Date of Award:


Document Type:


Degree Name:

Master of Science (MS)



Committee Chair(s)

Maria Kleinstäuber


Maria Kleinstäuber


Michael P. Twohig


M. Scott DeBerard


Medically unexplained symptoms (MUS) are physical symptoms that cannot be explained or are not sufficiently explained by medical examination. These symptoms most typically present as pain or other discomfort, and are associated with significant psychological distress, healthcare utilization, and disability. Both psychologists and medical professionals have struggled to treat this population, and MUS patients have noted their dissatisfaction with the care they receive. The present study analyzed a sample of 174 patient-therapist dyads to explore the role of congruence, or agreement, on aspects of the therapeutic alliance in therapy for MUS as congruence research has not yet been conducted in this population. This study aimed to learn more about the types of congruence present in this population, whether certain types of congruence were associated with treatment outcomes, and whether any patient characteristics were associated with types of congruence. The results of this analysis suggested that certain types of congruence were associated with treatment outcomes and patient characteristics. However, the analysis also revealed that other elements of congruence, such as whether patients and therapists agree things are going well, or whether they agree things are going poorly, or whether they disagree, are important elements to consider. In addition, patient characteristics, such as whether they have any mental health diagnoses, were shown to be associated with congruence. Overall, congruence alone did not consistently relate to treatment outcomes. The present study illustrated the importance of considering other congruence-related factors when treating patients with MUS both in psychological care and medical care settings.