The relationship between interpersonal problems and the helping alliance

Using data from a large longitudinal naturalistic study on course and outcome of psychotherapy, the present paper investigates the amount of interpersonal problems in an outpatient sample (N = 714) and the extent to which a patient's interpersonal problems determine the quality of the helping alliance. The results show that at the beginning of psychotherapy, subjects reported significant interpersonal distress on 2.43 of the eight IIP scales. Interpersonal problems were most prevalent in the octants “introverted,” “submissive,” “exploitable,” and “overly nurturant.” Furthermore, interpersonal problems were related to the helping alliance in different ways: “Too hostile” patients reported relatively poor initial helping alliance whereas “too friendly” patients rated more favorably the relationship to the therapist. However, interpersonal problems at intake did not predict the therapeutic alliance one‐and‐a‐half years later. The results indicate that a poor initial helping alliance might be reversed during the course of treatment. Implications for future research and psychotherapeutic practice are discussed. © 2004 Wiley Periodicals, Inc. J Clin Psychol.