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Negotiating the therapeutic alliance: Are we going to converge with time? The effect of psychotherapy treatment duration and psychotherapist's modality on the discrepancy in alliance ratings in the psychotherapeutic dyad.

Created on 23 Oct 2025

Authors

Tomasz Prusiński

Published in

Psychiatria polska. Volume 59. Issue 3. Pages 415-430. Jun 30, 2025. Epub Jun 30, 2025.

Abstract

The study aimed to analyze the discrepancies in alliance ratings in a psychotherapeutic dyad - between the patient and their therapist. It was also examined if these discrepancies differed depending on the modality of the psychotherapist's work.
The cross-sectional study included alliance measurement in 181 psychotherapeutic dyads. Psychotherapeutic processes were investigated at different moments of treatment, from the initial phase until the final one. Three psychotherapeutic modalities were controlled for: psychodynamic and psychoanalytic, cognitive-behavioral and systemic. To verify the hypotheses, the author performed difference tests and first-degree polynomial analysis, looking for a linear trend. Square and cubic trend analyses were also performed.
The assumption that patient-therapist discrepancy would decrease over the course of the psychotherapy process was not supported. The study confirmed the effect of the psychotherapist's modality on patient-therapist discrepancy in alliance quality ratings. Discrepancies were smaller in the case of cognitive-behavioral psychotherapists than in those of the systemic modality.
The results of the analyses show that the asymmetry in alliance perception is a permanent characteristic of the psychotherapeutic process and that changes in this respect depending on treatment duration tend to be small. A smaller patient-therapist discrepancy in alliance ratings may be a function of a quicker and more effective process of clarifying relational issues in the dyad and may stem from attunement, which forms and develops in the cognitive-behavioral modality.

PMID:
41124584
Bibliographic data and abstract were imported from PubMed on 23 Oct 2025.

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