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Assessing the alliance–outcome association adjusted for patient characteristics and treatment processes: A meta-analytic summary of direct comparisons.

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

Journal Journal of Counseling Psychology
Page(s) 1
Title of proceedings Journal of Counseling Psychology
DOI 10.1037/cou0000424

Open Access

Type of Open Access Repository (Green Open Access)


The alliance is widely recognized as a robust predictor of posttreatment outcomes. However, there is a debate regarding whether the alliance is an epiphenomenon of intake characteristics and/or treatment processes occurring over the course of treatment. This meta-analysis aimed to synthesize the evidence on this issue. We identified 125 effect sizes in 60 independent samples (6,061 participants) of studies that reported alliance−outcome correlations as well as parallel intake or process characteristics. We examined the impact of these potential confounds on the alliance−outcome correlations. We meta-analyzed the studies estimates by computing omnibus effects models as well as multivariate models. We identified 3 variable types that were used to adjust the alliance−outcome correlations: (a) intake characteristics (k = 35); (b) simultaneous processes, such as adherence or competence (k = 13); and (c) both intake and simultaneous processes (k = 24). We found moderate alliance−outcome correlations with or without adjustments for intake and simultaneous processes (range from r = .23 to r = .31). Our results provide robust empirical evidence for the assertion that the alliance−outcome association is an independent process-based factor. Findings suggest that alliance is positively related to outcome above and beyond the studied patient intake characteristics and treatment processes.