The Therapeutic Alliance
“ ...irrespective of the clinical problem or treatment modality, therapists should strive to establish, monitor, and maintain a positive bond and a strong level of collaboration with their clients.“
(Castonguay, Constantino, Holtforth, 2006, p272)
For psychotherapy to be effective, a therapeutic alliance needs to be developed between the therapist and client (Behan, 2018; Horvath, Del Re, Flückiger, & Symonds, 2011). The alliance (also called the working relationship) includes:
An affective bond between therapist and client, typically called the "therapeutic relationship."
Agreement on the goals and objectives of therapy (typically called "goal consensus").
Agreement on the tasks that will be used to achieve the goals.
In short, there needs to be agreement on what the problem is, what will be targeted in the therapy, and how this will be achieved - all embedded within the context of a warm supportive relationship (Safran, Muran, & Proskurov, 2009).
What it Means for Therapists
A strong therapeutic alliance exists when clients feel bonded to their therapist and confident in the collaborative direction that they are taking to resolve the client's concerns.
It is possible for there to be a strong therapeutic relationship without a strong therapeutic alliance (a mutual understanding of what the problem is and what is being done about it).
Therapists should be on guard if they are experiencing compassion fatigue, boredom, or frustration, as these factors are toxic to the therapeutic alliance.
Recommendations from the 2018
Meta-Analytic Synthesis of the Research on
the Alliance in Adult Psychotherapy
(Flückiger, Del Re, Wampold, & Horvath, 2018).