The evidence for the effect of therapeutic alliance in group cognitive behaviour therapy (CBT) for anxiety disorders is unclear. Identifying whether the alliance–outcome relationship depends on (1) which components are assessed, (2) who is measuring the alliance and (3) when the alliance is measured will help to clarify the role of the client–therapist relationship in therapy. The present study explored the effects of alliance component (agreement vs. bond), rater perspective (client vs. therapist) and timing (early vs. late therapy) on the alliance–outcome relationship. Individuals with an anxiety disorder enrolled into transdiagnostic group CBT were studied, with n = 78 at early therapy and n = 57 at late therapy. Results showed that greater client-rated agreement significantly predicted improved post-treatment outcomes throughout the course of therapy, while stronger client-rated bond in late therapy predicted reduced treatment gains. In contrast, therapist perceptions of agreement and bond were not associated with post-treatment outcomes at any point in therapy. Client-reported group cohesion also was not associated with additional variance in outcome after accounting for client-rated alliance. Overall, the findings highlight the importance of prioritizing the client's perception of the client–therapist relationship in CBT for anxiety disorders, as well as distinguishing the effects of component, rater and timing in future process–outcome studies.

中文翻译：

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哪个，谁，什么时候？焦虑症群体认知行为疗法的治疗过程

治疗联盟对焦虑症的团体认知行为疗法 (CBT) 效果的证据尚不清楚。确定联盟-结果关系是否取决于（1）评估哪些组成部分，（2）谁在衡量联盟以及（3）何时衡量联盟将有助于阐明来访者-治疗师关系在治疗中的作用。本研究探讨了联盟成分（协议与债券）、评估者观点（客户与治疗师）和时机（早期与晚期治疗）对联盟-结果关系的影响。研究了纳入跨诊断组 CBT 的焦虑症个体，早期治疗时n  = 78，n = 57 晚期治疗。结果表明，更高的客户评价一致性显着预测整个治疗过程中的治疗后结果改善，而晚期治疗中更强的客户评价联系预测治疗收益减少。相比之下，治疗师对协议和联系的看法在治疗的任何时候都与治疗后的结果无关。考虑到客户评价的联盟后，客户报告的群体凝聚力也与结果的额外差异无关。总体而言，研究结果强调了优先考虑来访者对​​焦虑症 CBT 中来访者-治疗师关系的感知的重要性，以及区分成分、评估者和时间在未来过程-结果研究中的影响。