Causal Modeling of Client Adherence Based on Coping Strategies with the Mediating Role of Therapeutic Alliance in Psychodynamic Interventions

Objective: This study aimed to evaluate the fit of a causal model of client adherence based on coping strategies, with the mediating role of therapeutic alliance, in psychodynamic psychotherapy interventions.

Methods and Materials: This descriptive-correlational study was conducted using structural equation modeling. The statistical population included adult clients attending psychotherapy clinics in Tehran in 2024 who had participated continuously in individual psychodynamic therapy for at least one year. Using convenience sampling, 261 participants were recruited, and after excluding incomplete questionnaires, 213 cases were analyzed. Data were collected using the Lazarus and Folkman Coping Strategies Questionnaire, the Client Adherence Scale, and Horvath’s Working Alliance Inventory. Data were analyzed using SPSS and AMOS.

Findings: The results showed that avoidant coping had a significant positive effect on therapeutic alliance (β = 0.521, p < 0.01), while problem-focused coping had no significant effect (β = -0.071, p > 0.05). Emotion-focused coping also significantly predicted therapeutic alliance (β = 0.343, p < 0.01). In addition, avoidant coping (β = 0.207, p < 0.01), problem-focused coping (β = 0.094, p < 0.05), emotion-focused coping (β = 0.129, p < 0.01), and therapeutic alliance (β = 0.710, p < 0.01) had significant direct effects on client adherence. The model explained 56.3% of the variance in therapeutic alliance and 89.9% of the variance in client adherence. Therapeutic alliance significantly mediated the effects of avoidant and emotion-focused coping on client adherence.

Conclusion: The findings highlight the importance of strengthening therapeutic alliance and evaluating coping strategies to improve client adherence in psychodynamic psychotherapy.