A Meta-Analysis of Client–Therapist Perspectives on the Therapeutic Alliance: Examining the Moderating Role of Eating Disorders Versus Anxiety Disorders, Treatment Orientation, and Measurement Time Points

Objective: The effectiveness of therapy is correlated with the therapeutic alliance (TA) rating congruence between clients and therapists. The current meta-analysis seeks to determine how clientswith eating disorders versus anxiety disorders and their therapists differ in their assessments of the TA. This investigation focuses on two potential moderators: treatment orientation, and measurement time points. Method: Three electronic databases were searched, and a total of 2,688 articles were identified using a combination of search terms. 40 studies (N= 2,727) met the inclusion criteria. Data were coded, and a risk of bias assessment was conducted for each included study. We then analyzed the data using multivariate random effects models. Moderation analyses were conducted with a series of univariate metaregressions. Results: The overall mean therapist–client discrepancy in TA was moderate in size, with clients typically having a higher evaluation, g= 0.41, 95% confidence interval (CI) [0.28, 0.53], SE= 0.06. Furthermore, the effect size for eating disorders samples (g= 0.51, 95% CI [0.31, 0.71], SE= 0.09) was descriptively larger than anxiety disorders samples (g= 0.37, 95% CI [0.21, 0.53], SE= 0.08), but moderation analysis did not reveal any significant moderators of the therapist–client discrepancy in TA assessment. Conclusion: Our analysis shows that therapist–client discrepancy in TA assessment is robust.