The Impact of Client Distress on Alliance Ratings: An Experimental Test

Kelly R. McKnight, Catherine M. Reich

Research output: Contribution to journalArticlepeer-review


The alliance-outcome relationship is typically interpreted to mean alliance contributes to client outcomes; however, it remains possible that when clients are feeling better, they provide more lenient or positive ratings of the alliance. The aim of this research was to test whether client mood states impact alliance perceptions by experimentally manipulating clients’ mood before they rated the alliance. Clients (N = 177) watched a randomized mood induction film clip that was either positive or negative. Then, clients completed the Working Alliance Inventory, the Alliance Negotiation Scale, and questions about alliance ruptures. Preliminary analyses suggested successful random assignment and mood induction. However, there were no statistically significant differences between mood conditions for any of the measures of alliance. Overall, findings did not support the hypothesis that mood influences alliance perceptions, though some potential differences for depressed clients are discussed. Future research might utilize this novel method with different therapeutic and client contexts, such as mood disorders, and might further explore other aspects of outcome that might influence alliance ratings.

Original languageEnglish (US)
Pages (from-to)291-300
Number of pages10
JournalJournal of Psychotherapy Integration
Issue number3
StatePublished - 2022

Bibliographical note

Funding Information:
This study was made possible due to support from the University of Minnesota Duluth Department of Psychology Internal Project Funding. We thank Lara LaCaille, Jim Amell, Connor Eickhoff, and Grace Pegel for feedback on this article. We have no conflicts of interest to disclose. The dataset and stimuli from the study can be requested from Catherine M. Reich, following Institutional Review Board addendum approval and agreement on appropriate authorship credit.

Publisher Copyright:
© 2022. American Psychological Association


  • Alliance
  • Alliance-outcome association
  • Bias
  • Causal
  • Psychotherapy process


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