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We aim to examine how different trajectories of symptom change and working alliance in early psychotherapy predict treatment outcomes. We performed a growth mixture model (GMM) to examine trajectories of symptom change and working alliance in the first five therapy sessions in a sample of 272 outpatients and tested the association of early symptom trajectories and alliance patterns with treatment outcome. We identified two symptom trajectories:  high symptom/steady change  (63.2%) and  early improving  (36.8%), and four alliance development patterns:  undeveloped alliance  (40.1%),  strengthening moderate alliance  (31.6%) , optimal alliance  (17.3%) ,  and  improved alliance  (11%) in early psychotherapy. The symptom trajectories and alliance patterns both independently and interactively predicted treatment outcomes. The  optimal alliance  was generally associated with the best outcome. The effect of  improved alliance  on treatment outcome was moderated by symptom trajectories: for  high symptom/steady change  subgroup, the  improved alliance  was related to better treatment outcome, whereas for  early improving  subgroup, the  improved alliance  was associated with poorer outcome. Patients fell into different trajectories regarding symptom reduction and alliance development in early psychotherapy that affected final treatment outcome. Combining early symptom trajectories and alliance trajectories simultaneously can facilitate routine outcome monitoring and contribute to the prediction of treatment outcome.

Early trajectories of symptom change and working alliance as predictors of treatment outcome