The working alliance in stuttering treatment: a neglected variable?
Hilda Sønsterud, Melanie Kirmess, Kirsten Howells and 3 others
PMID 30866151WHAT IT FOUND
Adults who felt aligned with their therapist on tasks and goals early in treatment reported better stuttering outcomes six months later.
Agreement on what to work on mattered more than the emotional bond alone. This suggests explicitly negotiating therapy tasks and goals may support better results.
Key findings
01Client-rated working alliance, particularly agreement on tasks and goals, was associated with better self-reported stuttering outcomes at six-month follow-up.
02Participants with higher alliance scores on tasks and goals showed greater improvement in stuttering severity, anxiety, and communication compared to those with lower scores.
03Client motivation and willingness to set aside time for training were strongly correlated with the task component of the working alliance.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample size was small (n=18), limiting generalizability. The study used a multiple single-case design within a larger trial, not a randomized controlled trial, so causal relationships cannot be firmly established. All outcome measures were self-reported, which introduces subjectivity and potential bias. The therapist was the lead author, creating a risk that participants may have over-reported positive alliance experiences to please the clinician, despite blinding measures. The study did not include objective speech measures, relying solely on client perception of stuttering impact.
Declared interests
The study received non-U.S. government funding. The lead author was also the clinician who delivered the treatment, which is a significant potential source of bias acknowledged in the limitations.
The easy way to misread this
Do not interpret the correlations between working alliance and outcomes as proof that improving the alliance causes better stuttering treatment results. The study design cannot rule out reverse causality, where clients who are doing well simply report a better alliance, nor can it account for the influence of the therapist being the study author.