Behavioural treatment of agoraphobia - usually by a controlled exposure to the outside world - is one of the best-researched and most effective interventions in psychotherapy. However, even here, roughly one in three patients do not show any signs of improvement. Recent research in psychotherapy has drawn attention to the significance of the relationship between the therapist and their patient and in particular the working, or therapeutic alliance, i.e. both patient and therapist working together to solve the patient's problem(s). A study of 59 patients in Stockholm looked into patients' and therapists' perceptions of each other and what effect, if any, this had on the outcome of their treatment for agoraphobia. The researchers found that there was initially a low correspondence between therapists' and patients' perceptions of each other although their perceptions of each other grew closer as treatment went on. The clients' perceptions of their therapists showed virtually no link with the outcomes of their treatment whereas the therapists' ratings of their clients 'active participation' and 'goal direction' were linked to the outcomes of the treatment. There was no significant relationship between the quality of the working alliance and the outcome of the treatment at the time of the treatment although a year after the end of the treatment those patients who had had a good quality relationship with their therapists did better than those who had a less good relationship.
Ramnero, Jonas and Ost, Lars-Goran - Therapists' and clients' perception of each other and working alliance in the behavioral treatment of panic disorder and agoraphobia Psychotherapy Research May 2007, 17(3), 320-328