Belief, bond, and relief: Longitudinal associations between client belief about counseling success, working alliance, and symptom relief.

Abstract

This study examined how clients' outcome expectations (OE; belief about positive outcome of counseling session) was associated with working alliance and symptom relief longitudinally in a sample of Chinese beginning therapist trainees and their clients. Participants included 204 Chinese therapist trainees and their 1,214 clients who provided data for 11,198 sessions. Before every therapy session after intake, clients reported their symptom severity level and OE; after every session, clients reported their perceived working alliance quality. The latent curve model with structured residuals (Curran et al., 2014) was utilized to disentangle the between-person (average client differences) and within-person (session-by-session fluctuations) effects and test the temporal directionality between the three variables of interest. Results showed that, at the between-person level, clients who began treatment with stronger positive OE tended to form stronger alliances and report lower symptom distress at the beginning of therapy; and clients who sustained or increased their OE during treatment showed greater alliance growth and faster symptom reduction over time. At the within-person level, a cyclical pathway emerged where higher OE before a session temporally led to higher working alliance rating after that session, which subsequently led to higher OE at the next session; however, results did not support the OE → working alliance → symptom mediation model, nor the bidirectional associations between client OE and symptom relief. Practical implications are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).