Therapeutic alliance in face-to-face and telephone-administered cognitive behavioral therapy

Colleen Stiles-Shields, Mary J. Kwasny, Xuan Cai, David C. Mohr*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Objective: Telephone-administered therapies have emerged as an alternative method of delivery for the treatment of depression, yet concerns persist that the use of the telephone may have a deleterious effect on therapeutic alliance. The purpose of this study was to compare therapeutic alliance in clients receiving cognitive behavioral therapy (CBT) for depression by telephone (T-CBT) or face-to-face (FtF-CBT). Method: We randomized 325 participants to receive 18 sessions of T-CBT or FtF-CBT. The Working Alliance Inventory (WAI) was administered at Weeks 4 and 14. Depression was measured during treatment and over 1 year posttreatment follow-up using the Hamilton Rating Scale for Depression and Patient Health Questionnaire-9. Results: There were no significant differences in client or therapist WAI between T-CBT or FtF-CBT (Cohenâs franged from 0 to.013, all ps >.05). All WAI scores predicted depression end of treatment outcomes (Cohenâs franged from.009 to.06, all ps <.02). The relationship between the WAI and depression outcomes did not vary by treatment group (Cohenâs franged from 0 to.004, ps >.07). The WAI did not significantly predict depression during posttreatment follow-up (all ps >.12). Conclusions: Results from this analysis do not support the hypothesis that the use of the telephone to provide CBT reduces therapeutic alliance relative to FtF-CBT. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Original languageEnglish (US)
Pages (from-to)349-354
Number of pages6
JournalJournal of Consulting and Clinical Psychology
Issue number2
StatePublished - Apr 2014


  • Alliance
  • CBT
  • Depression
  • Telephone therapy

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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