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Cited by 17Psychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology ResearchCounseling Practices and Supervision

Therapeutic alliance in individual adult psychotherapy: a systematic review of conceptualizations and measures for face-to-face- and online-psychotherapy

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Saxler, Eva, Schindler, Theresa, Philipsen, Alexandra, Schulze, Marcel, Lux, Silke·2024·Frontiers in Psychology
DOI 10.3389/fpsyg.2024.1293851PMC PMC11238262
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Abstract

Background The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. Methods We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. Results A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments ( n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures ( n = 14), based on literature searches ( n = 3) or on an empirical survey ( n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. Discussion The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.

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  • Central to effectiveness of psychosocial interventions is therapeutic alliance, characterized by trust, empathy, and open communication, which enhances clients' engagement and motivation.

    “Central to the effectiveness of psychosocial interventions is the therapeutic alliance, characterized by trust, empathy, and open communication, which significantly enhance clients’ engagement and motivation [51].”

    From Psychosocial interventions for improving marital intimacy, sexual satisfaction, and quality of life of women and couples with infertility problems in low and middle-income countries: Systematic review protocol (2025) · cites this paper as [51]

    The Results (Overview of conceptualizations of therapeutic alliance; page not provided) describe empathy, mutual trust, effective communication, and patient motivation as aspects of therapeutic-alliance concepts, and report an association between one form of alliance and long-term therapy success. The Discussion (page not provided) likewise identifies trust, active participation, and motivation in alliance measures. The review concerns individual adult psychotherapy, however, and does not establish that these qualities significantly increase engagement and motivation across psychosocial interventions. (LLM, conf=0.86)

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Research works printed but not linked: 3

  1. Freud S. (1982a) in Zur Dynamik der Übertragung in Sigmund Freud: Studienausgabe Ergänzungsband, Schriften zur Behandlungstechnik. eds. Mitscherlichs A. Richards A. Strachey J. Grubrich-Simitis I. (Frankfurt am Main: Fischer Taschenbuch Verlag), 157– 168. (originally published as: “Zur Dynamik der Übertragung, 1912”, Zentralblatt für Psychoanalyse, 2(4), 167–73). Available at: https://moodle.phil.hhu.de/pluginfile.php/57669/mod_resource/content/2/FREUD%20Schriften%20zur%20Behandlungstechnik.pdf
  2. Freud S. (1982b) in Zur Einleitung der Behandlung: Weitere Ratschläge zur Technik der Psychoanalyse I, in Sigmund Freud: Studienausgabe Ergänzungsband, Schriften zur Behandlungstechnik. eds. Mitscherlichs A. Richards A. Strachey J. Grubrich-Simitis I. (Frankfurt am Main: Fischer Taschenbuch Verlag), 181– 204. (originally published as: “Zur Einleitung der Behandlung: Weitere Ratschläge zur Technik der Psychoanalyse I”, 1913, Internationale Zeitschrift für ärztliche Psychoanalyse, 1(1), 1–10 und (2), 139–146). Available at: https://moodle.phil.hhu.de/pluginfile.php/57669/mod_resource/content/2/FREUD%20Schriften%20zur%20Behandlungstechnik.pdf
  3. Gaston L. Marmar C. R. (1993). Manual of California psychotherapy alliance scales (CALPAS). Montreal: McGill University Available at: https://www.researchgate.net/publication/321732093_CALPAS_Manual.

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Authors
Saxler, E., Schindler, T., Philipsen, A., Schulze, M., & Lux, S.
Affiliations
University Hospital Bonn (DE)
Corresponding author
  • Saxler, Eva
  • Lux, Silke
ORCID
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2024-06-27
Volume
15
Pages
1293851-1293851
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2024.1293851
PMC
PMC11238262
OpenAlex
W4400086855
Cited by
17
References
131
Citations by year
2026: 12 · 2025: 3 · 2024: 2
FWCI
1.51
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DZNE Pub (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Rheinische Friedrich-Wilhelms-Universität Bonn
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, individual psychotherapy, online therapy, face-to-face psychotherapy, self-report measures, self-disclosure, trust, attachment, patient motivation, treatment outcomes

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