Patterns and impact of the alliance and affective arousal in psychotherapy: An application to cognitive therapy for avoidant and obsessive-compulsive personality disorders

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)


Clinical Psychology

First Committee Member

Adele M. Hayes, Committee Chair


In recent decades, the role of the client-therapist alliance in therapy process and outcome has received considerable attention from psychotherapy theorists and researchers. Empirical findings consistently demonstrate a relation between the strength of the alliance and outcome. A similar trend characterizes recent theoretical and empirical interest in the role of emotional arousal in the therapeutic change process. The current study endeavored to integrate and extend these two growing literatures. Hypotheses were tested on a sample of individuals diagnosed with either avoidant or obsessive-compulsive personality disorders who underwent a 52-week course of cognitive therapy. Results indicated a curvilinear association between variability in the alliance and outcome, which accounted for the significant relation between average strength of the alliance and outcome. The strength of the alliance moderated the relation between clients' affective arousal and outcome, with a strong alliance and high level of arousal predicting the most favorable outcomes. Results are discussed in the context of recent affiance rupture-repair theories of the change process and emotional processing literatures.


Psychology, Clinical

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