The influence of childhood maltreatment on the early working alliance in adult patients: the mediating role of personality functioning

Childhood maltreatment (CM) has been associated with mental health problems and less favorable treatment outcomes in adulthood. The working alliance is a key component of psychotherapy, yet evidence on CM’s effect on the working alliance is inconclusive and contradictory. While personality functioning has been identified as a significant mediator between CM and adult mental health, this mechanism remains unexplored in the context of the working alliance. This naturalistic cross-sectional study examined the mediating role of personality functioning in the relation between CM and early working alliance in a clinical adult sample. A total of 215 adults starting individual psychotherapy completed intake self-report questionnaires assessing CM experiences, personality functioning, and mental health problems. Early working alliance was measured after the first five sessions. Bootstrap mediation analyses tested the mediating role of personality functioning in the association between CM and early working alliance. Personality functioning significantly mediated this association. Among CM types, only mediation models involving emotional neglect and emotional abuse were significant. Findings support partial mediation, highlighting personality functioning as a central mechanism linking CM and emotional maltreatment to difficulties in early working alliance. These results emphasize the importance of targeting personality functioning impairments in adults with CM to improve alliance.