Therapeutic Change May Begin before the Therapist and Patient Ever Meet: Pretreatment Alliance Changes Predict Clinical Outcomes.

ABSTRACT:

Introduction

Mechanisms of change are widely assumed to be activated by the onset of treatment. This foundational premise underlies decades of psychotherapy research and guides the timing of measurement and intervention in clinical science. The present study challenges this assumption by demonstrating that one of the most well-established predictors of treatment outcome - the therapeutic alliance - not only changes before therapy begins, but that these early, pretreatment changes predict both alliance development and symptom reduction throughout treatment.

Methods

In a randomized controlled trial for depression (N = 100), the therapeutic alliance was assessed twice before patients met their therapist and weekly thereafter.

Results

The pretreatment change in alliance s

SUBMITTER: Zilcha-Mano S 

PROVIDER: S-EPMC12716845 | biostudies-literature | 2025 Nov

REPOSITORIES: biostudies-literature