Psychotherapy, Vol 62(4), Dec 2025, 457-473; doi:10.1037/pst0000603
Extensive research, including meta-analytic studies, has underscored the role of working alliance in influencing psychotherapy outcomes. However, far fewer studies and meta-analyses have delved into the predictors of working alliance quality. To synthesize the literature and highlight key predictors for alliance, the present study conducted a meta-analysis of predictors of subsequent working alliance. Drawing on 898 Pearson’s r effects from 130 studies involving 12,449 clients and 2,840 therapists, a multilevel meta-analysis identified five major groups of factors that preceded alliance. Among client-related factors, client resource and readiness positively correlated with alliance, showing small and medium effect sizes, respectively (r = 0.18, 95% CI [0.12, 0.24], pr = 0.34, 95% CI [0.25, 0.42], p r = −0.14, 95% CI [−0.18, −0.11], p r = 0.15, 95% CI [0.03, 0.28], p = .019), and rapport building contributed to alliance quality with a medium effect size (r = 0.39, 95% CI [0.31, 0.47], p