Psychology and psychotherapy · 2026
How recent psychological distress relates to session quality in psychotherapy: The mediating roles of the real relationship and working alliance.
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Stefana Alberto
Аннотация
OBJECTIVE: To examine how clients' recent psychological distress (PD) relates to perceived psychotherapy session quality (SQ), and to test whether this association is statistically accounted for by clients' ratings of the real relationship (RR) and the working alliance (WA).
METHODS: Secondary analyses combined data from two studies of adults (N = 1175) receiving individual psychotherapy. Following a session, clients completed measures of anxiety and depressive symptoms (7-day recall), RR, WA (task, goal and bond), and SQ. A covariate-adjusted path model was performed.
RESULTS: PD was associated with weaker RR and poorer task agreement, but not with goal or bond. RR was positively associated with all WA dimensions. When predicting SQ simultaneously, task showed the largest unique association, with smaller unique contributions from goal, bond, and RR; PD also retained a small direct association. Bootstrap decomposition indicated that indirect associations through task accounted for most of the distress-SQ link, with additional indirect associations through bond and an RR-only pathway. Task effects reflected both a direct distress-to-task pathway and a serial distress-to-RR-to-task pathway.
DISCUSSION: This study suggested task agreement as a central correlate of SQ when clients are distressed but cannot establish temporal ordering or causality.
METHODS: Secondary analyses combined data from two studies of adults (N = 1175) receiving individual psychotherapy. Following a session, clients completed measures of anxiety and depressive symptoms (7-day recall), RR, WA (task, goal and bond), and SQ. A covariate-adjusted path model was performed.
RESULTS: PD was associated with weaker RR and poorer task agreement, but not with goal or bond. RR was positively associated with all WA dimensions. When predicting SQ simultaneously, task showed the largest unique association, with smaller unique contributions from goal, bond, and RR; PD also retained a small direct association. Bootstrap decomposition indicated that indirect associations through task accounted for most of the distress-SQ link, with additional indirect associations through bond and an RR-only pathway. Task effects reflected both a direct distress-to-task pathway and a serial distress-to-RR-to-task pathway.
DISCUSSION: This study suggested task agreement as a central correlate of SQ when clients are distressed but cannot establish temporal ordering or causality.