Oxytocin as a biomarker of the formation of therapeutic alliance in psychotherapy and counseling psychology

Sigal Zilcha-Mano, Simone Shamay-Tsoory, Tohar Dolev-Amit, Orna Zagoory-Sharon, Ruth Feldman

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


The therapeutic alliance is one of the most consistent predictors of therapeutic change, including symptom reduction and improvement in wellbeing and quality of life, across a variety of mental health interventions. Yet, little is known about its biological mechanisms. Oxytocin (OT) has been suggested as a biological mechanism by which bonds are formed and strengthened across species. This article is intended to demonstrate the potential of OT as a biomarker of therapeutic change in psychotherapy and counseling psychology, especially of the therapeutic alliance. We delineate three main potential paths of investigation based on the most recent research on OT in parent-child and romantic partner dyads. For each path, we provide a detailed explanation for whom, when, and how OT should be measured. Each path is illustrated using data collected in a randomized controlled trial of psychotherapy for major depressive disorder. These illustrations demonstrate the great potential of OT as a biomarker of (a) trait-like characteristics of the patients and the therapists, (b) the processes of therapeutic change, and (c) the dyadic synchrony between patients and their therapists. The potential clinical contribution of OT as a biomarker for each of these three paths is further demonstrated using a case study. Practical suggestions and directions for future research are discussed.

Original languageEnglish
Pages (from-to)523-535
Number of pages13
JournalJournal of Counseling Psychology
Issue number4
StatePublished - Jul 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 American Psychological Association.


This work was supported by the Israeli Science Foundation (Grant 186/15), and the Charles J. Gelso, Psychotherapy Research Grants Program and by the simms/mann foundation chair to Ruth Feldman.

FundersFunder number
Israeli Science Foundation
Israel Science Foundation186/15


    • Alliance
    • Biomarkers
    • Oxytocin
    • Psychotherapy
    • Therapeutic relationship


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