Effects of the therapist's statements on the patient's outcome and the therapeutic alliance: A systematic review

This systematic review summarizes articles that examined the effects of the psychotherapist's statements on the outcome of the patient and the therapeutic alliance. The databases PsychINFO, PSYNDEX, PubMed, and PsychARTICLES were searched, and English peer‐reviewed articles were included. Participants should be adult patients with Diagnostic and Statistical Manual of Mental Disorders diagnosis who were receiving evidence‐based psychotherapy in an individual setting. Studies with a standardized, observer‐based measurement of the therapist's verbal utterances on the basis of verbatim transcripts of therapy sessions were included. Furthermore, there should be a standardized measurement of the symptom outcome or a measurement of the therapeutic alliance. The 10 included articles showed that supportive and exploratory statements and addressing aspects in the therapeutic relationship were perceived as positive regarding symptom outcome. Negative effects were particularly evident with controlling and challenging statements of the therapist. Regarding the therapeutic alliance, both positive and negative as well as nonsignificant results were obtained. The results of this review suggest that the question of which statements by therapists correlate positively or negatively with the outcome of therapy and the therapeutic alliance cannot be answered unequivocally and must be applied to more individual and specific situations.