver, 2003; Karver et al., 2006; Ardito and Rabellino, 2011).”
From Piloting a New Model for Treating Music Performance Anxiety: Training a Singing Teacher to Use Acceptance and Commitment Coaching With a Student (2020) · cites this paper as Horvath and Symonds, 1991
In the citing paper
“The therapeutic working alliance, defined by Bordin (1979) as the collaboration on tasks and goals within an affective bond, has been identified in several meta‐analyses as a robust predictor of psychotherapy outcomes (Horvath et al. 2011; Horvath and Symonds 1991; Lambert and Barley 2001).”
From Reciprocal Dynamics of Therapeutic Alliance and Depressive Symptoms in Inpatient Cognitive Behavioural Analysis System of Psychotherapy: The Role of Attachment Insecurity. (2025) · cites this paper as Horvath and Symonds 1991
In the citing paper
“Traditionally, working alliance has been characterized as the cooperation and collaboration in the therapeutic relationship between the patient and the therapist [53-55].”
From A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study (2021) · cites this paper as [54]
In the citing paper
“Research reviews have consistently reported a positive relationship across studies between the quality of the therapeutic alliance and therapy outcome, although there are some instances where the working alliance fails to predict outcome or where associations are nonsignificant [5-10].”
From Does the Quality of the Working Alliance Predict Treatment Outcome in Online Psychotherapy for Traumatized Patients? (2006) · cites this paper as [8]
In the citing paper
“It has also been suggested that treatment outcome may be particularly well predicted by the quality of the working alliance as measured in early sessions [5,8,11].”
From Does the Quality of the Working Alliance Predict Treatment Outcome in Online Psychotherapy for Traumatized Patients? (2006) · cites this paper as [8]
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Metadata
- Authors
- Horvath, A. O., & Symonds, B. D.
- Affiliations
- Simon Fraser University (CA)
- ORCID
- Horvath, Adam O.
- Venue
- Journal of Counseling Psychology
- Published
- 1991-04
- Volume
- 38
- Issue
- 2
- Pages
- 139-149
- ISSN
- 0022-0167 (ISSN-L)
- 1939-2168
- OpenAlex
- W2088864483
- Cited by
- 2,673
- References
- 51
- Citations by year
- 2026: 46 · 2025: 53 · 2024: 63 · 2023: 67 · 2022: 78 · 2021: 92 · 2020: 80 · 2019: 85 · 2018: 100 · 2017: 88 · 2016: 99 · 2015: 123 · 2014: 141 · 2013: 140 · 2012: 161
- FWCI
- 21.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Counseling Psychology (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Counseling Practices and Supervision
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- therapeutic relationship, psychotherapy outcome, client ratings, therapist ratings, observer ratings, treatment outcome prediction
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