Assessing Therapeutic Alliance: A Pilot Study Measuring Therapeutic Alliance and It's Impact on Patient Outcomes

Background: According to the US Department of Health and Human Services, the US can expect continuing declines in the adequacy of the behavioral health workforce.  Worldwide estimates of health and medical needs are also outpacing workforce development (Boniol, M, et al., 2022).  Many studies have shown that the quality of the relationship between psychotherapy staff and patients has a significant effect on clinical mental health outcomes. Relating or interpersonally connecting with patients is especially important in the beginning of an emerging therapeutic relationship (Shattell, etal, 2007).  Therapeutic alliance is defined as the mutual collaboration between clinician and patient, which includes emotional bonding, a sense of warmth and openness, and shared expectations of both tasks and goals of therapy (Connors, GJ, et al., 1997).  There is a consistent relationship between therapeutic alliance and outcome demonstrated in the literature, regardless of the variables that have been evaluated to influence the relationship (Martin, et al., 2000).  Methods: A pilot study evaluating the ability of a tool to predict therapists’ ability to initiate therapeutic alliances against patient outcomes was undertaken.  The evaluation included 346 patients and the therapists on staff at the treatment center.  The treatment settings were across Crisis (n=146), Residential (n=159) and outpatient (PHP/IOP; n= 71).  Results: We compared symptom scores at intake, treatment plan update and discharge using the PHQ-9 and the GAD-7.  Length of stay in treatment was also reviewed as an outcome as longer lengths of stay are generally consistent with treatment engagement and ultimately long-term outcomes.  Analysis linking scores to therapists’ scores on a new and novel therapeutic alliance measurement tool is underway.  Conclusions:  The role of therapeutic alliance is strongly and positively associated with positive treatment outcomes. Clients with strong alliances are more likely to adhere to treatment plans (Fluckiger et al., 2012) and strong alliances are also associated with greater reductions in symptoms (Martin, et al., 2000).  Measuring a therapist’s ability to generate strong alliances, and offering training and support to enhance areas of deficiency can improve patient outcomes and support workforce development efforts.  We are examining the ability of such an instrument to determine its ability to predict patient outcomes.