Congruence About Working Alliance in Chinese Context: The Moderating Effect of Therapists' Self-Efficacy and the Relationship Between Congruence and Psychotherapy Outcome

The present study was conducted to (a) identify the clients and therapists' perceptual directional discrepancy and temporal congruence in different aspects of working alliance (i.e., goals/tasks and bond), (b) examine the moderating effect of therapists' client-specific self-efficacy on the directional discrepancy and congruence, (c) clarify the relationship between specific working alliance aspects congruence and the next-session symptom, and (d) test the relationship between the congruence of goals/tasks or bond and the psychotherapy outcome under different levels of therapists' self-efficacy. Clients (n = 87, 80.9% female, average age = 21.78 [1.90]) and therapists (n = 43, 65% female) in a Chinese university mental health center evaluated the working alliance session by session. Clients self-reported session-level symptom severity were assessed at the beginning of every session and therapists' self-efficacy for a specific client were assessed at the end of the first session. The truth-and-bias approach was used to analyze the perceptual directional discrepancy and temporal congruence in goals/tasks and bond, and examine the moderating effect of therapists' self-efficacy. Multilevel polynomial regression and response surface analysis were used to clear the relationship between congruence/incongruence and client symptom level in the next session. (a) Clients and therapists temporally agreed on both the goals/tasks and bond dimensions of the working alliance. Averagely, therapists tended to rate goals/tasks agreement lower than clients but did not rate more or less intense bond than clients. (b) Therapists with low or medium self-efficacy for specific client underrated goals/tasks and bond more than therapists with high client-specific efficacy, and among the therapist-client dyads, the higher therapists' client-specific self-efficacy, the higher temporal congruence in bond rather than goals/tasks. (c) For both goals/tasks and bond, when clients and therapists were in agreement, client symptoms decreased as the congruent combinations of therapists' and clients' goals/tasks increased. Clients' symptom level increased more sharply as the degree of discrepancy increases for goals/tasks, not affected by the direction. (d) However, for therapists with high client-specific self-efficacy, their underestimations were more associated with the less severe next-session symptoms of their clients than their overestimations. This association was not found among clients whose therapists' self-efficacies for them were low. The findings provide a deeper insight into the congruence of the working alliance.