Working Alliance and Therapeutic Change in Integrated Psychotherapy: A Longitudinal Study.
Start therapy with a brief functional assessment and an early CBT skill; it builds alliance fast and sets the stage for deeper work.
01Research in Context
What this study did
Eleonora and colleagues ran a year-long therapy program for adults with mixed mental-health needs. They blended two styles: CBT skills and deeper psychodynamic talk.
The team started every client with a functional assessment. They then tracked symptoms and the strength of the working alliance each month.
What they found
Symptom severity dropped steadily across the 12 months. Clients also rated the alliance stronger as time went on.
Early CBT pieces—like tracking triggers—seemed to kick-start trust and teamwork.
How this fits with other research
Hagopian et al. (2000) already showed that warmth and alliance help CBT work. Eleonora’s team puts that idea into action by weaving alliance-building moves into every CBT step.
Lambert et al. (2022) used function-based plans to cut severe behavior. Eleonora borrows the same logic—start with assessment, pick tools that match—for talk therapy instead of behavior plans.
Rojahn et al. (1994) added moment-to-moment shaping to CBT. Eleonora extends this by layering longer-term psychodynamic themes on top of early behavioral wins.
Why it matters
You can copy the recipe: open with a quick functional assessment, teach one CBT skill first, then invite deeper talk once cooperation is solid. The study gives you a road map that lasts a full year and keeps the alliance strong.
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02At a glance
03Original abstract
The Focus-Based Integrated Model (FBIM) tailors interventions based on a functional assessment of clients' needs, integrating psychotherapy with pharmacological or rehabilitative support when necessary and emphasizing a strong Working Alliance (WA). This study evaluated therapeutic progress in clients treated with FBIM at four time points: baseline (T0), 3 months (T1), 12 months (T2), and follow-ups at 3 months post-therapy (T3). From April 2022 to July 2024, this longitudinal study was conducted at a community-based psychotherapy centre in Italy, enrolling 154 participants (Mage = 32.8 years; 54.3% female) who completed baseline assessments, with sociodemographic and clinical data collected on symptom severity, WA, and client motivation. Symptom severity declined significantly from T0 to T2. Within the integrated approach employed, that combined psychodynamic and Cognitive Behavioural Therapy (CBT) components, CBT showed stronger Task subscale scores at T2. Resistance to change impacted WA at T1 but decreased by T2. Contextual differences in WA at T1 diminished over time. Client motivation had no effect on WA. Structured approaches like CBT foster early collaboration, while changes in the WA over time reflect the therapist's capacity to adapt to client needs and therapeutic challenges.
Behavior modification, 2026 · doi:10.1177/01454455261416501