The most frequently examined aspect of the therapeutic relationship is the working alliance, which reflects the conscious collaborative bond, and agreement on task and goal. In addition to the established importance of the working alliance, the therapists' attunement and responsiveness might reflect another important aspect of the therapeutic relationship that can be considered in relation to session-by-session progress over treatments. Emerging research suggests that the quality of the working alliance not only differs between patients but also within patients over time. However, little is known about the quality of the therapeutic relationship between and within patients in relation to progress in psychotherapy. We examined fluctuations of the working alliance measure (WAI) and the newly developed measure of the Patients' Experiences of Attunement and Responsiveness (PEAR) during treatment in a naturalistic sample of patients in an outpatient psychotherapy clinic. Multilevel modelling was used to examine the respective contribution of these measures to subsequent improvement in psychological functioning longitudinally. Results suggest that the within-patient effect, instead of between-patient effect, was significant for WAI (and did not reach significance for PEAR), indicating that the fluctuation of WAI was predictive of psychological functioning in the subsequent month. Based on these findings, therapists and their patients might benefit from regular tracking of the patient-reported working alliance. The findings underscore the importance of the alliance, specifically at the within-patient level. It also highlights the challenge for research to tap into other aspects of the therapeutic relationship that can help explain progress in therapy. Given the breadth and accessibility of the working alliance construct, more work is needed for researchers to examine the construct of attunement and responsiveness.

中文翻译：

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患者内部对联盟和协调的看法：与心理治疗进展的关联

治疗关系中最常检查的方面是工作联盟，它反映了有意识的协作纽带，以及对任务和目标的一致意见。除了工作联盟的既定重要性之外，治疗师的协调和反应可能反映了治疗关系的另一个重要方面，可以考虑与治疗的逐次治疗进展有关。新兴研究表明，工作联盟的质量不仅在患者之间存在差异，而且随着时间的推移在患者内部也存在差异。然而，对于患者之间和患者内部与心理治疗进展相关的治疗关系的质量知之甚少。我们检查了工作联盟测量 (WAI) 的波动和新开发的患者测量 在门诊心理治疗诊所的自然主义患者样本中治疗期间的协调和反应能力 (PEAR) 经验。多层次模型被用来检查这些措施对随后纵向改善心理功能的各自贡献。结果表明，患者内效应而非患者间效应对 WAI 具有显着性（而对 PEAR 没有显着性意义），表明 WAI 的波动可预测随后一个月的心理功能。基于这些发现，治疗师及其患者可能会受益于定期跟踪患者报告的工作联盟。研究结果强调了联盟的重要性，特别是在患者内部。它还强调了研究如何利用治疗关系的其他方面来帮助解释治疗进展的挑战。鉴于工作联盟结构的广度和可访问性，研究人员需要做更多的工作来检查协调性和响应性的结构。