Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy


Dr Anne Grete Hersoug, Department of Psychiatry, Section Vinderen, PO Box 85 Vinderen, N-0319 Oslo, Norway (e-mail:


Objectives. Patient expectancy has been regarded as an important predictor of psychotherapy outcome, for more than half a century. In recent years, some evidence has emerged indicating that the therapeutic alliance may mediate the association between expectancy and outcome.

Design. In this dismantling, randomized clinical study, 100 out-patients who sought psychotherapy due to depression, anxiety, and personality disorders, were assigned to 1 year of dynamic psychotherapy with and without transference interpretation.

Methods. Patients' pre-treatment target expectancies and global expectancy were measured in this clinical trial. Tests of mediation were performed with two patient-rated and one therapist-rated measure of the therapeutic alliance, using regression analyses. Six putative moderators of the mediational paths were explored.

Results. Global Optimism was significantly associated with two clinician-rated outcome measures – the Psychodynamic Functioning Scales and Global Assessment of Functioning. Both patient ratings, but not the therapist rating of alliance mediated the association between global expectancy and clinician-rated outcome. None of the putative moderators had a significant effect.

Conclusion. The results, together with previous findings, indicate that the expectancy–alliance–outcome mediational chain is a general phenomenon, not limited to subgroups of patients or modes of treatment.