Cognitive Therapy and Research

, Volume 42, Issue 2, pp 146–158 | Cite as

Not Just a Non-specific Factor: Moderators of the Effect of Within- and Between-Clients Alliance on Outcome in CBT

  • Sigal Zilcha-Mano
  • J. Christopher Muran
  • Catherine F. Eubanks
  • Jeremy D. Safran
  • Arnold Winston
Original Article


The working alliance is one of the most consistent predictors of outcome. Yet, little empirical knowledge exists on how therapists can use this association to maximize the outcome of cognitive behavioral therapy (CBT) for individual clients. The present study aimed to examine pre-treatment client interpersonal characteristics that determine what function the alliance should fulfill in order to maximize its effect on outcome. We did so by identifying moderators of the within- and between-clients effects on outcome. Data of 185 clients receiving CBT treatment was disaggregated to study the effects of the within- and between-clients alliance on outcome. Findings suggest that for clients who described themselves as overly cold and were described by their therapists as low on intrusiveness, state-like strengthening of alliance predicted better outcome, and that for clients not overly cold but overly exploitable, the general tendency of the client to report stronger alliance was associated with better outcome.


Alliance Interpersonal problems Process-outcome moderator Alliance-outcome association Rupture resolution patterns 


Compliance with Ethical Standards

Conflict of Interest

Sigal Zilcha-Mano, J. Christopher Muran, Catherine F. Eubanks, Jeremy D. Safran, and Arnold Winston, declare that they have no conflict of interest.

Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sigal Zilcha-Mano
    • 1
  • J. Christopher Muran
    • 2
    • 5
  • Catherine F. Eubanks
    • 3
    • 5
  • Jeremy D. Safran
    • 4
    • 5
  • Arnold Winston
    • 5
  1. 1.The Department of PsychologyUniversity of HaifaHaifaIsrael
  2. 2.The Derner Institute of Advanced Psychological StudiesAdelphi UniversityGarden CityUSA
  3. 3.Ferkauf Graduate School of PsychologyYeshiva UniversityNew YorkUSA
  4. 4.Psychology DepartmentNew School For Social ResearchNew YorkUSA
  5. 5.Mount Sinai Beth IsraelNew YorkUSA

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