Examining the Role of the Therapeutic Alliance in Treatment Efficacy by Mediating Client Engagement

Abstract

The purpose of this study is to determine the role of the therapeutic alliance in treatment effectiveness through mediation of client engagement. Individuals who had approached counseling centers of welfare organization, oil company, and Tabriz municipality in 2019 were selected as the statistical population. The statistical sample of the present study consists of 324 participants (225 women and 99 men) who were selected through purposive sampling based on entry and exit criteria, after obtaining their consent. The Working Alliance Inventory-Short Revised (WAI-SR), Client Engagement (CES), Client Satisfaction (CSQ), and Client Outcome (COM) questionnaires were used to collect data, and the data were analyzed using structural equation modeling and Amos24 software. Results showed that therapeutic alliances with client engagement mediation were able to explain changes in treatment effectiveness. In addition, the results of the mediation test showed that client engagement partially mediated the relationship between the therapeutic alliance and treatment outcome, but fully mediated the relationship between the therapeutic alliance and client satisfaction. The results of the fit indices indicated that the measured model was in good agreement with the theoretical research model. In conclusion, this study showed that client engagement was a mediating variable in explaining treatment efficacy, so therapists should pay special attention to the role of client engagement in treatment efficacy in addition to selecting appropriate treatment approaches.

Keywords

• therapeutic alliance
• client engagement
• treatment efficacy