Neural and Physiologic Correlates of the Therapeutic Alliance: A Narrative Review of International Research


Cite item

Full Text

Abstract

A quality therapeutic alliance, as a component of a successful psychotherapeutic process, provides a trusting relationship and effective collaboration between psychotherapist and client. This narrative review examines research that explores the relationship between psychophysiological measures of psychotherapy participants and their subjective perceptions of alliance quality. The results of 10 empirical articles, selected after a systematic literature search, are presented within several paragraphs. Each of the paragraphs analyzes and discusses studies using measures of the same human body system, followed by recommendations for further research in the conclusion. Thus, as a result of the analysis of the selected sources, the perceived quality of the alliance showed a positive relationship with the synchronization of brain activity indices, heart rate variability, heart rate, skin electrical activity, and breathing patterns between the participants in the process. However, the only study examined the contribution of participants' individual heart rate variability indices, which showed a relationship only for the client alliance. At the same time, the structure of interrelationships between alliance components and psychophysiological parameters differed depending on the number of participants: in dyadic, in family, in the presence of a supervisor or a second therapist. Recorded changes in physiological parameters may reflect both the patterns of participants' cognitive processes and their affective states - and together add to the understanding of the dynamic process of establishing and experiencing an alliance between participants in a psychotherapy session. Future research should unify the research design, continue to clarify the role of interpersonal synchronization in alliance experience, pay attention to differences in couples and group psychotherapy, and examine multiple psychophysiological variables simultaneously using a multilevel approach.

About the authors

Galina V. Oreshina

Sirius University of Science and Technology

Author for correspondence.
Email: oreshinagalina.kosm@gmail.com
ORCID iD: 0000-0002-5955-6471
SPIN-code: 8084-3501

Junior Researcher, Sirius Center for Cognitive Sciences

1 Olympiysky Ave., Sirius urban-type settlement, Federal Territory “Sirius”, Krasnodar Territory, 354340, Russian Federation

Irina V. Golovanova

Sirius University of Science and Technology

Email: golovanova.iv@talantiuspeh.ru
ORCID iD: 0000-0002-0826-6386
SPIN-code: 2852-7406

Candidate of Psychological Sciences, Senior Researcher, Sirius Center for Cognitive Sciences

1 Olympiysky Ave., Sirius urban-type settlement, Federal Territory “Sirius”, Krasnodar Territory, 354340, Russian Federation

References

  1. Alldredge, C. T., Burlingame, G. M., Yang, C., & Rosendahl, J. (2021). Alliance in group therapy: A meta-analysis. Group Dynamics: Theory, Research, and Practice, 25(1), 13-28. https://doi.org/10.1037/gdn0000135
  2. Appelhans, B. M., & Luecken, L. J. (2006). Heart Rate Variability as an Index of Regulated Emotional Responding. Review of General Psychology, 10(3), 229-240. https://doi.org/10.1037/1089-2680.10.3.229
  3. Atzil-Slonim, D., Soma, C. S., Zhang, X., Paz, A., & Imel, Z. E. (2023). Facilitating dyadic synchrony in psychotherapy sessions: Systematic review and meta-analysis. Psychotherapy Research, 33(7), 898-917. https://doi.org/10.1080/10503307.2023.2191803
  4. Avdi, E., Paraskevopoulos, E., Lagogianni, C., Kartsidis, P., & Plaskasovitis, F. (2022). Studying physiological synchrony in couple therapy through partial directed coherence: Associations with the therapeutic alliance and meaning construction. Entropy (Basel, Switzerland), 24(4), 517. https://doi.org/10.3390/e24040517
  5. Baier, A. L., Kline, A. C., & Feeny, N. C. (2020). Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clinical Psychology Review, 82, 101921. https://doi.org/10.1016/j.cpr.2020.101921
  6. Bar-Kalifa, E., Prinz, J. N., Atzil-Slonim, D., Rubel, J. A., Lutz, W., & Rafaeli, E. (2019). Physiological synchrony and therapeutic alliance in an imagery-based treatment. Journal of Counseling Psychology, 66(4), 508-517. https://doi.org/10.1037/cou0000358
  7. Blanck, P., Stoffel, M., Bents, H., Ditzen, B., & Mander, J. (2019). Heart rate variability in individual psychotherapy: Associations with alliance and outcome. The Journal of Nervous and Mental Disease, 207(6), 451-458. https://doi.org/10.1097/NMD.0000000000000994
  8. Cuijpers, P., Reijnders, M., & Huibers, M. J. H. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15, 207-231. https://doi.org/10.1146/annurev-clinpsy-050718-095424
  9. Dai, X., Li, X., Xia, N., Xi, J., & Zhang, Y. (2023). Client-counselor behavioral and inter-brain synchronization among dismissing and secure clients and its association with alliance quality and outcome. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 1-14. https://doi.org/10.1080/10503307.2023.2249587
  10. Doorn, K. A., Spina, D. S., Horne, S., & Békés, V. (2024). The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clinical Psychology Review, 102430. https://doi.org/10.1016/j.cpr.2024.102430
  11. Feindler, E. L., & Smerling, C. (2022). A review of therapeutic alliance and child CBT. Child & Family Behavior Therapy, 44(1), 18-34. https://doi.org/10.1080/07317107.2022.2027191
  12. Finsrud, I., Nissen-Lie, H. A., Vrabel, K., Høstmælingen, A., Wampold, B. E., & Ulvenes, P. G. (2022). It’s the therapist and the treatment: The structure of common therapeutic relationship factors. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 32(2), 139-150. https://doi.org/10.1080/10503307.2021.1916640
  13. Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy (Chicago, Ill.), 55(4), 316-340. https://doi.org/10.1037/pst0000172
  14. Høgenhaug, S. S., Kongerslev, M. T., & Kjaersdam Telléus, G. (2024). The role of interpersonal coordination dynamics in alliance rupture and repair processes in psychotherapy - A systematic review. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1291155
  15. Kaiser, J., Hanschmidt, F., & Kersting, A. (2021). The association between therapeutic alliance and outcome in internet-based psychological interventions: A meta-analysis. Computers in Human Behavior, 114, 106512. https://doi.org/10.1016/j.chb.2020.106512
  16. Kemp, A. H., Quintana, D. S., Gray, M. A., Felmingham, K. L., Brown, K., & Gatt, J. M. (2010). Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biological Psychiatry, 67(11), 1067-1074. https://doi.org/10.1016/j.biopsych.2009.12.012
  17. Kleinbub, J. R. (2017). State of the art of Interpersonal Physiology in Psychotherapy: A systematic review. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.02053
  18. Kykyri, V.-L., Tourunen, A., Nyman-Salonen, P., Kurri, K., Wahlström, J., Kaartinen, J., Penttonen, M., & Seikkula, J. (2019). Alliance formations in couple therapy: A multimodal and multimethod study. Journal of Couple & Relationship Therapy, 18(3), 189-222. https://doi.org/10.1080/15332691.2018.1551166
  19. Koole, S. L., & Tschacher, W. (2016). Synchrony in Psychotherapy: A review and an integrative framework for the therapeutic alliance. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.00862
  20. Mylona, A., Avdi, E., & Paraskevopoulos, E. (2022). Alliance rupture and repair processes in psychoanalytic psychotherapy: Multimodal in-session shifts from momentary failure to repair. Counselling Psychology Quarterly, 35(4), 814-841. https://doi.org/10.1080/09515070.2021.2013162
  21. Oreshina, G.V., & Zhukova, M.A. (2023). The historical evolution and modern research of the alliance in psychotherapy and counseling. Clinical Psychology and Special Education, 12(3), 30-56. (In Russ.) https://doi.org/10.17759/cpse.2023120302
  22. Paap, D., Karel, Y. H. J. M., Verhagen, A. P., Dijkstra, P. U., Geertzen, J. H. B., & Pool, G. (2022). The Working Alliance Inventory’s Measurement Properties: A systematic review. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.945294
  23. Paulick, J., Deisenhofer, A.-K., Ramseyer, F., Tschacher, W., Boyle, K., Rubel, J., & Lutz, W. (2018). Nonverbal synchrony: A new approach to better understand psychotherapeutic processes and drop-out. Journal of Psychotherapy Integration, 28(3), 367-384. https://doi.org/10.1037/int0000099
  24. Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74(2), 116-143. https://doi.org/10.1016/j.biopsycho.2006.06.009
  25. Riess, H. (2011). Biomarkers in the psychotherapeutic relationship: The role of physiology, neurobiology, and biological correlates of E.M.P.A.T.H.Y. Harvard Review of Psychiatry, 19(3), 162-174. https://doi.org/10.3109/08941939.2011.581915
  26. Stratford, T., Meara, A., Psychotherapy, M. G., & Lal, S. (2014). Heart rate variability and the anxious client: cardiac autonomic and behavioral associations with therapeutic alliance. The Journal of Nervous and Mental Disease, 202(8), 613-619. https://doi.org/10.1097/NMD.0000000000000163
  27. Tourunen, A., Kykyri, V. L., Seikkula, J., Kaartinen, J., Tolvanen, A., & Penttonen, M. (2020). Sympathetic nervous system synchrony: An exploratory study of its relationship with the therapeutic alliance and outcome in couple therapy. Psychotherapy (Chicago, Ill.), 57(2), 160-173. https://doi.org/10.1037/pst0000198
  28. Tschacher, W., & Meier, D. (2020). Physiological synchrony in psychotherapy sessions. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 30(5), 558-573. https://doi.org/10.1080/10503307.2019.1612114
  29. Vakhrushev, D.S., & Zhukova, M.A. (2021). Current view on the dyadic synchrony mechanism. Journal of Modern Foreign Psychology, 10(2), 86-95. (In Russ.) https://doi.org/10.17759/jmfp.2021100209
  30. Wehmann, E., Köhnen, M., Härter, M., & Liebherz, S. (2020). Therapeutic Alliance in Technology-Based Interventions for the Treatment of Depression: Systematic Review. Journal of Medical Internet Research, 22(6), e17195. https://doi.org/10.2196/17195
  31. Witte, M., Orkibi, H., Zarate, R., Karkou, V., Sajnani, N., Malhotra, B., Ho, R. T. H., Kaimal, G., Baker, F. A., & Koch, S. C. (2021). From Therapeutic Factors to Mechanisms of Change in the Creative Arts Therapies: A Scoping Review. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.678397
  32. Wolf, N., Oppen, P. van, Hoogendoorn, A. W., Balkom, A. J. L. M. van, & Visser, H. A. D. (2022). Therapeutic Alliance and Treatment Outcome in Cognitive Behavior Therapy for Obsessive-Compulsive Disorder. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.658693
  33. Xiaoyan, D. a. I., Yi, H. U., & Ya, Z. (2022). Interpersonal synchrony: A new perspective to elucidate the essence of working alliance in psychological counseling. Advances in Psychological Science, 30(9), 2078. https://doi.org/10.3724/SP.J.1042.2022.02078
  34. Zhang, Y., Meng, T., Hou, Y., Pan, Y., & Hu, Y. (2018). Interpersonal brain synchronization associated with working alliance during psychological counseling. Psychiatry research. Neuroimaging, 282, 103-109. https://doi.org/10.1016/j.pscychresns.2018.09.007
  35. Zhang, Y., Meng, T., Yang, Y., & Hu, Y. (2020). Experience-dependent counselor-client brain synchronization during psychological counseling. eNeuro, 7(5), ENEURO.0236-20.2020. https://doi.org/10.1523/ENEURO.0236-20.2020
  36. Zhao, Q., Zhao, W., Lu, C., Du, H., & Chi, P. (2024). Interpersonal neural synchronization during social interactions in close relationships: A systematic review and meta-analysis of fNIRS hyperscanning studies. Neuroscience & Biobehavioral Reviews, 158, 105565. https://doi.org/10.1016/j.neubiorev.2024.105565

Copyright (c) 2024 Oreshina G.V., Golovanova I.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies