The Interaction Between Alliance and Technique Use in the Prediction of Client Change: Replication and Extension of Owen et al. (2013) in a Different Cultural Context

Abstract

Although the relationship between alliance and outcome is well established, the relationship between technique and outcome seems to be more complex. Accordingly, interest has been rising in the interaction between alliance and technique. In this study, using the new Hebrew version of the Comparative Psychotherapy Process Scale (CPPS), we set out to replicate and extend Owen et al.'s findings regarding the interaction between psychodynamic-interpersonal (PI) technique, cognitive-behavioural (CB) technique and the alliance with patient rated change, 10 years later, and in a different cultural context (Israel vs. United States). A sample of 112 clients completed an online survey including three measures to rate their most recent session: the CPPS, the Working Alliance Inventory (WAI-SF-P) and the Client Task Specific Change Measure Revised (CTSC-R). We found a significant positive relationship between both PI and CB technique with patient rated change, as well as a significant positive relationship between PI technique and the working alliance. We also found interactions between both PI and CB technique use with alliance, in predicting patient rated change. A PROCESS moderation analysis was utilized to better understand these interactions. Whereas amplified PI technique use was most effective in low alliance levels; CB technique was most effective in the context of a strong alliance. The findings support the notion that the technique–alliance interaction may be related to whether the technique a therapist is considering amplifying is adherent or non-adherent to their primary model.