Meta-analyses have established the alliance as the most robust predictor of outcome in psychotherapy. A growing number of studies have evaluated potential threats to the conclusion that alliance is a causal factor in psychotherapy. One potential threat that has not been systematically examined is the possibility that the alliance-outcome association is driven by low alliance outliers. We examined the influence of removing low alliance outliers on the alliance-outcome association using data drawn from two large-scale, naturalistic psychotherapy data sets (Ns = 1,052; 11,029). These data sets differed in setting (university counseling center, community mental health center), country (United States and Canada), alliance measure (four-item Working Alliance Inventory Short Form Revised, 10-item Session Rating Scale), and outcome measure (Counseling Center Assessment of Psychological Symptoms-34, Outcome Questionnaire-45). We examined the impact of treating outliers in five different ways: retaining them, removing values three or two standard deviations from the mean, and winsorizing values three or two standard deviations from the mean. We also examined the effect of outliers after disaggregating alliance ratings into within-therapist and between-therapist components. The alliance-outcome correlation and the proportion of variance in posttest outcomes explained by alliance when controlling for pretest outcomes were similar regardless of how low alliance outliers were treated (change in r ≤ .04, change in R² ≤ 1%). Results from the disaggregation were similar. Thus, it appears that the alliance-outcome association is not an artifact of the influence of low alliance outliers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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威胁警报：异常值对联盟结果相关性的影响。


荟萃分析已将该联盟确立为心理治疗结果最有力的预测因子。越来越多的研究评估了潜在的威胁，得出结论：联盟是心理治疗的因果因素。尚未系统检查的一种潜在威胁是联盟结果关联可能是由低联盟异常值驱动的。我们使用从两个大规模自然主义心理治疗数据集中提取的数据（Ns = 1,052；11,029）研究了删除低联盟异常值对联盟结果关联的影响。这些数据集在环境（大学咨询中心、社区心理健康中心）、国家（美国和加拿大）、联盟衡量标准（四项工作联盟清单简表修订版、10 项会话评级量表）和结果衡量标准（咨询中心心理症状评估 - 34，结果问卷 - 45）。我们检查了以五种不同方式处理异常值的影响：保留它们、删除距平均值三或两个标准差的值以及对距平均值三或两个标准差的值进行缩尾处理。在将联盟评级分解为治疗师内部和治疗师之间成分后，我们还检查了异常值的影响。无论联盟异常值的处理有多低（r 的变化 ≤ .04，R² 的变化 ≤ 1%），在控制前测试结果时，联盟与结果的相关性以及由联盟解释的后测试结果的方差比例都是相似的。分解的结果是相似的。因此，联盟-结果关联似乎并不是低联盟异常值影响的产物。 （PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。