Clients' Perceptions of the Working Alliance as a Predictor of Increases in Positive Affect

The working alliance is routinely touted, and empirically supported, as a common factor and robust predictor of decreases in psychological distress. However, advances in more balanced, positively-oriented perspectives in psychotherapy have led to calls to conceptualize therapeutic success as both the decrease of distress and the increase of positive factors. One such positive characteristic that may be enhanced during psychotherapy is positive affect. Engendering positive affect has been considered a common process to psychotherapy but remains underexplored in relation to therapeutic processes common across. If the alliance is a robust predictor of decreases in distress, it may also predict increases in positive affect. To explore this hypothesis, we collected data for this naturalistic psychotherapy study from a doctoral training clinic. Participants (N = 102; 1,118 sessions) completed measures of positive affect, distress, and the alliance at every session. Using multilevel modeling, we disaggregated distress and alliance coefficients into within-participant and between participants effects. Accounting for session number as a linear growth covariate, we found that increases in participants' perceptions of their alliance with their therapists significantly predicted increases in positive affect over the course of treatment. We confirmed the multilevel result using cross-lagged panel modeling via SEM, which indicated that increases in the alliance predict increases in positive affect. The alliance, though a meaningful predictor of distress reduction, is a common factor useful in predicting more than distress reduction alone. Implications for a more balanced conceptualization of outcome and applying positive psychology to psychotherapy are discussed.