(PS14-74) Is This a Safe Space?: The Relationship Between Patient’s Therapeutic Alliance and Experiential Avoidance

Therapeutic working alliance can be a useful vessel for decreasing experiential avoidance and increasing psychological flexibility (Hayes et al., 2011; Walser et al., 2013). Conversely, experiential avoidance can impede the development of successful working alliance (Kelly et al., 2018). Despite the acknowledged importance of the therapeutic relationship, few studies have empirically investigated the relationship between experiential avoidance and working alliance. To better understand the relationship between experiential avoidance and working alliance, we analyzed data from 183 Veterans and Veteran family members who enrolled in a tele-mental health clinic between August 2019 and October 2023 and completed online assessments via Qualtrics before, during and after receiving evidence-based treatments. We hypothesized that patients with higher experiential avoidance, as measured by scores on the Acceptance and Action Questionnaire II (AAQ-II) at pre- and post-treatment, would report weaker working alliance with their therapist, as measured by scores on the Working Alliance Inventory (WAI-SR) at the beginning (Session 3) and post-treatment. To evaluate the relationships between pre-treatment AAQ-II scores and Session 3 WAI-SR scores and post-treatment AAQ-II and WAI-SR scores, respectively, correlation analyses were conducted. As hypothesized, results revealed an inverse relationship between pre-treatment AAQ-II scores and the WAI-SR Bond domain at Session 3 (r(145) = -.24, p = .004) and between post-treatment AAQ-II scores and the WAI-SR Bond domain (r(132) = - .33, p < .001). Contrary to the hypothesis, higher AAQ-II scores (indicating greater experiential avoidance) at post-treatment were positively associated with higher WAI-SR Goal domain scores (indicating agreement between patient and therapist on the goals of therapy) at post-treatment (r(132) = .31, p < .001). These findings suggest that developing and maintaining a positive therapeutic bond is associated with less experiential avoidance at both the early and end stages of treatment. On the other hand, these findings also suggest a more nuanced interpretation regarding agreement on therapy goals. Although agreement is typically considered a positive aspect of working alliance, it is possible that agreement may at times serve an avoidant or collusive function. Further research is needed to elucidate this relationship. As the current study was limited to patient-report data, future research could also explore similar questions from the therapist’s perspective (i.e., using the WAI-SR therapist version). Further understanding of how the therapeutic alliance impacts treatment outcomes, including but not limited to experiential avoidance, can improve existing efforts to train therapists and provide quality treatment.