When is it Effective to Focus on the Alliance? Analysis of a Within-Client Moderator

concerns the working alliance, commonly defined as the emotional bond established in the therapeutic dyad, and the agreement between client and therapist concerning the goals of therapy and the tasks required to achieve them (Bordin 1979; Hatcher and Barends 2006). The strength of the working alliance is a consistent predictor of outcome in psychotherapy, with stronger alliance predicting better therapeutic outcomes (Horvath et al. 2011). Until recently, most of the studies on the alliance-outcome association focused on the alliance in a given early session in treatment (e.g., week 3) as a predictor of outcome from preto post-treatment. Although these studies have been instrumental in establishing the consistent association between alliance and outcome, their methods cannot take us beyond this discovery and thus cannot demonstrate how alliance may be used to maximize treatment efficacy. Recently, a new line of alliance research has been developing, which advanced from a general understanding that alliance is associated with outcome to a more detailed investigation, seeking to understand the different roles alliance may play in treatment and how it can be used to improve treatment efficacy (for a review, see Zilcha-Mano 2016). As part of the general progress in psychotherapy study design, toward session-to-session assessment of both outcome and process measures, three new possibilities for investigation have arisen: (a) the establishment of a correct temporal relationship between alliance and outcome, (b) the disaggregation of withinand between-clients alliance effects, and (c) the identification of moderators of the alliance-outcome association, as described below. The first path of recent alliance research focuses on the temporal relationship between alliance and outcome. The importance of the alliance in influencing treatment outcome has been challenged by the question whether alliance is the cause or rather the result of symptomatic change Abstract Contemporary studies on the working alliance seek to move forward from demonstrating an association between alliance and outcome to investigating how alliance can be used to maximize treatment outcome by identifying the clients for whom state-like changes in alliance predict symptomatic change (between-clients moderators). Yet, very little is known empirically on when state-like changes in alliance predict outcome for individual clients (withinclient moderators). The present study, based on a sample of 327 clients, demonstrates that state-like changes in alliance at a given session have a significant effect on subsequent session outcome only in the case of higher life satisfaction in that session. This finding suggests that strengthening in the state-like component of the alliance has a greater effect on outcome when the client suffers less from poor life satisfaction.