The Therapeutic Alliance: The Fundamental Element of Psychotherapy
In my early professional years, I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?
–Carl R. Rogers.
According to the National Institutes of Health (NIH), there is consistent evidence that the quality of the therapeutic alliance is linked to the success of psychotherapeutic treatment across a broad spectrum of types of patients, treatment modalities used, presenting problems, contexts, and measurements. Although scholars may differ in how the alliance is conceptualized, most theoretical definitions of the alliance have three themes in common: the collaborative nature of the relationship, the affective bond between patient and therapist, and the patient’s and therapist’s ability to agree on treatment goals and tasks. The therapeutic alliance is posited to be a measure of the therapist’s and client’s mutual engagement in the work of therapy—thus representing an important component for achieving treatment success, regardless of the specific treatment modality employed.
The American Psychological Association (APA) defines the therapeutic alliance as a cooperative working relationship between client and therapist, considered by many to be an essential aspect of successful therapy. Derived from the concept of the psychoanalytic working alliance, the therapeutic alliance comprises bonds, goals, and tasks. Bonds are constituted by the core conditions of therapy, the client’s attitude toward the therapist, and the therapist’s style of relating to the client; goals are the mutually negotiated, understood, agreed upon, and regularly reviewed aims of the therapy; and tasks are the activities carried out by both client and therapist.
The therapeutic alliance refers to the strength of the relationship between a therapist and a client. It is defined by mutual trust, honest communication, and a feeling of safety within the confines of treatment.
A client who feels a strong alliance with their therapist is more likely to engage in the work of therapy, and a therapist who feels a strong alliance with their client is more likely to understand their challenges and help create a treatment plan that works for that individual.
The therapeutic alliance, sometimes called the “therapeutic relationship” or “therapeutic rapport,” is the factor most likely to produce positive outcomes from therapy. It allows the therapist and client to agree on the goals of treatment, agree on what it will take to achieve those goals, and for a bond to grow between the therapist and client that sets the tone for a positive experience.
Why is the Therapeutic Alliance important?
The therapeutic alliance has been shown to be the most important factor in successful therapeutic treatments, according to copious research in the field. This finding holds across all types of therapies.
Communication can be one of the most challenging aspects of therapy. Many clients are naturally withholding and find it difficult to talk about painful experiences in their lives. The ability to be open and honest on these fronts, and to feel safe when discussing sensitive matters, allows the therapist to get to the heart of what brought a client to therapy and how to help them heal. Mutual trust is the key to opening these doors of communication, and for the real work of therapy to begin.
Key Elements of the Therapeutic Alliance
Several factors have been highlighted as important for building and maintaining a strong relationship between therapist and client. These elements set the groundwork for productive work in therapy sessions and for reaching the goals the client and therapist set. They include:
- Authenticity: The client feels comfortable enough that they’re able to be open and honest with their therapist, and the therapist feels similarly, allowing them to give honest feedback to the client. Authenticity in the relationship allows both parties to be more efficient with time in session and helps the therapist and client address the root of challenges and how to handle them.
- Attentiveness: An attentive therapist will be actively listening to what the client says, and vice versa. This might be demonstrated through body language, such as increased eye contact, or by the ease with which the client and therapist converse. If both parties are attentive, they are likely to absorb what the other says and consider it, rather than interrupt or talk past each other.
- Positivity: The hallmark of positivity in the therapeutic alliance is that the client feels the therapist always has their best interest at heart, that the therapist is on their team. This is important because there are times when the therapist may have feedback that is difficult to hear or want to know more about painful experiences from the client’s life. If a positive tone has been established, this communication is delivered with more ease and understanding.
Impact of the Therapeutic Alliance
The quality of the therapeutic alliance between a therapist and client has far-reaching implications for the success of therapy.
It also creates an environment where meaningful change can occur as clients explore their thoughts and feelings in a safe, non-judgmental space. Ultimately, the therapeutic alliance is an essential part of successful therapy.
The strength of the therapeutic alliance helps determine how well clients respond to treatment and how likely they are to make positive changes that last beyond therapy.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.
