In Here and Out There: Systemic Alliance and Intersession Processes in Psychotherapy

The processes clients engage in between therapy sessions (referred to as intersession processes; ISPs) are empirically supported as influential factor in psychotherapy. The current study examined the impact of the therapeutic alliance-both the individual alliance and the systemic alliance-on client engagement in ISP-thoughts, ISP-actions, and client perceptions of therapy progress. Eighty-one therapy clients provided responses regarding these therapy process variables, and results revealed that higher ratings of client/therapist alliance (referred to as "self-alliance"), and higher ratings of alliance between one's social network and therapy (referred to as "other-alliance") were related to greater engagement in ISP-actions, but not ISP-thoughts. In addition, an interaction factor was supported wherein those who reported high self-alliance and high other-alliance also engaged in greater ISP-actions, but this association was not found when other-alliance was reported to be low. Clients' positive perceptions of therapy progress were associated with greater engagement in ISP-thoughts, ISP-actions, and higher ratings of self- and other-alliance. Discussion and implications are offered for how therapists may be more effective at monitoring and promoting engagement in ISPs and aligning with clients' many systems. Public Significance Statement What clients do between sessions has important influence on the process and outcome of psychotherapy. This article advances our understanding of the mechanisms that promote clients' therapy related thoughts and actions between sessions, while connecting the influence of the individual and systemic alliances.