Causal Modeling of Client Engagement Based on Coping Strategies with the Mediating Role of Therapeutic Alliance in Psychodynamic Interventions
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Objective: This study aimed to evaluate the fit of a causal model of Client engagement based on coping strategies, with the mediating role of therapeutic alliance, in psychodynamic psychotherapy interventions.
Methods and Materials: This descriptive-correlational study employed structural equation modeling. The statistical population included adult clients attending psychotherapy clinics in Tehran in 2025 who had participated continuously in individual psychodynamic therapy for at least one year. Using two-stage cluster sampling method, 261 participants were recruited, and after excluding incomplete questionnaires, 213 cases were analyzed. Data were collected using the Lazarus and Folkman Coping Strategies Questionnaire, the Client engagement Scale, and Horvath’s Working Alliance Inventory. Data were analyzed using SPSS and Smart PLS.
Findings: The results showed that avoidant coping had a significant positive effect on the therapeutic alliance (β = 0.521, p < 0.01), whereas problem-focused coping had no significant effect (β = -0.071, p > 0.05). Emotion-focused coping also significantly predicted therapeutic alliance (β = 0.343, p < 0.01). In addition, avoidant coping (β = 0.207, p < 0.01), problem-focused coping (β = 0.094, p < 0.05), emotion-focused coping (β = 0.129, p < 0.01), and therapeutic alliance (β = 0.710, p < 0.01) had significant direct effects on Client engagement. The model explained 56.3% of the variance in therapeutic alliance and 89.9% of the variance in Client engagement. Therapeutic alliance significantly mediated the effects of avoidant and emotion-focused coping on Client engagement.
Conclusion: The findings highlight the importance of strengthening therapeutic alliance and evaluating coping strategies to improve Client engagement in psychodynamic psychotherapy.
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