The Relationship Between Working Alliance and Treatment Outcome in an Internet-Based Grief Therapy for People Bereaved by Suicide

Background Working alliance is an important component in the therapy process, however its’ role in bereavement interventions has rarely been studied. This study investigates the relationship between working alliance and treatment outcome, the change of working alliance throughout therapy and patient characteristics as predictors of working alliance. Methods Data from a randomized controlled trial including 44 participants was used. Patient characteristics were assessed at baseline and working alliance was assessed after two, four, six, eight and ten sessions. A linear mixed model, multiple linear regression and best subset regression were conducted. Results Working alliance changed significantly during therapy (β = 1.46, SE = 0.27, t (162) = 5.38, p < .001). Early working alliance predicted prolonged grief symptoms, when controlled for baseline scores of grief (β = − .27, p = .023). Moreover, self-efficacy (β = .47, p < .001) and need for social support (β = − .38, p = .010) predicted early working alliance. Conclusions This study shows the relevance of establishing early working alliance in the therapeutic process. Attention should be paid to the initial self-efficacy and need for social support of patients, as it influences the experience of working alliance. To address individual working alliance patterns and characteristics in therapy, further research is needed.