Can we Modulate Therapeutic Interpersonal Style Experimentally to Address Alliance? A Proof-of-Concept Study

Abstract

Background: With a lack of experimental designs that explore which therapeutic style is helpful for which patient, the aim of this study was to test the feasibility of experimentally varying the therapeutic style under realistic conditions and to investigate how this affects alliance ratings by clients and counselors. Methods: We defined two manualized therapeutic styles (neutral/distant relational style vs. high affiliation relational style) based on the interpersonal circumplex. In a randomized two-group design, 64 healthy university students (70% female, Mage = 23.78, SDage = 2.81) received a single psychological counseling session on interpersonal conflicts by one of four counselors and in one of the two styles. We checked the manipulation success using observer-rated degree of affiliation and ratings of counselors’ interpersonal behavior with the Interpersonal Message Inventory (IMI-R). A series of linear regression models analyzed whether the style predicted working alliance, assessed via the Working Alliance Inventory (WAI). Results: In accordance with the hypotheses, significant differences in the rated degree of affiliation (p ≤.001) and IMI-R ratings (p ≤.001 in friendly, p =.003 in hostile dimension) were found between the two groups. Overall, alliance ratings were high across groups and raters (WAI overall scores ranging from 3.76 to 4.07). The style did not predict clients’ alliance ratings. Conclusion: The experimental variation of the therapeutic style proved feasible under realistic conditions with high overall alliance ratings. The novel experimental design may provide a basis for further research.