Therapeutic bond judgments: Congruence and incongruence

Objective: The present study had 2 aims: (a) to implement West and Kennya's (2011) Truth-and-Bias model to simultaneously assess the temporal congruence and directional discrepancy between clientsa' and therapistsa' ratings of the bond facet of the therapeutic alliance, as they cofluctuate from session to session; and (b) to examine whether symptom severity and a personality disorder (PD) diagnosis moderate congruence and/or discrepancy. Method: Participants included 213 clients treated by 49 therapists. At pretreatment, clients were assessed for a PD diagnosis and completed symptom measures. Symptom severity was also assessed at the beginning of each session, using client self-reports. Both clients and therapists rated the therapeutic bond at the end of each session. Results: Therapists and clients exhibited substantial temporal congruence in their session-by-session bond ratings, but therapistsa' ratings tended to be lower than their clientsa' across sessions. Additionally, therapeutic dyads whose session-by-session ratings were more congruent also tended to have a larger directional discrepancy (clientsa' ratings being higher). Pretreatment symptom severity and PD diagnosis did not moderate either temporal congruence or discrepancy at the dyad level; however, during sessions when clients were more symptomatic, therapist and client ratings were both farther apart and tracked each other less closely. Conclusions: Our findings are consistent with a better safe than sorrya pattern, which suggests that therapists are motivated to take a vigilant approach that may lead both to underestimation and to attunement to fluctuations in the therapeutic bond.