Behavioral Indicators of the Therapeutic Alliance in Relation to Discontinuation in Couple Therapy

Abstract

Client discontinuation is prevalent in psychotherapy with up to half discontinuing therapy before meeting the goals of therapy (Thalmayer, 2018). When therapists work to improve the therapeutic alliance, clients are more likely to stay in treatment and chances of recovery improve (D’Aniello et al., 2018; Escudero & Friedlander, 2017). Most of the alliance research, however, comes from client self-report of the alliance with less research based on observations of alliance behaviors that occur during a session. There has been limited research on how in-session alliance behaviors may be related to client discontinuation in couple therapy. The current exploratory study examined this question in a sample of thirty matched pairs of heterosexual couples (15 couples who discontinued prematurely and 15 who successfully completed treatment). Alliance behaviors were coded using the System for Observing Family Therapy Alliances (Friedlander et al., 2005; SOFTA-o) and t-tests were used to identify whether couples differed significantly on four dimensions of the therapeutic alliance: Engagement in the therapeutic process, emotional connection to the therapist, safety within the therapeutic system, and shared sense of purpose within the family. Results indicate that emotional connection was significantly lower for both male and female partners in the discontinuation group, as was the male partner’s sense of safety and shared sense of purpose. Within these dimensions, several individual alliance behaviors were also significant suggesting their potential importance in helping therapists identify couples at risk of discontinuation.