Aim: Research on close relationships demonstrates that dyadic convergence, or two people becoming more concordant in their experiences and/or beliefs over time, is commonplace and adaptive. As psychotherapy involves a close relationship, patient–therapist convergence processes may influence treatment-specific outcomes. Although prior research supports that patients and therapists tend to converge on their alliance perspectives over time, which associates with subsequent patient improvement, no research has similarly examined belief convergence during therapy. Accordingly, this study focused on patient–therapist convergence in their outcome expectation (OE), a belief variable associated with patient improvement when measured from individual participant perspectives. I predicted both that significant OE convergence would occur and relate to better posttreatment outcome. Method: Data derived from a trial of naturalistic psychotherapy. Patients and therapists repeatedly rated their respective OE through treatment, and patients rated their symptom/functional outcomes at posttreatment. For dyads (N = 154) with the requisite OE data, I tested my questions using multilevel structural equation modeling. Results: There was no discernable OE convergence pattern over treatment (g100 = 0.02, SE = 0.04, p = .275) and OE convergence was unrelated to outcome at the between-dyad (b02k = 1.86, SD = 10.08, p = .406) and between-therapist (g002 = -0.06, SD = 3.54, p = .473) levels. However, higher early patient OE was significantly associated with better outcome at the between-dyad level (b05k = -0.04, SD = 0.01, p < .001). Discussion: Results suggest that OE may be more of a facilitative patient versus relational process factor.

The degree to which patients and their therapists align over time on their perceptions of therapeutic processes and intermediary outcomes has generally been regarded as an important element of effective psychotherapy; however, few studies have examined empirically the influence of such dyadic convergences on ultimate treatment outcomes. This study examined (a) whether early treatment convergences in patient-therapist alliance and session progress ratings were associated with subsequent worry and distress reduction (and final posttreatment level) in psychotherapy for generalized anxiety disorder (GAD), and (b) whether treatment type and the initial (session 1) levels of perceived alliance and session progress moderated these associations. Data derived from a clinical trial in which patients with severe GAD were randomly assigned to receive either 15 sessions of cognitive-behavioral therapy (CBT; n = 43) or 4 sessions of motivational interviewing (MI) followed by 11 integrative CBT-MI sessions (n = 42). Patients and therapists rated the alliance and session progress after each session. Patients rated their worry and distress multiple times throughout treatment. Dyadic multilevel modeling revealed, as predicted, that alliance convergence over the first half of therapy was associated with greater subsequent worry (p = .03) and distress (p = .01) reduction. Additionally, the combination of low initial patient-rated alliance and early divergence was associated with the worst trajectory for the distress outcome (p = .04). Unexpectedly, session progress divergence had a near significant association with lower posttreatment worry (p = .05) and was significantly associated with more accelerated subsequent distress reduction (p = .03). Additionally, for patients who perceived their initial progress more positively, whether dyads converged or diverged in early session progress ratings affected the trajectories (though not the ultimate amount) of distress change (p = .02). These findings suggest that divergence of early patient-therapist alliance perspectives, especially when coupled with lower initial patient-rated alliance quality, may be an important marker for patient nonresponse and therapist responsiveness (e.g., use of alliance repair strategies). The findings on patient-therapist session progress convergence are less straightforward, though several possible implications are discussed.