Therapists' and clients' perception of each other and working alliance in the behavioral treatment of panic disorder and agoraphobia

Fifty-nine patients who fulfilled criteria for a primary diagnosis of panic disorder with moderate to severe agoraphobia were treated with 16 sessions of behavioral therapy. The study investigated the relationship between therapists' and clients' perception of each other, working alliance, and outcome. There was initially a low correspondence between therapist and client perceptions but a growing consensus during treatment. This was most pronounced regarding high ratings of therapist qualities and the perception of the client as attractive. Clients' perceptions showed virtually zero correlation with outcome regardless of time. Therapist perception of client as showing active participation and goal direction yielded positive correlations with outcome at posttreatment and follow-up from Session 4 and throughout treatment. No significant relation between working alliance and outcome was found apart from the fact that those who improved during follow-up rated the alliance significantly higher than those who did not improve.