Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments

Although the clinical significance of therapeutic alliance with people with psychosis is well established, the agreement between client and therapist assessments of therapeutic alliance and the longitudinal changes of both assessments have been rarely addressed. The current study examined client and therapist assessments of therapeutic alliance longitudinally and sought to determine whether insight and severity of symptoms moderated the degree to which therapist and client assessments were in agreement with one another. Forty-five participants diagnosed with a schizophrenia spectrum disorder and their therapists were administered a therapeutic alliance questionnaire (Working Alliance Inventory-Short Form) monthly for 6 months. Baseline symptoms were assessed using the PANSS. Results did not produce evidence that insight into illness moderated the relationship between agreement on the therapeutic alliance. However, symptoms of emotional discomfort at baseline predicted differences in agreement between clients and therapists on the relationship aspect of therapeutic alliance over the course of therapy. These results suggest that the ability to express symptoms of emotional discomfort may affect whether clients and therapists form similar appraisals of the strength of the therapeutic alliance.