Modeling the Causal Relationships of Client Engagement Based on Personality Traits with the Mediating Role of Therapeutic Alliance in Psychodynamic Interventions
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Objective: The aim of the present study was to determine the fit of a causal model of the relationships between personality traits and client engagement, with the mediating role of therapeutic alliance in analytic, or psychodynamic, psychotherapy interventions.
Methods and Materials: The research method was descriptive-correlational and based on structural equation modeling (SEM). The statistical population included all adult clients referring to psychotherapy clinics in Tehran in 2024 who had attended individual psychodynamic therapy continuously for at least one year. Sampling was conducted using the convenience method, and after incomplete questionnaires were excluded, data from 261 participants were entered into the analysis. The research instruments included Hazan and Shaver’s Attachment Styles Questionnaire (1987), Lazarus and Folkman’s Coping Strategies Questionnaire (1985), McCrae and Costa’s NEO Personality Inventory, the Client Engagement Scale developed by Holdsworth et al. (2014) and Yuskowitz (2018), and Horvath’s Working Alliance Inventory (1993). Data were analyzed using SPSS version 29 and AMOS version 26.
Findings: The results showed that personality traits (β = 0.106, p < 0.05) and therapeutic alliance (β = 0.496, p < 0.01) had direct and significant effects on client engagement, with therapeutic alliance being the strongest predictor of client engagement. The findings also indicate that in analytic psychotherapy, although relatively stable individual characteristics such as personality directly affect engagement, the quality of the therapeutic alliance, as the most proximal relational factor, plays a central role in strengthening client engagement.
Conclusion: These findings emphasize the importance of assessing clients’ personality structures and coping capacities, as well as prioritizing the strengthening of the therapeutic alliance at different stages of treatment.
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Aldao, A., Sheppes, G., & Gross, J. J. (2015). Emotion regulation flexibility. Cognitive therapy and research, 39(3), 263-278. https://doi.org/10.1007/s10608-014-9662-4
Baer, R. A. (2015). Mindfulness-based treatment approaches: Clinician's guide to evidence base and applications. Elsevier. https://shop.elsevier.com/books/mindfulness-based-treatment-approaches/baer/978-0-12-416031-6
Chen, F., Bollen, K. A., Paxton, P., Curran, P. J., & Kirby, J. B. (2001). Improper solutions in structural equation models: Causes, consequences, and strategies. Sociological methods & research, 29(4), 468-508. https://doi.org/10.1177/0049124101029004003
Collins, N. L., & Read, S. J. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of personality and social psychology, 58(4), 644. https://doi.org/10.1037/0022-3514.58.4.644
Diener, M. J., & Monroe, J. M. (2011). The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: a meta-analytic review. Psychotherapy, 48(3), 237. https://doi.org/10.1037/a0022425
Ebrahimi Moaghar, F., Rahimian Boogar, I., & Talepasand, S. (2025). The Mediating Role of Academic Self-Efficacy in the Relationship between Diffusion Academic Identity, Ambivalent Attachment Style and Adaptive Cognitive Emotion Regulation Strategies with Addiction to Social Networks among Students. Journal of Cognitive Strategies in Learning, 12(23), 207-228. 10.22084/j.psychogy.2025.29563.2706
Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48(1), 43. https://doi.org/10.1037/a0022187
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316. https://doi.org/10.1037/pst0000172
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of marketing research, 18(1), 39-50. https://doi.org/10.2307/3151312
Friedman, L. (1969). The therapeutic alliance. The International Journal of Psycho-analysis, 50, 139. https://pep-web.org/search/document/IJP.050.0139A
Gefen, D., Rigdon, E. E., & Straub, D. (2011). Editor’s Comments: An Update and Extension to SEM Guidelines for Administrative and Social Science Research1. In (Vol. 35, pp. iii-A7): Management Information Systems Research Center, University of Minnesota. https://doi.org/10.2307/23044042
Hanney, W. J., Dhalla, F., Kelly, C., Tomberlin, A., Kolber, M. J., Wilson, A. T., & Salamh, P. A. (2023). The influence of personality type on patient outcome measures and therapeutic alliance in patients with low back pain. NeuroSci, 4(3), 186-194. https://doi.org/10.3390/neurosci4030017
Holdsworth, E. (2014). A Theory of Engagement in Group Offending Behaviour Programmes Coventry University]. https://pureportal.coventry.ac.uk/en/studentTheses/a-theory-of-engagement-in-group-offending-behaviour-programmes/
Horvath, A. O. (2014). Therapeutic/working alliance. The encyclopedia of clinical psychology, 1-5. https://doi.org/10.1002/9781118625392.wbecp262
Imanzadeh, S., Alivandi Vafa, M., Hashemi, T., & Azemoudeh, M. (2021). Examining the role of the therapeutic alliance in treatment efficacy by mediating client engagement. Journal of Applied Psychological Research, 12(3), 171-190.
Johansen, R., Melle, I., Iversen, V. C., & Hestad, K. (2013). Personality traits, interpersonal problems and therapeutic alliance in early schizophrenia spectrum disorders. Comprehensive psychiatry, 54(8), 1169-1176. https://doi.org/10.1016/j.comppsych.2013.05.016
Krause, M., Altimir, C., & Horvath, A. (2011). Deconstructing the therapeutic alliance: Reflections on the underlying dimensions of the concept. Clinical and Health, 22(3), 267-283. https://doi.org/10.5093/cl2011v22n3a7
Kushner, S. C., Quilty, L. C., Uliaszek, A. A., McBride, C., & Bagby, R. M. (2016). Therapeutic alliance mediates the association between personality and treatment outcome in patients with major depressive disorder. Journal of Affective Disorders, 201, 137-144. https://doi.org/10.1016/j.jad.2016.05.016
Maroda, K. J. (2009). Psychodynamic techniques: Working with emotion in the therapeutic relationship. Guilford Press. https://www.guilford.com/books/Psychodynamic-Techniques/Karen-Maroda/9781462563098?srsltid=AfmBOorA9Vsy_DKklr3E8Baelf5-lDI1CmoazcuQCNpvxgRKICV74z-I
McCrae, R. R., & Costa, P. T. (2008). Empirical and theoretical status of the five-factor model of personality traits. The SAGE handbook of personality theory and assessment, 1, 273-294. https://doi.org/10.4135/9781849200462.n13
Mohsenin, S., & Esfidani, M. (2014). Structrul Equation Based on Partial Least Square Approach. Tehran, Mehraban Nashr Book Inistitude Press. Persian.
Morgan, M. C., Cardaciotto, L., Moon, S., & Marks, D. (2020). Validation of the Philadelphia Mindfulness Scale on experienced meditators and nonmeditators. Journal of Clinical Psychology, 76(4), 725-748. https://doi.org/10.1002/jclp.22907
Notsu, H., Blansfield, R. E., Spina, D. S., & Levy, K. N. (2025). An updated meta-analysis of the relation between adult attachment style and working alliance. Psychotherapy Research, 35(5), 721-734. https://doi.org/10.1080/10503307.2024.2370344
Shaver, P. R., & Hazan, C. (1993). Adult romantic attachment: Theory and evidence. Advances in personal relationships, 4, 29-70. https://www.scirp.org/reference/referencespapers?referenceid=2132348
Soldz, S. (1990). The Therapeutic Interaction Research Perspectives. In Handbook of the brief psychotherapies (pp. 27-53). Springer. https://doi.org/10.1007/978-1-4899-2127-7_2
Tenenhaus, A., Tenenhaus, M., & Dijkstra, T. K. (2026). Structural equation modeling with factors and composites within the framework of the basic design. Advances in Data Analysis and Classification, 20(1), 227-254. https://doi.org/10.1007/s11634-025-00647-4
Tetley, A., Jinks, M., Huband, N., & Howells, K. (2011). A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment. Journal of Clinical Psychology, 67(9), 927-941. https://doi.org/10.1002/jclp.20811
Weiner, I. B., & Bornstein, R. F. (2009). Principles of psychotherapy: Promoting evidence-based psychodynamic practice. John Wiley & Sons. https://books.google.me/books?id=nzzpukiMTLkC&printsec=frontcover#v=onepage&q&f=false
Wilson, J. P., & Thomas, R. B. (2004). Empathy in the treatment of trauma and PTSD. Routledge. https://doi.org/10.4324/9780203020999
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