A meta-analysis of client-therapist perspectives on the therapeutic alliance: Examining the moderating role of type of measurement and diagnosis.
BACKGROUND
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.


METHOD
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.


RESULTS
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.


CONCLUSIONS
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.
['Igra|Libby|L|0000-0002-1872-4539', 'Lavidor|Michal|M|', 'Atzil-Slonim|Dana|D|', 'Arnon-Ribenfeld|Nitzan|N|', 'de Jong|Steven|S|0000-0002-0421-3041', 'Hasson-Ohayon|Ilanit|I|']
D000328:Adult D006801:Humans D010554:Personality Disorders D011369:Professional-Patient Relations D011613:Psychotherapy D012559:Schizophrenia D019966:Substance-Related Disorders D000078462:Therapeutic Alliance
meta-analysis therapeutic alliance Agreement