Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)


Graduate Department of Clinical Psychology

First Advisor

Mark McMinn

Second Advisor

Mary Peterson

Third Advisor

Joel Gregor


The therapeutic alliance is considered a demonstrably effective variable for therapy outcomes independent of treatment type, yet the extent to which it may be affected by technology is vague. Similarly, studies examining how technology alters the therapeutic relationship in a traditional face-to-face context are sparse and inconclusive. The robust association between psychotherapy alliance and therapy outcomes combined with the lack of conclusive evidence concerning how technology influences this calls for more research on the relationship between alliance and technology. The current study examines how clients’ perceptions of therapy alliance over the course of 10 sessions change with the administration of alliance and outcome measures via smartphone or pen and paper technologies. First-year graduate trainees (n = 24) of an APA-accredited doctoral program in clinical psychology served as beginning therapists to a non-clinical, volunteer population of undergraduate students (n = 47). Beginning therapists were randomly assigned to a control condition that administered paper-and-pen versions of the Session Rating Scale and Outcome Rating Scale or an experimental condition administering modified versions of the same instruments through the use of an Apple iOS device. A repeated measures ANOVA was used to test for alliance differences across sessions 1, 5, and 10. Session Rating Scale administration method was used as the between-groups measure with the Outcome Rating Scale used as a covariate. Results indicated significant differences in alliance over the course of 10 sessions, F (2, 43) = 7.00, p = .002. No significant differences were found between alliance and administration method, F (2, 43) = 0.43, p = .651. Implications for clinical practice, research, and graduate training are considered.

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