(PS9-44) The Relationships Among Therapy Experience, Social Support, and Therapy Outcomes

Therapy is a finite process that consumes considerable client and therapist resources. As such, understanding the predictors of therapy outcomes is important. One predictor that has been consistently associated with client outcomes is working alliance, which is conceptualized as agreement about therapy tasks; agreement about goals; and therapist/client bond (see Fluckiger et al., 2018; Horvath et al., 2011, for reviews). In an effort to better understand this link – and ultimately, improve client outcomes – researchers have recently pivoted from investigating the alliance/outcome link to exploring mechanisms that may strengthen or weaken that relation (e.g., therapist characteristics, Del Re et al., 2021; client characteristics and treatment processes, Fluckiger et al., 2021; specific disorders, Fluckiger et al., 2013). One unexplored but potentially important moderator of this relation is client social support, which is also associated with better therapy outcomes (Zimmerman et al., 2021). As it pertains to the therapy process, clients with solid knowledge of therapy tasks may solicit and/or receive help from friends and family to complete those tasks. Clients who feel bonded to their therapist may then feel empowered to discuss their problems in an adaptive manner with friends and family – contributing to symptom improvement and thereby strengthening the alliance/outcome relation, as it is bidirectional (DeRubeis et al., 2005; Falkenstrom et al., 2014). Investigating the associations among therapy experience, social support, and outcomes is especially important as feelings of isolation increased during the COVID-19 pandemic (Hwang et al., 2020) and in some cases have had lasting effects (Nails et al., 2023) – leading therapists who practice evidence-based care to emphasize the need for building social connections and community engagement (Thompson et al., 2023).   

The goal of this study was to examine the degree to which social support moderates the relation between working alliance and symptoms in clients currently participating in therapy. Participants were N=145 adults recruited from a private liberal arts university and the crowdsourcing platform Prolific, an effective forum for collecting online data (Peer et al., 2022). Participants ranged from 18-76 years old (M=38.47); 65.5% identified as cisgender women, 22.8% identified as cisgender men, and 11.7% identified as transgender men, genderqueer, non-binary, or preferred not to answer. The racial breakdown was 69.7% White, 17.2% Black, 3.4% American Indian or Alaska Native, 5.5% Asian, and 3.4% Multiracial. Participants completed self-reports assessing working alliance, perceived social support, and therapy outcomes (i.e., symptoms).   

Both working alliance (β = -.28) and social support (β = -.49) were associated with outcomes in expected directions. However, social support did not moderate the relation between alliance and outcomes.  

Our results replicate prior work that linked alliance and outcomes, and social support and outcomes. However, alliance and social support may not work together to impact outcomes. Nevertheless, encouraging clients to bolster their social networks may lead to improved outcomes – irrespective of the level of working alliance.