Reciprocal influence model of working alliance and therapeutic outcome over individual therapy course.

A reciprocal influence model of the working alliance and the therapeutic outcome was examined in a sample of clients (n = 638) seen by novice therapists. Past researchers have found a relation between the working alliance and symptom improvement and this relation has been interpreted as the alliance leading to such symptom change. The current study was an examination of whether the alliance does indeed lead to symptom change, or whether symptom change leads to subsequent alliance change, or whether each is related to the other in a reciprocal way over time. By modeling the longitudinal development of the working alliance and the symptomatic severity over the individual therapy course, we found support for the reciprocal model being superior to the unidirectional models. The ideas of relationship as strategy and relationship as outcome along with the reciprocal pattern revealed in the findings were discussed with respect to the theoretical and clinical implications. We also discussed the limitations of the study and provided suggestions for future research.