The therapeutic alliance in exposure therapy for anxiety-related disorders: A critical review

The therapeutic alliance has been the subject of a great deal of psychotherapy research, and evidence from numerous empirical studies suggests that a strong patient-therapist relationship predicts favorable treatment outcomes. Despite the consistency of the alliance outcome relationship across treatment modalities and diagnoses, little attention has been given to this potential prognostic indicator in exposure therapy for anxiety-related disorders. Given that exposure therapy requires patients to engage in challenging and distressing activities (e.g., confrontation with feared stimuli), a strong alliance between patient and therapist is conceptually relevant to treatment. Relatively few published exposure therapy trials have included the therapeutic alliance as a process variable, and no single review summarizes findings from this body of literature. Accordingly, the purpose of this review is to provide an overview and synthesis of existing research on the alliance-outcome relationship in exposure therapy. Methodological and conceptual considerations will be discussed, and future research priorities will be identified.