Balancing clinical risk with countertransference management protects alliance

The working alliance has been recognized as a predictor of psychotherapy outcome across therapeutic orientations. Despite mixed findings regarding the effect of problem severity on the alliance formation, there is evidence suggesting that therapist factors may interfere in this association. This study examined how clients baseline clinical features affected the early alliance and the possible role of therapists countertransference management as a mediator. Thirteen therapeutic dyads were assessed at 2 different time points. Clients clinical dimensions were assessed prior to the 2nd session, and therapists countertransference management and clients ratings of the alliance were measured after the 2nd session. Positive associations were found between clients subjective wellbeing, social functioning, risk, and global psychological distress and countertransference management dimensions and total score. Empathy-based countertransference management suppressed the negative impact of clinical risk on alliance. Our findings suggest that clinical problems activate countertransference management, which in turn may buffer their negative effect on alliance.