Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
Lentis Psychiatric Institute, Lentis Research & FACT noord- Groningen, The Netherlands.
Eur Psychiatry. 2020 Jun 29;63(1):e67. doi: 10.1192/j.eurpsy.2020.67.
Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients' and therapists' estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument.
We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size.
Heterogeneity analyses (k = 22, Cohen's d = -.46, 95% confidence interval = .31-1.1) produced a significant Q-statistic (Q = 94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate.
Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client's diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients' and therapists' estimations than do more general instruments that are applied to assess TA.
客户和治疗师对治疗联盟（TA）通常有不同的看法，这会影响治疗的过程和结果。本元分析的目的是评估严重障碍患者中客户和治疗师对 TA 的估计之间的平均差异，同时关注两个潜在的调节因素：客户诊断和联盟工具。
我们对研究精神分裂症谱系障碍、人格障碍和物质使用障碍患者心理治疗中客户视角和治疗师视角的 TA 进行了系统的文献检索。然后，我们使用随机效应荟萃分析模型和 Cohen's d 标准化平均效应大小分析数据。
异质性分析（k=22，Cohen's d=-.46，95%置信区间=.31-1.1）产生了显著的 Q 统计量（Q=94.96），表明存在高度异质性，表明适合进行调节分析。
我们的研究结果表明，TA 工具的类型调节了客户和治疗师对 TA 的一致性，但客户诊断并没有调节这种效果的迹象。客户和治疗师估计之间的一致性似乎取决于用于评估 TA 的工具。特定于设置的相关工具似乎比应用于评估 TA 的更通用的工具更能提高客户和治疗师估计之间的一致性。
