Abstract
<jats:title>Abstract</jats:title> <jats:p>In this chapter, the author aims to demonstrate how practice-oriented research can provide informative solutions to issues that have been challenging to resolve through experimental research. Although research has demonstrated a robust relationship between alliance and outcome, debates have persisted over the last five decades about the nature of this relationship: Does the alliance have a causal effect on treatment outcome, or is it mostly a consequence (positive or negative) of the client’s improvement or lack thereof? The author will describe an innovative line of practice-oriented research that uses cutting edge statistics and design (i.e., within-client analyses used on session-by-session assessments of alliance and outcome) to provide support for a bidirectional relationship between the alliance and therapeutic change. Having been conducted as part of clinical routine (outpatient clinics in Sweden and hospitals in Kenya), this research program shows that practice-oriented research can not only contribute to the empirical foundations of psychotherapy but also advance such foundations into unresolved areas. In the chapter, the author will also describe how research in non-Western worlds can attest to the generality of core findings in psychotherapy, as well as provide valid (internally and externally) empirically based information to understand, disseminate, and improve mental health services to individuals with limited economic resources. Finally, the author presents future-oriented ideas about improving the design of practice-oriented research, to increase its internal validity without compromising its strengths in terms of external validity.</jats:p>