Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Educational and Counseling Psychology


Counseling Psychology

Content Description

1 online resource (viii, 49 pages) : 1 illustration, forms.

Dissertation/Thesis Chair

Lisa McAndrew

Committee Members

Myrna Friedlander, L. Alison Phillips


Therapist and patient, Psychotherapist and patient, Well-being, Physical fitness, Mental health

Subject Categories

Counseling Psychology


The working alliance, conceptualized as an emotional bond and client/therapist agreement on tasks and goals is considered integral to psychotherapy success. However, the mechanisms by which the working alliance develops are poorly understood. The Common Sense Model of Self-Regulation is well supported in understanding the role of patient illness beliefs in physical health management. The present study evaluated the role of discussion of psychotherapy clients’ illness beliefs in the development of working alliance in psychotherapy. Further, the contribution of client expectations for psychotherapy on treatment outcomes was investigated as the mechanism by which discussion of illness beliefs contributes to the working alliance. It was hypothesized that more discussion of client illness beliefs would increase clients’ perceptions of the working alliance, and that clients’ outcome expectations would mediate this relation.A sample (N = 202) of adults was recruited via Amazon’s Mechanical Turk to respond to a questionnaire regarding perceptions of their current psychotherapy relationship. Participants were largely men who were employed full-time, and college-educated with a mean age of 30.67 years (SD = 8.3), who had attended an average of 15.83 (SD = 78.99) sessions with their current therapist. Results indicated that participants recalled their therapists discussing most of the five categories of illness beliefs (identity, cause, consequence, timeline, control/cure) with them, and that more discussion of illness beliefs was associated with stronger perceptions of the working alliance. Outcome expectations mediated this relationship, as hypothesized. Future research on this topic is suggested, including the development of instruments to measure discussion of illness beliefs in psychotherapy specifically, and identification of which illness beliefs are most influential, for whom the discussion of illness beliefs is most important, and how this discussion affects clients.