An investigation of the relationship between therapist characteristics and alliance in group therapy for individuals with treatment-resistant auditory hallucinations

Background: Alliance is a well-studied construct; however, little research has investigated predictors of alliance in a group context. Aims: This study investigates the relationship between therapist characteristics and group alliance in 65 individuals with schizophrenia receiving outpatient group therapy for treatment-resistant auditory hallucinations. Methods: Raters coded 120 sessions of cognitive behavioral therapy or supportive therapy for therapist warmth and friendliness, therapist exploration and negative therapist attitude. Alliance was assessed at week six. Results: Higher average levels of therapist warmth and friendliness and lower average levels of negative therapist attitude in sessions one to five were associated with stronger alliance at week six at the trend level (p < 0.10). Therapist exploration did not predict alliance at week six. Higher negative therapist attitude at treatment engagement was associated with higher post-treatment symptom scores. Conclusions: Our results suggest that therapist attributes but not therapist techniques are associated with client's perceptions of alliance and that negative therapist behaviors are associated with higher symptom levels at post-treatment. Implications for clinical practice are discussed.