Client-therapist agreement on target problems, working alliance, and counseling outcome

It is widely asserted that clients and therapists should agree on which client problems are to be the focus of treatment. According to working alliance theory, client-therapist agreement on therapy objectives contributes to treatment success. However, few empirical studies exist of the relevance of target problem agreement to therapy outcome. We examined the relationships among actual client-therapist agreement on target problems, working alliance (perceived agreement), and therapy outcome. Client-counselor dyads completed target complaint lists and symptom ratings at 3 points during therapy. Improvement and working alliance ratings were also completed after the 4th session and at a final ratings point. Fourth-session target complaint agreement and working alliance contributed to the prediction of therapy outcome. However, actual target complaint agreement was unrelated to working alliance (perceived agreement) ratings. Implications for working alliance theory are discussed.