One Dance, Two Partners: Session-To-Session Therapist-Client Rating Configurations and Outcomes

This study identified session-level patterns of therapists' and clients' perceptions of the therapeutic alliance and treatment progress and examined whether these patterns were associated with client-reported outcomes. Data included 15 therapist trainees, 86 clients, and 1035 session ratings. After each session, therapists and clients separately provided ratings, and clients rated their personal functioning and psychological symptoms. A multilevel latent class analysis identified five session patterns: "all-high" (53.3%), "bond-focused" (16.3%), "goals/tasks-focused" (3.3%), "client-low" (18.5%), and "all-low" (8.5%). Longitudinal multilevel models revealed lower current personal functioning after client-low sessions, than after all-high or bond-focused sessions, and higher current psychological symptoms after client-low sessions than after all-high sessions. Clients reported higher next-session symptoms after client-low sessions than after all-high or bond-focused sessions. No difference was detected in outcomes between all-low or goals/tasks-focused sessions and the rest. This study has significant implications for treatment planning, monitoring of the therapeutic alliance, and supervision of therapists-in-training.