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Research shows that psychotherapy leads to improved outcomes, including a reduction in psychological symptoms, an increase in daily functioning, and improvement in subjective well-being and quality of life (American Psychological Association 2012; Shedler 2010; Barber et al. 2013). A new wave of research is moving beyond the question of whether treatment works and examining how and why treatment works by identifying the active ingredients.
Researchers have identified several predictors of successful outcomes and components of effective treatments, including alliance strength, therapist technique, and therapist countertransference (Owen, Hilsenroth, and Rodolfa 2013; Owen and Hilsenroth 2011; Imel et al. 2013; DeFife, Hilsenroth, and Gold 2008; Barber et al. 2013; Betan and Westen 2009).
Theorists, researchers, and clinicians alike have argued that the therapeutic relationship between client and therapist may be one of the most significant contributors to positive outcomes (Bordin 1994; Crits-Christoph, Gibbons, and Mukherjee 2013). In a meta-analysis of seventy-nine studies, Martin, Gaske, and Davis (2009) showed that the overall relationship between alliance and outcome is moderate but consistent, showing a correlation of .27 across many studies. Thus, the meta-analysis clearly showed that patients who have stronger relationships with their therapists consistently have better outcomes. Further, Falkenström, Granström, and Holmqvist (2013) found in a sample of 646 patients not only that stronger alliance is related to more positive outcomes across the overall span of treatment, but that higher patient alliance ratings after a given session are related to lower symptom ratings at the next session.