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Cited by 303Psychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology ResearchCounseling Practices and Supervision

Is the alliance really therapeutic? Revisiting this question in light of recent methodological advances.

Zilcha-Mano, Sigal·2017·American Psychologist
DOI 10.1037/a0040435
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Abstract

The therapeutic value of alliance is a contested supposition. Although many theorists and researchers believe that alliance is therapeutic in itself, others see it as a byproduct of effective treatment or as a common nonspecific factor enabling the truly effective ingredients of treatment to work. For many years, the debate was confined mainly to the domain of theory, and no studies were available to confirm which of these approaches is correct. The only empirical evidence that existed was studies showing a correlation between alliance and outcome, and advocates of the above conflicting opinions used the same correlation to prove the validity of their position. Over the last few years, however, a revolution has taken place in alliance research, which brings this theoretical debate into the realm of the empirical. Several recent alliance studies have applied advanced methodologies to achieve this aim. Based on an integration of these studies, the present article proposes a new model for understanding the potential therapeutic role of alliance as sufficient to induce change by itself. The model stresses the importance of differentiating between patients' general tendencies to form satisfying relationships with others, which affect also the relationship with the therapist ("trait-like" component of alliance), and the process of the development of changes in such tendencies through interaction with the therapist ("state-like" component of alliance). The former enables treatment to be effective; the latter makes alliance therapeutic. Based on the literature, this article attempts to determine which of these components is the predictor of treatment outcome. (PsycINFO Database Record

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  • Zilcha-Mano (2017) concluded that studies that account for temporality and disentangle between- and within-patient variability show that changes in the alliance may indeed precede symptom reduction.

    “Zilcha-Mano (2017) reviewed these new studies in an elegant overview and concluded that the studies that account for temporality and disentangle the effects of between-and within-patient variability show that changes in the alliance may indeed precede symptom reduction.”

    From The Role of Common Factors in Psychotherapy Outcomes (2019) · cites this paper as Zilcha-Mano 2017

  • A good trait-like alliance is a prerequisite to engaging in therapy and making it effective, while state-like changes in the alliance during treatment can predict subsequent outcome and might make the alliance therapeutic in itself.

    “A good trait-like alliance is a prerequisite to engaging in therapy and making it effective, while the state-like changes in the alliance during treatment can predict the subsequent outcome and, thus, might make the alliance therapeutic in itself.”

    From The Role of Common Factors in Psychotherapy Outcomes (2019) · cites this paper as Zilcha-Mano 2017

  • Preliminary findings suggest that trait-like and state-like mechanisms can exhibit contrasting correlations with treatment effectiveness.

    “Importantly, preliminary findings suggest that these trait-like and state-like mechanisms can exhibit contrasting correlations with treatment effectiveness [114].”

    From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [114]

  • Some researchers have argued that a positive correlation between TA and clinical outcome at one time point was not sufficient in proving the importance of TA in face-to-face therapy.

    “In addition, some researchers have argued that a positive correlation between TA and clinical outcome at one time point was not sufficient in proving the importance of TA in face-to-face therapy (56).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [56]

  • Prior studies have shown that a better therapeutic alliance precedes and predicts better outcomes, and better outcomes precede and predict an improved therapeutic alliance.

    “Prior studies have shown that a better therapeutic alliance precedes and predicts better outcomes, and better outcomes precede and predict an improved therapeutic alliance [71, 73, 84].”

    From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [84]

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Authors
Zilcha-Mano, S.
Venue
American Psychologist
Publisher
American Psychological Association (APA)
Published
2017-05
Volume
72
Issue
4
Pages
311-325
ISSN
  • 0003-066X (ISSN-L)
  • 1935-990X
DOI
10.1037/a0040435
OpenAlex
W2611981785
Cited by
303
References
99
Citations by year
2026: 25 · 2025: 31 · 2024: 21 · 2023: 27 · 2022: 22 · 2021: 54 · 2020: 46 · 2019: 37 · 2018: 29 · 2017: 10 · 2012: 1
FWCI
41.28
Type
journal article
Language
en
Open access
closed
Locations
  • American Psychologist (publishedVersion)
  • PubMed (publishedVersion)
Funders
Israel Science Foundation
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, non-specific factors, treatment outcome prediction, psychotherapy effectiveness
MeSH terms
Cooperative Behavior, Humans, Professional-Patient Relations, Treatment Outcome

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