The alliance in adult psychotherapy: A meta-analytic synthesis
Also known as The alliance in adult psychotherapy, Flückiger et al. 2018
2018 meta-analysis of 295 studies: a stronger alliance goes with better therapy outcomes
At a glance
What it found
A robust link, Same for every approach, Online too
See all 3Key ideas
What the alliance is, Pan-theoretical
See all 2Criticism and limits
Effects vary, Causality and limits
See all 2Read next
How important are the common factors in psychotherapy? An update, The Great Psychotherapy Debate
See all 2Connections
Christoph Flückiger, A. C. Del Re and 5 others
See all 7
Also on this page: Key facts · Links · Sources · Related pages
- The alliance is the collaborative bond between client and therapist.
- This meta-analysis pooled 295 independent studies covering more than 30,000 patients.
- A stronger alliance went with better outcomes, a correlation of about .28.
- The link held across therapy types, measures, patients, countries and who rated the alliance.
- It held for internet-based therapy too.
Why it matters
- The strongest single piece of evidence that the relationship matters in therapy, whatever the approach.
- Useful to anyone deciding where to put their effort as a therapist or client.
Key facts
- Authors
- Christoph Flückiger, A. C. Del Re, Bruce E. Wampold, Adam O. Horvath1
- Published
- May 20181
- Journal
- Psychotherapy, vol. 55, issue 4, pp. 316–3401
- DOI
- 10.1037/pst00001721
- Design
- Three-level random-effects meta-analysis, face-to-face and internet-based psychotherapy1
- Sample
- 295 independent studies, more than 30,000 patients, published 1978–20171
- Main result
- Face-to-face alliance-outcome correlation r = .278 (95% CI .256 to .299), equivalent to d = .5791
- Internet-based therapy
- r = .275 across 23 studies1
- Cited by
- 859 (Europe PMC count, October 2026)1
What it found
-
A robust link1
The positive relation between alliance and outcome is robust: only 2% of the 295 effect sizes were negative.
-
Same for every approach1
The link was consistent across rater perspectives, alliance and outcome measures, treatment approaches, patient types and countries.
-
Online too1
Internet-based therapy showed about the same link (r = .275).
Key ideas
Criticism and limits
Read next
-
How important are the common factors in psychotherapy? An update
Puts the alliance next to empathy, expectations and therapist effects.
-
The Great Psychotherapy Debate
Co-author Wampold's book-length argument for common factors.
Connections
Written by
- Christoph Flückiger
- A. C. Del Re
- Bruce WampoldPerson
- Adam O. Horvath
Links
Sources
Last checked against its sources today
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