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Falkenström, F. Larsson, M. (2017). The Working Alliance: From Global Outcome Prediction to Micro-Analyses of Within-Session Fluctuations. Psychoanal. Inq., 37(3):167-178.

(2017). Psychoanalytic Inquiry, 37(3):167-178

The Working Alliance: From Global Outcome Prediction to Micro-Analyses of Within-Session Fluctuations

Fredrik Falkenström, Ph.D. and Mattias Holmqvist Larsson, M.A.

The working alliance, originally a psychoanalytic concept, is probably the most empirically studied psychotherapy process variable. There are many studies showing that a better alliance predicts better outcomes (e.g., Horvath et al., 2011), although the causal direction of this relationship is still debated (Barber et al., 2000; DeRubeis, Brotman, and Gibbons, 2005; Falkenström, Granström, and Holmqvist, 2013). Additionally, most of the empirical research on the working alliance is limited in clinical utility because of the relative simplicity of the research. Specifically, most empirical research on the working alliance has aimed to link patient-therapist dyads’ overall level of working alliance with global treatment outcomes. In actual clinical practice, therapists may be most interested in the fluctuations in the alliance from one session to the next, or even from one moment to the next within a session. There is a rich tradition in psychoanalysis of evaluating the results of therapeutic interventions by examining the patient’s responses. With the help of modern statistical methods, we believe the impact of a single intervention or series of interventions on factors such as working alliance, symptomatic improvement, or emotional experiences can be studied. Although this research is still in its infancy, we believe it is the future of scientific investigation of the talking cure.

[This is a summary excerpt from the full text of the journal article. The full text of the document is available to journal subscribers on the publisher's website here.]

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