Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department (Legacy)

Department of Educational and Counseling Psychology

Committee Chair

Owen, Jesse

Committee Co-Chair (if applicable)

Valentine, Jeffrey C.


Psychotherapist and patient; Therapist and patient; Psychotherapy


This dissertation explored the relationship between the therapeutic alliance and perceptions of therapist empathy and genuineness through a systematic review and meta-analysis. Alliance, empathy, and genuineness are each integral parts of the therapeutic relationship. Prior meta-analyses demonstrated that alliance, empathy, and genuineness each had a moderate relationship to therapy outcome. No previous analysis has explored how therapist empathy and genuineness contribute to the therapeutic alliance. Studies for this analysis were obtained through a multi-part search strategy. Out of 2,141 obtained abstracts, 46 studies contained enough data for inclusion in the meta-analysis. Thirty-six studies reported alliance/empathy relationships, six studies reported alliance/genuineness relationships, and four studies reported both. Random effects meta-analyses revealed that therapeutic alliance was related to perceptions of therapist empathy with a mean r(k = 40) = .51 (95% CI = 0.43-0.59). Therapeutic alliance was related to perceptions of therapist genuineness with a mean r(k = 10) = .53 (95% CI = 0.40-0.65). Tests of publication bias indicated a low likelihood of publication bias affecting the strength and direction of the results. Potential moderating variables were explored. These included: rater perspective (client, therapist, and observer), measure of therapeutic relationship variables, client and therapist race/ethnicity, theoretical approach to treatment, publication source, and client-to-therapist ratio. Future directions for study of the therapeutic relationship are discussed. The dissertation concludes with practice implications for clinicians practicing psychotherapy.