Date of Award

Spring 2007

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Saunders, Stephen M.

Second Advisor

Wierzbicki, Michael J.

Third Advisor

Oswald, Debra


The therapeutic alliance has been accepted as a central component of the psychotherapeutic process. Numerous aspects of the alliance have been examined. The most frequently studied relationship is the one that exists between alliance and outcome. Research has consistently shown that alliance is a moderate yet reliable predictor of outcome. Less frequently studied are pretreatment variables that predict the alliance. Research that has examined pretreatment predictors has been mixed. The most support / has been provided for client interpersonal variables in predicting the alliance. Even fewer studies have examined ways in which to improve the therapeutic alliance. Researchers have examined ways in which to repair a damaged alliance, however, no studies have been conducted on improving the early alliance. Studies have shown that the use of feedback aids in repairing ruptured alliances and improving outcomes. Currently no studies have examined the effects of feedback on the initial development of the therapeutic alliance. The present studies investigated three facets of the alliance, using it to predict outcome, examining its pretreatment predictors, and using inferential feedback in a pilot study to enhance its development. The knowledge obtained from this investigation can be used to increase clinicians' and researchers' ·knowledge about the therapeutic alliance to ultimately improve the practice of psychotherapy.



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