Temporal associations between interpersonal problems and therapeutic alliance in cognitive behavioral therapy.

Abstract

Interpersonal problems have been identified as a potential risk factor for a weaker therapeutic alliance during psychotherapy, yet their temporal relationship and underlying dynamics remain unclear. To address this, the present study explores these associations during the first 20 sessions of cognitive behavioral therapy. The data from 2,123 patients undergoing treatment in an outpatient clinic were analyzed. Interpersonal problems were assessed every fifth session with the 12-item version of the Inventory of Interpersonal Problems-12, while therapeutic alliance was measured after every session with the Session Rating Scale. Temporal associations were modeled using both a random-intercept cross-lagged panel model and an autoregressive latent trajectory model with structured residuals, as they allow the differentiation of within- and between-patient components. The random-intercept cross-lagged panel model produced more reliable and interpretable estimates. At the within-patient level, contemporaneous associations were significant, indicating that higher-than-usual interpersonal problems within a session were associated with lower-than-usual experienced therapeutic alliance at the same time point (β = -.067 to -.074, p = .005). Over time, higher-than-usual interpersonal problems negatively influenced therapeutic alliance at the next assessment (β = -.052 to -.063, p = .032), while higher-than-usual therapeutic alliance predicted reductions in interpersonal problems five sessions later (β = -.051 to -.083, p = .002). These findings suggest a reciprocal dynamic between interpersonal problems and therapeutic alliance, where improvements in one construct are associated with beneficial changes in the other over time, highlighting the importance of addressing interpersonal difficulties to strengthen the therapeutic alliance. (PsycInfo Database Record (c) 2025 APA, all rights reserved).