The Impact of Client Motivational Language on the Therapeutic Alliance in Cognitive-Behavioural Therapy

Abstract

Building on past research demonstrating a link between client motivation and the alliance, this study examined whether motivational interviewing (MI) can alter the impact of motivation on the alliance. Using data from a recent trial of cognitive behavioural therapy (CBT) for 85 individuals with generalized anxiety disorder, this study tested whether observed motivational language against change (counter-change talk; CCT) and in support of change (change talk; CT) in session 1 affects alliance quality over time and whether this relationship varies between two treatments: MI integrated with CBT (MI-CBT) or CBT alone. CCT, but not CT, predicted lower client alliance ratings at the early, middle, and late stages of therapy. At the late stage only, treatment group moderated this relationship such that CCT was associated with poorer alliances for CBT alone, relative to MI-CBT. Thus, without strategies for managing ambivalence (such as in MI), ambivalence can predict subsequent alliance problems.