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The alliance in adult psychotherapy: A meta-analytic synthesis.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Flückiger Christoph, Del Re A. C., Wampold Bruce E., Horvath Adam O.,
Project Design development in randomized clinical trials - Psychological treatment in generalized anxiety
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Original article (peer-reviewed)

Journal Psychotherapy
Page(s) 1 - 25
Title of proceedings Psychotherapy
DOI 10.1037/pst0000172

Open Access

Type of Open Access Repository (Green Open Access)


The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood esti- mators. The overall alliance–outcome association for face-to-face psychotherapy was r .278 (95% confidence intervals [.256, .299], p .0001; equivalent of d .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r .275, k 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteris- tics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.