What therapists bring to therapy: an examination of therapist effects on the alliance and the characteristics which build the therapist-client alliance

The therapeutic alliance is well established as an important common factor of therapies. This thesis focused on the therapists' contribution to the therapeutic alliance. Although there has been substantial research into therapists' factors which relate to therapy outcome, and the research pertaining to therapist effects on outcome is developing, there is little research which has focused on the impact of the therapist on the alliance. Given the association between alliance and therapy outcome it is important to know what contributes to the development of strong alliances. This thesis aimed to examine therapist effects on the early client-rated alliance, as well as on the rate of growth in alliance, as perceived by clients, over the course of therapy. Thereafter it sought to identify therapist characteristics which explained difference between therapists with relatively strong or weak early alliances and growth in these alliances. It was hypothesised that early alliance and growth in alliance would be associated with therapists’ early maladaptive schemas, attachment style, degree of mindfulness, experiential avoidance, theoretical orientation, and the amount of supervision and personal therapy they had received. Furthermore it was hypothesised that therapists' and clients' attachment style would interact such that the early alliance, and the rate of alliance growth, would be higher when the therapist and client attachment style was different (i.e. avoidant and anxious), compared to when their attachment style was similar (e.g. both avoidant). Similarly it was hypothesised that therapists’ experience and client attachment would interact, such that when clients have greater attachment insecurity more experienced therapists will have a stronger early alliance, and rate of growth in alliance, than less experienced therapists. These hypotheses were examined in a sample of 53 therapists who together counselled 222 clients attending a university psychology clinic. Analysis was conducted using multilevel modelling and demonstrated that 15% of the variation on early alliance scores, and 85% of the variation in linear growth in alliance, was attributable to differences between therapists. The differences between therapists on early alliance were not significant and hence an analysis of the impact of therapists’ characteristics on this variable was not undertaken. Several therapist characteristics explained the significant differences between therapists on alliance growth. The amount of supervision therapists had received in their career to date was negatively associated with alliance growth, whereas psychological flexibility and the schema approvaliii seeking were positively associated with alliance growth. Therapists’ anxious attachment, when paired with clients’ anxious attachment, had a deleterious effect on alliance growth. This thesis highlights that specific therapist characteristics do influence their capacity to develop alliances with their clients. Therapists’ experiential avoidance is a psychological process that is amenable to change and, given its association with alliance, therapists’ training may be improved by some focus on this. The results suggest that therapists' schema and attachment anxiety, which are generally considered maladaptive, can have a positive effect on alliance. The therapeutic contexts which allow these vulnerabilities to operate as strengths are discussed. The counterintuitive result for supervision is concerning given psychologists’ investment in this type of professional development. Hence there is a pressing need for further examination of the impact of therapists’ supervision on the alliance. Overall, this research points to the importance of considering how therapists, alongside clients and therapies, contribute to the alliance and by association, good therapy outcomes.