Client and therapist agreement about the client's problems—Associations with treatment alliance and outcome

Rolf Holmqvist, Björn Philips, John Mellor-Clark

A shared understanding of the patient's symptoms and problems is seen by most theories as a crucial aspect of the collaboration in therapy, presumably influencing alliance and outcome. The empirical ground for this argument is not solid, however. Several studies have found weak associations between a common view of the patient's problems and outcome. The purpose of the present study was to analyze whether agreement in the understanding of the patient's depression and anxiety problems was important for alliance and outcome. The study used data from a practice-based study using the CORE system with 846 patients who received psychological treatment in primary care. The analyses indicated that although patients who were assessed by their therapists as having depression and anxiety problems scored higher on these subscales than other patients, about half of the patients reported such problems when the therapists did not, and vice versa. Agreement was not associated with better alliance or outcome. Productive collaboration in psychotherapy may be based on other factors than agreement about symptoms.