1. Introduction

In the contemporary world, mental disorders have emerged as a pressing issue that significantly impacts the well-being and psychological health of an escalating number of individuals [1]. Despite psychotherapy's long-standing recognition for its century-old history and efficacy in assisting individuals to overcome psychological challenges, there still exist critical deficiencies and challenges. Particularly concerning the question of "how does psychotherapy work?", academia has witnessed extensive debates and diverse theoretical perspectives thus far [1]. To attain a deeper comprehension of the mechanisms underlying psychotherapy, researchers have persistently explored pivotal factors that are deemed crucial for therapeutic interventions' beneficial effects [2].

Among these factors, the therapeutic alliance holds paramount importance as it encompasses various aspects such as treatment relationship, goal establishment, task execution, and interpersonal communication between clients and therapists [2]. Universally acknowledged as one of the key elements influencing psychotherapy's success, the therapeutic alliance has garnered widespread attention and undergone profound exploration [2]. While early psychotherapy theories emphasized transference's role, subsequent scholars have conducted comprehensive examinations within this field to further enrich its content [2]. Firstly, in terms of treatment goals, therapeutic alliance underscores the necessity of establishing a shared understanding and agreement between the client and therapist, serving as the fundamental basis for facilitating smooth progress throughout the entire treatment process. The therapeutic alliance also encompasses collaboratively determining a series of sequential tasks to ensure a systematic and efficacious nature of the treatment process. Lastly, fostering an indispensable and effective supportive bond between the client and therapist constitutes one of the pivotal elements within the therapeutic alliance, with its stability directly influencing whether desired treatment outcomes can be successfully attained.

Numerous studies have extensively investigated the association between therapeutic alliance and treatment outcomes, with multiple large-scale meta-analyses clearly indicating a significant correlation regardless of the timing of measurement during the treatment process[2]. This correlation remains consistent even after considering various factors such as different measurement methods for alliance, perspectives from patients, therapists, and observers, assessment times throughout the treatment process (early, middle, late, and average), outcome types, and therapy modalities[2]. These findings further validate the crucial role of therapeutic alliance in psychotherapy and its substantial impact on treatment outcomes.

There are two primary perspectives regarding the therapeutic alliance's role, with one emphasizing its inherent therapeutic effect [2]. Through the process of establishing and maintaining the therapeutic alliance, therapists offer a valuable and unique opportunity to address past relationship issues by delicately managing potential transference phenomena between patients and themselves, as well as effectively resolving any ruptures in the alliance. This profound experience enables patients to re-evaluate and reflect upon their historical patterns and interpersonal problems, thereby facilitating gradual exploration of the underlying causes behind their current distressing symptoms or functional disorders. By confronting these deep-seated emotional challenges with therapist support, patients take a significant step towards recovery and personal growth, ultimately enhancing the overall success of the therapeutic process.

Another perspective highlights the therapeutic alliance as a fundamental cornerstone for successful therapeutic interventions [2]. The therapeutic alliance is widely regarded as an indispensable component of the treatment process, serving as a crucial prerequisite and guarantee for achieving effective therapy. The therapist's professional skills and methods can be effectively implemented and advanced, leading to expected therapeutic effects only when a strong and stable alliance is established between the therapist and the patient [2]. Consequently, establishing a stable, positive, and interactive alliance enhances the likelihood of achieving long-term improvement in mental health problems. Proficiency in building alliances facilitates deeper exploration of problems by both patients and therapists while fostering appropriate treatment plans. By establishing a working relationship based on mutual respect and trust, patients feel understood, supported, and are more willing to actively participate in their own recovery process. However, it should be noted that merely forming an alliance is insufficient to drive therapy progress. This perspective aligns closely with the concept of therapeutic alliance which emphasizes the mutually reinforcing relationship between positive alliance states and therapeutic outcomes.

In psychotherapy, the client's capacity to establish social relationships and form an alliance with the therapist significantly influences therapeutic outcomes [2]. Simultaneously, individual personality traits such as trustworthiness, insightfulness, and openness to change play a pivotal role in this process. Research suggests that clients who possess higher levels of trustworthiness, keen insight, and greater willingness to accept change are more likely to benefit from treatment by exhibiting enhanced cooperation with the therapist, establishing trust and shared goals more easily, thus facilitating smooth therapy progress [3]. Individuals demonstrating these traits prominently often forge a stronger therapeutic alliance with their therapists.

Therefore, considering the client's personality traits during treatment and fostering a strong therapeutic alliance between the client and therapist are crucial for enhancing therapeutic outcomes. However, there remains a gap in effectively utilizing patient personality traits and the therapeutic alliance to optimize psychotherapeutic effects.

To address this gap and provide targeted treatment recommendations, this study conducts a comprehensive exploration by integrating existing literature through systematic review. The primary objective of this study is to deeply investigate how client personality traits and the therapeutic alliance collectively influence treatment outcomes while offering suggestions to enhance the therapeutic alliance within hospital settings. By delving into the intricate relationship between client personality traits, the therapeutic alliance, and psychotherapy effectiveness, this research aims to provide valuable insights for clinical practice while further advancing treatment efficacy and patients' recovery process.

2. The Impact of Individual Personality on the Effectiveness of Psychotherapy

2.1. Definition and Classification of Individual Personality

Personality is defined as the dynamic integration of an individual's internal psychological and physiological systems that regulate their characteristic behaviors and cognitive processes [4]. The five-factor model (FFM) for conceptualizing personality traits is widely accepted and applied in practice. This model comprises five domains: neuroticism, extraversion, agreeableness, conscientiousness, and openness, which capture a person's overall personality pattern [5]. Extensive research on the FFM has consistently supported its validity, demonstrating its stability over time - indicating that individuals' traits tend to remain relatively consistent across different stages or periods of their lives. Moreover, it has been found to have universal applicability across diverse cultural contexts, effectively explaining and predicting individual behavior in both Eastern and Western cultures [5].

2.2. The Impact of Personality Traits on Therapeutic Interactions and Outcomes

Comprehending the client's personality is imperative for therapists to ascertain the most appropriate treatment plan [6]. By acquiring a profound understanding of the client's personality traits and behavioral patterns, therapists can better grasp their needs and deliver suitable treatment [6].

The five distinct personality traits exhibit variations in individuals' responses to external and internal stimuli. The neurotic personality trait is characterized by a heightened tendency to experience negative emotions in reaction to external triggers or inner conflicts, such as anxiety, fear, guilt, anger, and sadness [5]. Furthermore, individuals with neurotic tendencies perceive the world as a perilous realm teeming with threats and harbor the belief that confronting stressors is an insurmountable task [5]. Due to an inadequate ability to effectively utilize coping skills, individuals with neurotic tendencies often demonstrate emotional instability and vulnerability. This emotional volatility can significantly disrupt their daily functioning and impede the progress of treatment, thereby negatively impacting overall psychological well-being. For instance, when confronted with difficulties and challenges, they may experience heightened feelings of helplessness and depression, leading to a lack of motivation and capability in seeking out and implementing problem-solving strategies. Consequently, this hampers the attainment of desired treatment outcomes.

Extraversion is a personality trait closely associated with social interaction and mental well-being [5]. Extraversion, as a core personality trait of individuals, is closely linked to social interaction and mental health [5]. Research has found that people with high extraverted traits typically display positive emotions, confidence, and active tendencies. They excel at self-expression, building social relationships, and managing emotions effectively in the face of adversity [7]. These traits enable them to stand out in social settings and communicate easily with others, sharing thoughts and emotions. Therefore, in terms of treatment outcomes, high extraversion may bring about positive effects, as they may be more likely to establish effective communication with therapists and more actively participate in the treatment process, leading to better treatment outcomes [5].

Personality trait differences also manifest in different sensitivity to and response patterns to external and internal trigger factors, which further impacts treatment outcomes. Excessively low or high levels of extraversion are associated with psychological problems, which may pose challenges during the treatment process. Specifically, low levels of extraversion may be linked to depression, social anxiety disorder, agoraphobia, and other psychological disorders [5]. Such individuals often suffer from persistent depression and negative emotions, lacking enthusiasm and enjoyment for positive aspects of life. They are also more likely to encounter social difficulties and fear. They may respond more negatively to external stimuli and feel pressure and discomfort in social situations, which may lead them to withdraw, resist, or lack positive engagement in the treatment process, thus affecting treatment outcomes.

However, excessively high levels of extraversion may also pose problems and have a negative impact on treatment outcomes. Research has shown that excessively high levels of positive emotions are a risk factor for the development of mania in bipolar disorder [5]. Such individuals may respond excessively positively to external stimuli, even exhibiting overly excited and impulsive behavior patterns. They may overly pursue social activities and stimulation, neglecting their inner needs and emotional balance. During the treatment process, they may display excessive activity, difficulty concentrating, or impulsive behavior, which may lead to tense treatment relationships or unstable treatment plans [5].

Conscientiousness refers to an individual's inclination towards self-discipline, accountability, industriousness, organization, and adherence to rules [5]. This trait exhibits a close association with work and academic performance, interpersonal relationship quality, as well as physical and emotional well-being [5]. Individuals characterized by high levels of responsibility typically demonstrate effective time management skills, timely task completion abilities, and a serious approach towards their professional or educational endeavors [7]. Notably in the context of cognitive-behavioral therapy (CBT), which emphasizes structured and continuous intervention strategies, individuals with high levels of responsibility tend to achieve more favorable treatment outcomes [6]. Their heightened focus during the therapeutic process enables them to effectively apply learned techniques for problem improvement. Conversely, individuals exhibiting lower levels of responsibility may encounter challenges throughout treatment that can impede progress. Difficulties in regular attendance or timely completion of assigned tasks coupled with susceptibility to distractions during therapy sessions may result in slower progress or suboptimal treatment outcomes [6].

Agreeableness refers to a positive, friendly, and cooperative inclination that individuals demonstrate in interpersonal interactions [5]. Individuals with high agreeableness exhibit traits such as trustworthiness, cooperative behavior, benevolence, genuineness, and compassion [5]. They tend to approach others with an open and accepting attitude, willing to listen and understand their views and needs, thus creating a harmonious and supportive social atmosphere.

The positive interpersonal interaction model plays a pivotal role in daily life, enhancing individuals' proficiency in conflict resolution and promoting effective teamwork. Moreover, it holds significant implications for the field of psychotherapy [6].

Individuals with high agreeableness are generally more willing to establish a collaborative relationship with the therapist, and are more likely to openly share their feelings, thoughts, and experiences. They are also more inclined to accept and internalize the therapist's advice and guidance, transforming it into actual actions and changes. Therefore, individuals with high often achieve more positive outcomes in psychotherapy. However, when levels are low, individuals may exhibit a range of oppositional behaviors in interpersonal interactions. They may tend towards revenge, harboring resentment towards others' offenses or harm, seeking opportunities for retaliation [5]. Furthermore, their aggressive behaviors are likely to significantly escalate, causing harm to both individuals and others. This may further lead to the manifestation of externalizing disorders such as behavioral disorders and antisocial personality disorders. These confrontational behaviors and externalizing disorders often make it difficult for them to establish stable and healthy interpersonal relationships, leading to the absence of social support networks [5]. In psychotherapy, this tense relationship and social disorder may become a barrier to treatment. The individual may express resistance to the therapist and be unwilling to open up and accept help. They may question the effectiveness of therapy and even refuse to participate in the treatment plan, seriously affecting the effectiveness of psychotherapy.

Openness refers to individuals who possess active imagination and creativity, are curious about new things and willing to try them [5]. Highly open individuals are usually rich in imagination and can think from different angles, and are open to new ideas and challenging traditional beliefs. They tend to engage in self-reflection, have keen insights, and are able to consider alternative strategies to promote an understanding of symptoms and take positive action, thereby increasing the effectiveness of treatment [6]. In contrast, individuals with lower openness scores may have more closed or rigid ways of thinking [6]. These individuals tend to be conservative about new things, and may face some difficulties and obstacles when receiving treatment. Therefore, it is important to measure an individual's level of openness when assessing them, and doctors can adjust their treatment and strategies based on their individual differences. For example, when communicating with highly open patients, more information about innovative drugs or alternative treatment options can be provided; when dealing with low openness patients, more gentle, stable, and consistent methods that align with their realistic cognitive framework should be used.

According to the study findings, high levels of neuroticism are associated with unfavorable outcomes across various treatment modalities and exert a pervasive influence on diverse clinical population [4]. Specifically, individuals exhibiting high levels of neuroticism often demonstrate lower response rates to cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). In clinical populations, the impact of elevated neuroticism extends across different types of disorders. For instance, individuals characterized by high neuroticism may encounter greater difficulty in deriving benefits from anxiety disorder treatments due to more persistent symptoms and a higher likelihood of recurrence. Similarly, among individuals with depressive disorders, heightened neuroticism predicts poorer treatment outcomes and an increased risk of relapse [4].

The study also revealed that patients with severe depression exhibited improved treatment outcomes when displaying higher levels of extraversion, openness, and conscientiousness [4]. These results suggest that individual personality traits can significantly influence treatment effectiveness. A similar conclusion was drawn by Bucher et al. , who employed the NEO PI-R to assess participants' personality traits [6]. The sample population was well-balanced in terms of gender distribution and predominantly consisted of outpatient samples; moreover, depression was the most prevalent diagnosis observed. Furthermore, Brudner et al. conducted a study employing identical measurements as the previous survey; however, they exclusively recruited college students as participants [7]. By focusing on this specific sample, Brudner et al. also inferred that individual personality traits exert a significant influence on treatment outcomes [7]. This discovery further underscores the significance of personality traits in the treatment process and suggests that diverse personality traits may impact an individual's response to and results from treatment.

Therefore, researchers underscore the significance of tailoring treatment plans based on the specific personality characteristics of individual patients [3]. Considering the distinct personality traits and individual needs of each patient is imperative in formulating treatment plans, as it ensures a comprehensive and tailored approach to their care. Psychological therapists can contribute to the development of more efficacious and personalized treatment plans for each patient by evaluating their personality traits and integrating clinical realities with precise interventions.

3. The Impact of the Doctor-patient Alliance on the Effectiveness of Psychotherapy

3.1. Definition and Significance of the Doctor-patient Alliance

The therapeutic alliance is commonly defined as an affective bond between the patient and therapist, accompanied by a shared comprehension of therapeutic objectives and the requisite tasks for their attainment [3]. The framework offers therapists a versatile approach to apply diverse methods and strategies, while establishing an efficient communication channel between therapists and patients [8]. Through fostering this alliance, therapists can cultivate a stable and trusting relationship with patients that aids in sustaining positive change amidst subjective discomfort or perceived functional challenges [8]. Moreover, the alliance serves to enhance patients' sense of active participation and responsibility within the therapeutic process, recognizing their proactive role in facilitating change fosters greater commitment and persistence [9].

3.2. The Impact of the Doctor-patient Alliance on the Psychotherapy Outcomes

In the field of psychotherapy, the therapeutic alliance plays a pivotal role in facilitating patients' recovery [8]. This alliance transcends the mere patient-therapist connection and encompasses intricate interactions and dynamic processes involved in establishing trust [8]. However, many studies assessing this relationship tend to adopt unidimensional approaches by solely considering either the patient's or therapist's perspectives while disregarding the diversity and interdependence inherent in therapeutic interactions. Throughout therapy, patients willingly disclose personal information encompassing their deepest emotions, affective states, and life experiences to therapists. Leveraging their expertise and experience, therapists adeptly analyze this data to offer appropriate advice and guidance. Moreover, due to shared therapeutic environments and similar experiences leading to comparable emotional responses among patients receiving treatment from the same therapist [3].

Petrocchi et al. also acknowledged the interdependence of collective data in their study, which exhibits a one-to-many relationship pattern wherein multiple patients are associated with a single doctor [9]. To further explore the dependency of this data, the research team examined the shared variance between patients and an individual doctor as an explicit indicator of data interdependence. This approach enabled them to gain a more precise understanding of how variations in communication quality during treatment impact treatment outcomes. The study involved 12 general practitioners, including 8 male doctors, and 189 patients, with females constituting 62% of the sample [9].

To comprehensively assess the quality of communication between healthcare professionals and patients, participants completed a questionnaire on perceived communication quality during consultations using a matched assessment tool known as the Medical Communication Performance Index (MPI). The MPI questionnaire comprises 19 items specifically designed to evaluate both the content and process of a doctor's communication skills, encompassing various aspects ranging from information delivery to emotional support. This questionnaire is divided into two versions: one for doctors to self-assess their own communication skills, and another for patients to provide an objective evaluation of their doctor's abilities. The questionnaire responses are obtained using a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), in order to comprehensively capture the diverse opinions and sentiments of the participants. The internal consistency of both versions of the questionnaire was found to be satisfactory in both therapistss (α = 0.94) and patient populations (α = 0.94), thereby demonstrating the high reliability and stability of this measurement tool. Moreover, this further underscores its robustness for practical applications.

During the alliance assessment process, a significant improvement in internal consistency was observed, leading to enhanced patient adherence to treatment and increased motivation and confidence in actively participating in the therapeutic process. This heightened consistency further facilitated positive therapeutic outcomes, ultimately augmenting the effectiveness and value of psychotherapy. This phenomenon strongly emphasizes the pivotal role played by therapeutic alliances in psychotherapy.

Tschuschke et al. also investigated the association between therapeutic alliance and psychotherapeutic outcomes [10]. Trained and independent psychotherapists evaluated psychotherapeutic outcomes using three assessments. Initially, patients were required to complete the Brief Symptom Inventory (BSI), which encompasses a wide range of psychological symptoms divided into nine subscales, prior to commencing treatment. These subscales aid in providing a comprehensive understanding of the patient's problems and distress, enabling calculation of the Global Severity Index (GSI) for better comprehension of their current situation. Upon completion of the entire psychotherapy course, patients were asked to immediately fill out the Outcome Questionnaire (OQ-45.2). This questionnaire primarily records improvements in various aspects such as mental state, interpersonal relationships, and social integration experienced by the patient. By collecting and statistically analyzing this information, accurate objective progress and changes from treatment initiation to completion can be reflected upon effectively. Additionally, follow-up visits approximately one year after completing therapy are crucially important for assessing long-term effects' sustainability and efficacy; during these visits, severity of depressive symptoms is assessed using the German version of Beck Depression Inventory (BDI-II). Comparing initial evaluation data allows for obtaining a more precise understanding regarding whether long-term effects are sustainable and effective.

The study findings demonstrate that the therapeutic alliance plays a pivotal role in the treatment process and exhibits a strong correlation with positive treatment outcomes [8]. This underscores the critical significance of attaining consensus between the therapist and patient, highlighting its indispensable role throughout the entirety of the treatment process. when a high level of consensus is achieved in the therapeutic alliance can effective collaboration and mutual trust be ensured, thereby establishing a robust foundation for successful treatment outcomes. This degree of agreement enhances treatment efficacy, boosts patient confidence and engagement, ultimately fostering the healing process [10]. However, it is crucial for therapists to acknowledge the potential negative impact of inappropriate or unsuitable psychotherapeutic interventions. In some cases, these methods may inadvertently harm patients by exacerbating emotional distress, fostering dependence, or increasing susceptibility to depression among other risks. These adverse reactions have the potential to detrimentally impact the patient's mental well-being and undermine the established therapeutic alliance. Therefore, future research should explore how negative psychotherapeutic outcomes influence the dynamics within this alliance.

4. The Impact of the Therapist’s Emotional Co-regulation Ability on the Doctor-Patient Alliance

The establishment of the doctor-patient alliance is not a coincidental occurrence; rather, it arises from the adept utilization of communication skills by therapists and patients, as well as their proficiency in emotional coordination with each other [11]. Emotional fluctuations play a pivotal role throughout the treatment process, acting as a compass that constantly guides the direction and depth of therapy [12]. Consequently, investigating diverse strategies employed by individuals during emotion regulation has become an essential and central aspect of therapeutic research and emotion regulation studies. This field explores how people effectively manage, adapt to, and even transform their emotional states amidst changing life circumstances and challenges, thereby providing a scientific foundation for achieving enhanced mental health outcomes and therapeutic results.

Recent advancements in emotional science and social psychology have also shed new light on this domain. These developments emphasize the crucial role of interpersonal relationships in regulating individual emotions, particularly within the specific context of doctor-patient interactions [13]. A doctor-patient alliance characterized by trustworthiness, understanding, and support can serve as a secure emotional haven for patients. It encourages them to willingly disclose their inner world while confronting various emotional challenges throughout the treatment process. Therefore, continuously optimizing and enhancing communication skills along with emotional coordination between doctors and patients hold profound significance in promoting patient's emotional regulation abilities alongside overall treatment effectiveness.

Research has demonstrated that individuals tend to regulate their emotional state through social interactions, which is considered a default and innate mechanism for emotional regulation [13]. People engage in sharing their emotions, seeking advice, or receiving emotional support from friends, family members, colleagues, or therapists during communication; these practices are crucial for effective emotional regulation. The concept of emotional co-regulation further expands this understanding by highlighting that emotional regulation is not solely driven by an individual's internal state but also significantly influenced by the emotions of others with whom they interact [13]. This implies that during the treatment process, healthcare professionals need to be attuned to and appropriately respond to patients' emotional changes while simultaneously monitoring and managing their own emotions. By doing so, they can ensure that their emotional responses do not negatively impact the treatment process and facilitate more effective outcomes in terms of both emotional co-regulation and treatment efficacy.

The investigation conducted by Heinonen and Nissen emphasizes the crucial role of emotional regulation throughout therapeutic interventions, suggesting that disruptions in emotional trajectories experienced by clients when addressing complex challenges may arise during treatment [13]. These disruptions in affective processes can manifest as significant mood oscillations, suppression of emotional expression, or sudden outbursts of affect, which typically reflect internal struggles and conflicts within the patient's psyche. The emotional expressions encountered during psychotherapy go beyond mere reactive responses; instead, they serve as integral components of a feedback loop [13]. Specifically, intense emotional states exhibited by one individual are often perceived by the other party involved, such as the therapist. Through effective communication and therapeutic interventions, these emotions can be modulated back to a more moderate and healthier level. For example, when confronted with emotionally aroused patients, therapists can maintain composure and employ gentle gestures and reassuring postures to navigate them through challenging moments. These techniques effectively alleviate patient anxiety and foster a secure emotional environment that facilitates empathy and acceptance. By utilizing various modes of communication effectively, patients are able to perceive the therapist's genuine sincerity and profound concern. Consequently, this fosters trust in the therapist and elicits a more proactive and collaborative attitude towards the therapeutic process [13].

Additionally, in the treatment process, the therapist's ability to co-regulate emotions plays a crucial role in guiding patients to enhance their emotional arousal and delve deeper into their emotional state. Simultaneously, the therapist's own emotional arousal is also an important consideration. During the initial stages of treatment, therapists often experience heightened levels of arousal due to their high activation and involvement when first encountering clients. In this stage, therapists demonstrate deep concern for clients' experiences and exhibit openness while remaining fully attentive and actively listening, striving to comprehend clients' inner worlds. This heightened state of arousal fosters a secure and inclusive therapeutic milieu, wherein clients perceive their worth and comprehension, gradually enabling them to lower their defenses and express emotions with greater freedom. Within such an environment, patients need not worry about judgment or criticism; they become more willing to engage in the therapeutic process collaboratively with therapists as they explore underlying causes of problems and seek solutions [13].

At the initiation of therapy, patients typically demonstrate a diminished level of emotional arousal [13]. This can be attributed to the necessary adjustment period within the therapeutic environment, as well as the gradual exploration and unfolding of emotions. However, as therapy progresses and emotional engagement deepens, there is a tendency for patients' emotional arousal to escalate. This becomes particularly evident when addressing more sensitive or challenging issues during therapy sessions, leading to further intensification of patients' emotional state [13]. The amplification of emotions is an inherent phenomenon observed during the course of treatment and serves as a significant indicator of progress, signifying that patients are delving deeper into their inner psyche [13].

To facilitate the enhancement of patients' emotional arousal, therapists can employ a variety of Emotional Co-regulation strategies. For instance, through the utilization of reflective statements, therapists can effectively guide patients to delve deeper into their emotions and experiences [13]. By employing questioning techniques, providing constructive feedback, and offering comprehensive explanations, therapists can assist patients in gaining a better understanding and expression of their emotions, thereby amplifying their emotional arousal. Furthermore, by establishing a secure and empathetic environment that fosters supportiveness, therapists can encourage patients to freely express their feelings and experiences with heightened emotional intensity.

As therapy progresses, therapists may gradually reduce their emotional involvement [13], as prolonged emotional investment can lead to stress and fatigue. However, in certain scenarios, if therapists fail to maintain a sufficient level of emotional engagement, they may be unable to provide clients with adequate emotional space and support. The absence of this emotional space may make clients feel neglected or misunderstood, thereby impeding their integration and growth within the therapeutic process [13]. Therefore, therapists should acknowledge the significance of maintaining an appropriate level of emotional engagement and strive to sustain this state throughout the therapeutic journey. They can enhance their emotional engagement through regular self-reflection, seeking peer support, and engaging in professional training. This contributes to better progress for patients during therapy, and strengthens the trust and therapeutic alliance between them and their therapists while establishing a solid foundation for positive therapeutic outcomes.

5. Discussion

In summary, numerous studies have demonstrated that individuals with lower levels of neuroticism and higher levels of extraversion, agreeableness, conscientiousness, and openness tend to exhibit more favorable treatment outcomes. This finding underscores the significance of incorporating personality assessment into the treatment plan, which can facilitate the development of personalized treatment strategies and foster the establishment and consolidation of the therapeutic alliance, thereby promoting positive treatment outcomes. Additionally, consistent research findings indicate that the quality of the therapeutic alliance significantly impacts the efficacy of psychotherapy. A robust therapeutic relationship can augment patient trust and indirectly enhance treatment outcomes by promoting treatment adherence. Moreover, it is crucial to acknowledge that the therapist's capacity to regulate emotions and arousal throughout the treatment process is a pivotal factor that should not be disregarded, as it influences the overall treatment outcome.

Currently, there is a paucity of research on personality, with the majority of studies focusing on personality disorders. The extant literature examining the relationship between various personality types and psychotherapeutic outcomes remains relatively limited, thereby impeding a comprehensive understanding of the role that personality plays in the therapeutic process. These limitations pose challenges in practical applications as they hinder our ability to fully anticipate and respond to potential reactions and changes exhibited by patients with specific personality types during treatment, consequently impacting overall treatment efficacy. Therefore, future investigations should prioritize exploring the relationship between various personality types and psychotherapy outcomes to attain a more profound comprehension of how personality influences the therapeutic process.

Furthermore, it is crucial to consider that personality types are subject to dynamic fluctuations over time in response to environmental factors and personal experiences. Therefore, future research should emphasize the assessment of initial personality traits in patients, as well as monitoring and evaluating any changes occurring during and after treatment, aiming to explore their association with treatment outcomes. The research design employed enables a more comprehensive understanding of the impact of personality on the treatment process, thereby facilitating the optimization of intervention measures and enhancing treatment efficacy.

6. Conclusion

The aim of this study is to investigate the influence of patient personality traits and the therapeutic alliance on the efficacy of psychotherapy, while providing recommendations for enhancing the therapeutic alliance. The findings indicate that patients exhibiting low neuroticism, high extraversion, agreeableness, conscientiousness, and openness tend to experience more favorable treatment outcomes. Additionally, a positive therapeutic alliance significantly impacts treatment effectiveness. Furthermore, therapists' ability to regulate emotions and emotional arousal emerges as a crucial factor affecting overall treatment outcomes.

Therefore, therapists should be attentive and responsive to patients' emotions while effectively managing their own emotions in order to achieve enhanced emotional co-regulation and improve treatment effectiveness. Therapists can employ intervention measures such as employing reflective statements and guiding patients towards exploring their emotions and experiences in depth to promote emotional arousal among patients. In conclusion, by investigating the relationship between patient personality traits and the therapeutic alliance, a comprehensive understanding of factors influencing psychotherapy efficacy can be attained along with targeted recommendations for optimizing the treatment process.