Client Motivation, Working Alliance and the Use of Homework in Psychotherapy

This study examined a preliminary model of client, therapist and process factors in relation to psychotherapy outcome. These factors included client motivation, homework compliance, therapist homework delivery behaviors and working alliance. Self-determination theory (Deci & Ryan, 2000; 2002) was used to examine qualitative differences in autonomous and controlled forms of client motivation. Data were collected from 147 participants receiving individual counseling at 1 of 3 university counseling centers in the United States. Participants completed an online survey which consisted of 6 questionnaires. Structural equation modeling with maximum likelihood estimation was used to estimate model parameters. Multiple fit indices were examined in order to assess overall fit and the preliminary model was respecified twice. Examination of the path coefficients revealed that 3 of the hypothesized relationships were not significant. Neither autonomous nor controlled motivation significantly predicted outcome, and working alliance did not significantly predict homework compliance. A significant relationship emerged which was not originally hypothesized: therapist homework delivery behaviors significantly predicted working alliance. Working alliance emerged as a strong mediator of autonomous motivation, controlled motivation, and therapist homework delivery behaviors in relation to psychotherapy outcome. Homework compliance significantly mediated the relationship between controlled motivation and psychotherapy outcome. Five indirect effects and 2 direct effects were reported, thus the final model was a strongly mediated model which accounted for 52% of the variance in treatment outcome. Overall, results indicated that qualitative differences in client motivation may influence psychotherapy process and outcome variables, and that working alliance and homework compliance are significant mediators of both client and therapist factors.