Therapeutic relationship

The Therapeutic Alliance

What is the alliance?

A good relationship between client and therapist is, at the very least, considered to be the base from which all therapeutic work takes place. One view of the therapeutic relationship which is often taken by cognitive and behavioural therapists (CBT) describes it as ‘professional skills’. For other psychotherapy schools, the therapeutic relationship is seen as one of the main therapeutic tools for achieving client change. Whatever therapeutic processes are involved in the client-therapist relationship, research has consistently shown a significant association between this relationship and outcome (e.g. Lambert & Barley, 2001).

What are the important elements?

The main components that contribute to the quality and strength of the therapeutic relationship are:

  • the emotional bond and partnership On reflection I need to focus more on the process and relationship between therapist and client and not just apply CBT techniques without thinking of their impact on my relationship with the client. - Therapist
  • the cognitive consensus on goals and tasks and
  • the relationship history of the participants.

A variety of terms have been used to conceptualise the therapeutic relationship that can be used interchangeably. These include therapeutic relationship, working relationship, alliance, therapeutic alliance, and therapeutic bond.

What can affect the alliance?

The establishment of a good relationship is necessary early in therapy. Clients tend to emphasise the importance of therapist warmth and emotional involvementI thought a therapist would be sort of a wise person that considers you seriously, listens to you and helps you." - Client, whilst He seemed compassionate and understanding.- Client therapists judge the quality of the relationship on clients’ active participation.I should have been better at explaining that the therapy process involves accepting responsibility and committing to behaviour changes. - Therapist

Together, these make the primary components of the initial objectives for the early alliance; expectancies, intentions and hope. As therapy continues, the second stage of the relationship develops into one in which therapeutic activity is carried out. This leads to a deepening of the therapist – client relationship, but may also lead to misunderstandings and negative reactions. Maintaining the quality of the relationship is the third stage in the relationship and involves therapists ensuring they are appropriately responsive to their clients, and repairing any ruptures in the relationship. This requires therapists to individualise their responses to specific aspects of clients’ needs. Therapist understanding and appreciation of contextual factors are important for developing and maintaining the therapeutic relationship.