Journal of Psychotherapy Integration, Vol 36(3), Sep 2026, 247-259; doi:10.1037/int0000385
This study investigates dynamic interplay among therapeutic alliance (TA), emotional experience (EE), and symptomatology in psychodynamic psychotherapy. Using a case study approach, three client–therapist dyads from a university counseling center were analyzed: a good outcome, a less successful outcome, and a dropout. Data were collected through session-by-session assessments of the therapist and clients’ TA, clients’ EE, and clients’ symptomatology. Individual group iterative multiple model estimation algorithm was applied to identify dynamic processes over time. Results showed that, in the good outcome case, TA and EE have opposing effects on symptomatology. EE had a negative impact on symptoms, which was indirectly attenuated by its positive effect on the client’s TA, ultimately leading to symptom reduction. Thus, TA plays a crucial role in indirectly reducing the adverse effects of EE. Even in the less successful outcome case, the therapist’s alliance emerged as central to maintaining therapeutic progress, suggesting that the development of a collaborative relationship had a positive impact on client’s improvement. The dropout case demonstrated a negative feedback loop between client and therapist alliances, resulting in dropout. EE was found to increase symptomatology when not adequately supported by the alliance. These findings highlight the importance of a robust TA as a relational process supporting therapy work and thus promoting therapeutic progress. Clinical implications include repairing potential alliance ruptures and tailor the EE to clients’ readiness to enhance therapy outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved)