A time-series analysis of therapeutic alliance, interventions, and client's clinical status in an evidence-based single-case study: Evidence for establishing change mechanisms in psychotherapy.

OBJECTIVE: The goal of this study was to analyze the time-series of alliance, interventions, and client's post-sessions clinical status, to establish if alliance and adherence to cognitive-behavioral interventions preceded improvement in psychotherapy Method: A single-case study of a complete Cognitive-Behavioral treatment of a 27-year-old male diagnosed with Generalized Anxiety Disorder treatment was conducted. Alliance, adherence to cognitive-behavioral interventions, and client's therapeutic condition were assessed every two sessions during the entire treatment.

RESULTS: After controlling for the effect of autocorrelations, the transfer functions showed that alliance predicted client's clinical condition with a lag of two sessions throughout the entire treatment. However, the inverse relationship was not observed.

CONCLUSIONS: Results support the hypothesis of a time-lagged association between alliance and subsequent client's changes in their clinical condition in single case of a cognitive-behavioral treatment.