--- title: "Clinical summary: Interpersonal Problems and the Therapeutic Alliance" description: The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social, University of Ottawa. His research focus is on psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders. image: https://collabzium.com/hubfs/George%20Tasca-2.jpg --- [![FAC_SOCIAL_SCIENCE_HEADER_BAR](https://collabzium.com/hubfs/FAC_SOCIAL_SCIENCE_HEADER_BAR.svg "FAC_SOCIAL_SCIENCE_HEADER_BAR")](https://www.uottawa.ca/faculty-social-sciences/) [![Collabzium](https://collabzium.com/hubfs/CollabziumLogoEnglish(Name)-COLOUR.svg "Collabzium")](https://collabzium.com/) - Articles - [Collabzium Guide](https://collabzium.com/en/articles/author/collabzium-guide) - [All articles](https://collabzium.com/en/articles) - Research - [Chairs and Labs](https://collabzium.com/en/chair-and-labs) - [About](https://collabzium.com/collabcrew) [Subscribe](https://20500402.hubspotpagebuilder.com/subscribe-now) [Subscribe](https://20500402.hubspotpagebuilder.com/subscribe-now) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) # Clinical summary: Interpersonal Problems and the Therapeutic Alliance [Dr. Giorgio Tasca](https://collabzium.com/en/articles/author/dr-giorgio-tasca) calendar icon Sep 30, 2024 · Reading time 2 min read [mailto:?subject=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email) The relationship quality between therapist and patient is a therapeutic factor that can lead to better patient outcomes. One of the key elements of the therapeutic relationship is the therapeutic alliance. The alliance is the agreement between patient and therapist on the goals of therapy, the tasks or type of work done in therapy, and their emotional bond. There is a [positive association](https://doi.org/10.1037/pst0000172?utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-8jFCTxnAbgfWLNOwDLAUvN2oxn6dDupp5pJDN2j_ygLu2L_Ti-r7Hjf0AiDYHKTfvgYMyLVOhHlMreaw4HkmJQubTEkQ&_hsmi=2) between a strong therapeutic alliance and patient mental health outcomes. There is also substantial [research](https://doi.org/10.1037/0000306-000?utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-8jFCTxnAbgfWLNOwDLAUvN2oxn6dDupp5pJDN2j_ygLu2L_Ti-r7Hjf0AiDYHKTfvgYMyLVOhHlMreaw4HkmJQubTEkQ&_hsmi=2) showing how ruptures in the alliance can lead to poorer outcomes and that repairing these ruptures may build an even stronger alliance. Establishing an alliance is a collaborative process in which patients and therapists affect each other’s interpersonal behaviours. If one person in the interaction has interpersonal difficulties, this might negatively impact their alliance. Individuals with [psychological problems](https://doi.org/10.1016/j.comppsych.2017.06.014?utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-8jFCTxnAbgfWLNOwDLAUvN2oxn6dDupp5pJDN2j_ygLu2L_Ti-r7Hjf0AiDYHKTfvgYMyLVOhHlMreaw4HkmJQubTEkQ&_hsmi=2) often experience interpersonal distress and have difficulty navigating social interactions. Even well-trained and experienced therapists may have issues working with patients with significant interpersonal problems. In this meta-analysis, Iovoli and colleagues were interested in how patients’ interpersonal problems at the beginning of therapy were associated with the quality of the therapeutic alliance during treatment. Their systematic review of the existing research revealed 27 studies representing 6,334 patients. The studies included patients with various diagnoses or problems and therapists working within different therapeutic orientations. The correlation between interpersonal problems at the beginning of therapy and the subsequent therapeutic alliance resulted in r = −.124, SE = .019, 95% CI \[−.162, −.082\], t(26) = −6.311, p < .001. This small but statistically significant effect indicates that patients with greater interpersonal problems tend to have a weaker therapeutic alliance with their therapists. The effect was more substantial when the alliance was measured early in therapy. The interpersonal problem–alliance association did not differ significantly depending on the type of therapy provided by the therapist. ## Practice Implications Individuals with higher interpersonal problems may face more significant challenges in developing a solid therapeutic alliance with their therapists. Therapists should identify and address these interpersonal problems. Patient’s interpersonal difficulties have a more substantial impact on developing an alliance early on in therapy, which could set the stage for therapeutic relationship difficulties throughout treatment. One could expect more alliance ruptures with such patients (disagreements on the tasks and goals of therapy or a strained relational bond). Therapists should learn to identify when an alliance rupture has occurred and learn skills to repair these ruptures. The PPRNet is currently conducting a study in which community-based therapists receive evidence-based training to identify and repair alliance ruptures. Go to [https://researchpprnet.ca/](https://researchpprnet.ca/?utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-8jFCTxnAbgfWLNOwDLAUvN2oxn6dDupp5pJDN2j_ygLu2L_Ti-r7Hjf0AiDYHKTfvgYMyLVOhHlMreaw4HkmJQubTEkQ&_hsmi=2) for more information on how to obtain this free training. > Iovoli, F., Flückiger, C., Gómez Penedo, J. M., Engelhardt, J. H., Kaschlaw, H. H., Lauterbach, R., Wester, R. A., & Rubel, J. A. (2024). The relationship between interpersonal problems and therapeutic alliance in psychotherapy: A three-level mixed-effects meta-analysis. *Psychotherapy, 61*(3), 198–211. [https://doi.org/10.1037/pst0000534](https://psycnet.apa.org/doi/10.1037/pst0000534?utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-8jFCTxnAbgfWLNOwDLAUvN2oxn6dDupp5pJDN2j_ygLu2L_Ti-r7Hjf0AiDYHKTfvgYMyLVOhHlMreaw4HkmJQubTEkQ&_hsmi=2) To learn more about the Psychotherapy Practice Research Network, visit [www.pprnet.ca](https://collabzium.com/en/psychotherapy-practice-research-network). calendar icon Sep 30, 2024 · Reading time 2 min read [mailto:?subject=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2&utm_medium=social&utm_source=email) --- ### [By Dr. Giorgio Tasca](https://collabzium.com/en/articles/author/dr-giorgio-tasca) The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders. ## Also Read - [PPRNet Clinical summary: Long-Term Effects of Psychotherapies for Depression](https://collabzium.com/en/articles/pprnet-clinical-summary-long-term-effects-of-psychotherapies-for-depression) - [PPRNet Clinical summary: Self-Compassion as a Protective Factor Against Burnout in Psychologists](https://collabzium.com/en/articles/pprnet-clinical-summary-self-compassion-as-a-protective-factor-against-burnout-in-psychologists) - [PPRNet Clinical summary: The Therapeutic Alliance in Internet-Based Interventions](https://collabzium.com/en/articles/pprnet-clinical-summary-1.-the-therapeutic-alliance-in-internet-based-interventions) - [PPRNet Clinical summary: What Do Individuals With Borderline Personalities Want From Treatment?](https://collabzium.com/en/articles/pprnet-clinical-summary-what-do-individuals-with-borderline-personalities-want-from-treatment) #### RELATED NEWS ![Clinical summary: Should Personal Therapy be Mandatory for Psychotherapy Trainees?](https://collabzium.com/hs-fs/hubfs/George%20Tasca-2.jpg?width=600&name=George%20Tasca-2.jpg) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) ## [Clinical summary: Should Personal Therapy be Mandatory for Psychotherapy Trainees?](https://collabzium.com/en/articles/clinical-summary-should-personal-therapy-be-mandatory-for-psychotherapy-trainees) As early as 1937, Freud proposed that every psychoanalyst should enter into analysis without... 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Freud first discussed it in... Sep 04, 2024Reading time 2 min read ![Clinical summary: Patient Attachment Insecurity Predicts Poorer Therapeutic Alliance](https://collabzium.com/hs-fs/hubfs/George%20Tasca-2.jpg?width=600&name=George%20Tasca-2.jpg) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) ## [Clinical summary: Patient Attachment Insecurity Predicts Poorer Therapeutic Alliance](https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-1) The therapeutic alliance is one of the most researched concepts in psychotherapy. It refers to the... 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