Cognitive Therapy and Research

, Volume 42, Issue 2, pp 159–171 | Cite as

When is it Effective to Focus on the Alliance? Analysis of a Within-Client Moderator

  • Sigal Zilcha-Mano
  • Ilana Lipsitz
  • Paula Errázuriz
Original Article


Contemporary studies on the working alliance seek to move forward from demonstrating an association between alliance and outcome to investigating how alliance can be used to maximize treatment outcome by identifying the clients for whom state-like changes in alliance predict symptomatic change (between-clients moderators). Yet, very little is known empirically on when state-like changes in alliance predict outcome for individual clients (within-client moderators). The present study, based on a sample of 327 clients, demonstrates that state-like changes in alliance at a given session have a significant effect on subsequent session outcome only in the case of higher life satisfaction in that session. This finding suggests that strengthening in the state-like component of the alliance has a greater effect on outcome when the client suffers less from poor life satisfaction.


Alliance Alliance-outcome association Process psychotherapy research Within-client moderators 


Compliance with Ethical Standards

Conflict of Interest

Sigal Zilcha-Mano, Ilana Lipsitz, and Paula Errázuriz, declare that they have no conflict of interest.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sigal Zilcha-Mano
    • 1
  • Ilana Lipsitz
    • 1
  • Paula Errázuriz
    • 2
  1. 1.The Department of PsychologyUniversity of HaifaHaifaIsrael
  2. 2.Psychology DepartmentPontificia Universidad Católica de ChileSantiagoChile

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