Articles
2026: Online Advance Publication
Are we on the same page? Examining client-therapist alliance congruence and psychological well-being
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 31 July 2026
0
Views
0
Downloads
Authors
This study examined client-therapist alliance congruence as a predictor of psychological well-being among 104 Filipino psychotherapy dyads. Descriptive analysis showed that although most dyads had non-identical ratings, 55.8% fell within the conservative broad agreement band; among dyads outside this band, therapist-higher discrepancies were more common. Client- and therapist-rated alliances were analyzed using polynomial regression with response surface analysis (RSA) to model both congruent and incongruent alliance effects on client psychological well-being. Treatment length, treatment interval, therapist professional maturity, and client symptom severity were included as covariates. Results indicated a significant positive linear effect along the line of alliance congruence, such that a mutually perceived alliance was associated with greater psychological well-being. In contrast, significant curvature along the line of incongruence (LOIC) showed that discrepancies between therapist and client alliance ratings were associated with lower well-being, with increasing mismatch predicting progressively poorer outcomes. The findings suggest that therapist and client alliance perceptions should not be treated as interchangeable and that their dyadic alignment provides clinically meaningful information beyond either perspective alone. These results are discussed in relation to alliance monitoring, client feedback, and culturally responsive psychotherapy practice in the Filipino context.
Downloads
Download data is not yet available.
Citations
Aafjes-van Doorn, K., Spina, D. S., Horne, S. J., & Békés, V. (2024). The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clinical Psychology Review, 110, 102430. doi: 10.1016/j.cpr.2024.102430
Alejo, A. E. (2018). Loob as relational interiority: A contribution to the philosophy of the human person. Social Transformations: Journal of the Global South, 6(1), 29-53.
Atzil-Slonim, D., & Tschacher, W. (2020). Dynamic dyadic processes in psychotherapy: Introduction to a special section. Psychotherapy Research, 30(5), 555-557. doi: 10.1080/10503307.2019.1662509
Barkham, M., De Jong, K., Delgadillo, J., & Lutz, W. (2023). Routine outcome monitoring (ROM) and feedback: Research review and recommendations. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 33(7), 841-855. doi: 10.1080/10503307.2023.2181114
Bateman, A., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders: A practical guide. Oxford University Press. doi: 10.1093/med:psych/9780199680375.001.0001
Chen, R., Bar-Kalifa, E., Sade, A., & Ziv-Beiman, S. (2022). Client-therapist congruence in session-helpfulness ratings and its association with therapy outcomes. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 32(4), 484-496. doi: 10.1080/10503307.2021.1974598
Clarke, P. J., Marshall, V. W., Ryff, C. D., & Wheaton, B. (2001). Measuring psychological well-being in the Canadian Study of Health and Aging. International Psychogeriatrics, 13(Supp 1), 79-90. doi: 10.1017/s1041610202008013
Dazzi, F., Shafer, A., & Lauriola, M. (2016). Meta-analysis of the Brief Psychiatric Rating Scale - Expanded (BPRS-E) structure and arguments for a new version. Journal of Psychiatric Research, 81, 140-151. doi: 10.1016/j.jpsychires.2016.07.001
Di Malta, G., Vos, J., Bond, J., van Rijn, B., & Cooper, M. (2025). Relational depth as predictor of mental health outcomes in psychotherapy: Random intercept cross-lagged analyses. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 1-12. doi: 10.1080/10503307.2025.2551073
Enriquez, V. G. (1978). Kapwa: A core concept in Filipino social psychology. Philippine Social Sciences and Humanities Review, 42, 100-108.
Falkenström, F., Hatcher, R. L., & Holmqvist, R. (2015). Confirmatory factor analysis of the patient version of the Working Alliance Inventory—Short Form Revised. Assessment, 22(5), 581-593. doi: 10.1177/1073191114552472
Fonagy, P., & Luyten, P. (2018). Attachment, mentalizing, and the self. In W. J. Livesley & R. Larstone (Eds.), Handbook of personality disorders: Theory, research, and treatment (2nd ed., pp. 123-140). The Guilford Press.
Gergov, V., Lindberg, N., Lahti, J., Lipsanen, J., & Marttunen, M. (2021). Effectiveness and predictors of outcome for psychotherapeutic interventions in clinical settings among adolescents. Frontiers in Psychology, 12, 628977. doi: 10.3389/fpsyg.2021.628977
Goldstein, L. A., Adler Mandel, A. D., DeRubeis, R. J., & Strunk, D. R. (2020). Outcomes, skill acquisition, and the alliance: Similarities and differences between clinical trial and student therapists. Behaviour Research and Therapy, 129, 103608. doi: 10.1016/j.brat.2020.103608
Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy Research, 16(1), 12-25. doi: 10.1080/10503300500352500
Hofmann, A. B., Schmid, H. M., Jabat, M., Brackmann, N., Noboa, V., Bobes, J., Garcia-Portilla, M. P., Seifritz, E., Vetter, S., & Egger, S. T. (2022). Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale. Psychiatry Research, 314, 114659. doi: 10.1016/j.psychres.2022.114659
Høgenhaug, S. S., Kongerslev, M. T., & Kjaersdam Telléus, G. (2024). The role of interpersonal coordination dynamics in alliance rupture and repair processes in psychotherapy: A systematic review. Frontiers in Psychology, 14, 1291155. doi: 10.3389/fpsyg.2023.1291155
Hsu, H.-Y., Hsu, T.-L., Lee, K., & Wolff, L. (2017). Evaluating the construct validity of Ryff’s scales of psychological well-being using exploratory structural equation modeling. Journal of Psychoeducational Assessment, 35(6), 633-638. doi: 10.1177/0734282916652756
Javier, R. E. (2017). Ang tao sa ka-taw-an at sa ka-tau-han: Paguugnay sa pagpapakatao, pakikipagkapuwa-tao, at pagkatao. Malay, 30(1), 70-85.
Khanjani, M., Shahidi, S., Fathabadi, J., Mazaheri, M. A., & Shokri, O. (2014). Factor structure and psychometric properties of the Ryff’s scale of Psychological well-being, short form (18-item) among male and female students. Thoughts and Behavior in Clinical Psychology, 9(32), 27-36.
Kraiss, J., Redelinghuys, K., & Weiss, L. A. (2022). The effects of psychological interventions on well-being measured with the mental health continuum: A meta-analysis. Journal of Happiness Studies, 23(7), 3655-3689. doi: 10.1007/s10902-022-00545-y
Lee, T. S., Sun, H. F., & Chiang, H. H. (2019). Development and validation of the short-form Ryff's psychological well-being scale for clinical nurses in Taiwan. Journal of Medical Sciences, 39(4), 157-62. doi: 10.4103/jmedsci.jmedsci_191_18
Ligon, J., & Thyer, B. A. (2000). Interrater reliability of the Brief Psychiatric Rating Scale used at a community-based inpatient crisis stabilization unit. Journal of Clinical Psychology, 56(4), 583-587. doi: 10.1002/(sici)1097-4679(200004)56:4<583::aid-jclp12>3.0.co;2-u
Maku Orleans-Pobee, R. C. (2020). The therapeutic alliance in integrated coping awareness therapy [Master’s Thesis, University of North Carolina]. doi: 10.17615/sbyf-5t40
McAleavey, A. A., de Jong, K., Nissen-Lie, H. A., Boswell, J. F., Moltu, C., & Lutz, W. (2024). Routine outcome monitoring and clinical feedback in psychotherapy: Recent advances and future directions. Administration and Policy in Mental Health, 51(3), 291-305. doi: 10.1007/s10488-024-01351-9
Munder, T., Wilmers, F., Leonhart, R., Linster, H. W., & Barth, J. (2010). Working Alliance Inventory-Short Revised (WAI-SR): Psychometric properties in outpatients and inpatients. Clinical Psychology & Psychotherapy, 17(3), 231-239. doi: 10.1002/cpp.658
Muran, J. C., Lipner, L. M., Podell, S., & Reinel, M. (2022). Rupture repair as change process and therapist challenge (Reparación de rupturas como proceso de cambio y desafío para el terapeuta). Studies in Psychology, 43(3), 482-509. doi: 10.1080/02109395.2022.2127234
Nordmo, M., Monsen, J. T., Høglend, P. A., & Solbakken, O. A. (2021). Investigating the dose-response effect in open-ended psychotherapy. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 31(7), 859-869. doi: 10.1080/10503307.2020.1861359
Overall, J. E., & Gorham, D. R. (1962). Brief Psychiatric Rating Scale (BPRS) [Database record]. APA PsycTests. doi: 10.1037/t01554-000
Paap, D., & Dijkstra, P. U. (2017). Working Alliance Inventory-Short Form Revised. Journal of Physiotherapy, 63(2), 118. doi: 10.1016/j.jphys.2017.01.001
Pe-Pua, R., & Protacio-Marcelino, E. A. (2000). Sikolohiyang Pilipino (Filipino psychology): A legacy of Virgilio G. Enriquez. Asian Journal of Social Psychology, 3, 49-71. doi: 10.1111/1467-839X.00054
Prusiński, T. (2022). The strength of alliance in individual psychotherapy and patient’s wellbeing: The relationships of the therapeutic alliance to psychological wellbeing, satisfaction with life, and flourishing in adult patients attending individual psychotherapy. Frontiers in Psychiatry, 13, 827321. doi: 10.3389/fpsyt.2022.827321
Prusiński, T. (2024). Consensus on alliance quality in the psychotherapeutic dyad and its differentiating effect on treatment outcomes in patients with adjustment disorders. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 54(1), 1-8. doi: 10.1007/s10879-023-09591-w
Reyes, J. (2015). Loób and Kapwa: An introduction to a Filipino virtue ethics. Asian Philosophy, 25(2), 148-171. doi: 10.1080/09552367.2015.1043173
Rilveria, J. R. C. (2024). Towards a culturally sensitive model of therapeutic alliance: Exploring the role of Filipino values and shared realities. Philippine Social Science Journal, 6(4), 19-32. doi: 10.52006/main.v6i4.875
Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719-727. doi: 10.1037/0022-3514.69.4.719
Sagui-Henson, S. J., Welcome Chamberlain, C. E., Smith, B. J., Li, E. J., Castro Sweet, C., & Altman, M. (2022). Understanding components of therapeutic alliance and well-being from use of a global digital mental health benefit during the COVID-19 pandemic: Longitudinal observational study. Journal of Technology in Behavioral Science, 7(4), 439-450. doi: 10.1007/s41347-022-00263-5
Saxler, E., Schindler, T., Philipsen, A., Schulze, M., & Lux, S. (2024). Therapeutic alliance in individual adult psychotherapy: A systematic review of conceptualizations and measures for face-to-face- and online-psychotherapy. Frontiers in Psychology, 15, 1293851. doi: 10.3389/fpsyg.2024.1293851
Seewald, A., & Rief, W. (2024). Therapist’s warmth and competence increased positive outcome expectations and alliance in an analogue experiment. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 34(5), 663-678. doi: 10.1080/10503307.2023.2241630
Tetzlaff, M., Bruins, J., & Castelein, S. (2025). Associated factors of the quality of therapeutic alliance in people with severe mental illnesses: A systematic review. Clinical Psychology Review, 122, 102656. doi: 10.1016/j.cpr.2025.102656
Tschuschke, V., Koemeda-Lutz, M., von Wyl, A., Crameri, A., & Schulthess, P. (2022). The impact of clients’ and therapists’ characteristics on therapeutic alliance and outcome. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 52(2), 145-154. doi: 10.1007/s10879-021-09527-2
Wampold, B. E., & Flückiger, C. (2023). The alliance in mental health care: Conceptualization, evidence and clinical applications. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 22(1), 25-41. doi: 10.1002/wps.21035
West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation modeling: Concepts, issues and applications. SAGE Publications.
Whelen, M. L., Ezawa, I. D., & Strunk, D. R. (2023). Congruence in patient and therapist-rated alliance predicts subsequent depressive symptoms in cognitive behavioral therapy for depression. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 33(6), 719-728. doi: 10.1080/10503307.2022.2156304
Yacat, J. A., de Villa, C., Clemente, J. A., & Toledo, J. (2009). Filipino social relationships: Surfacing underlying themes of ibang tao/hindi ibang tao [Conference paper]. 46th PAP Annual Convention, Silliman University, Dumaguete City, Philippines.
Zilcha-Mano, S., & Muran, J. C. (2024). Thinking transtheoretically about alliance and rupture: Implications for practice and training. Clinical Psychology in Europe, 6(Spec Issue), e12439. doi: 10.32872/cpe.12439
How to Cite
Are we on the same page? Examining client-therapist alliance congruence and psychological well-being. (2026). Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2026.896
Copyright (c) 2026 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.