Reason for Referral and Treatment Focus as Moderators of Alliance and Individual Symptom Distress in Couple Therapy

Abstract

Therapeutic alliance is a significant predictor of positive treatment outcomes for individuals and couples undergoing therapy (Davis et al., 2012; Baldwin, Wampold, & Imel, 2008; Horvath, 2001; Flükiger et al., 2019; Wiseman, 2017). Client-therapist agreement on the goals and tasks of therapy is essential to the alliance (Bordin, 1979), suggesting that couples in therapy may demonstrate improved alliance when the therapist focuses treatment on the primary type of problems reported at intake. This study sought to understand how therapeutic alliance formation was affected by the interplay between a couple’s presenting problem (symptom distress or relational adjustment) and the therapist’s treatment focus. While a hierarchical multiple regression demonstrated no significant findings for the therapist focus match by a change in symptom distress interaction term, several unique findings were observed. These included a significant influence of symptom distress upon alliance formation and the absence of a significant relationship between change in relational distress and alliance formation. Potential clinical applications and future directions for study are explored.

Keywords: couple, alliance, individual symptom, reason for referral