The ‘therapeutic alliance’, also called the ‘therapeutic relationship’, is how you and a therapist connect, behave, and engage with each other.
Some sum this up by saying the therapeutic alliance is the ‘bond’ that develops in the therapy room.
Nowadays, the therapeutic alliance is seen by most forms of counselling and psychotherapy as one of the main tools for achieving positive change in the lives of clients. The ability to develop a good therapeutic relationship with clients is focussed on in training as an essential professional skill.
Why is the therapeutic relationship so important?
Just think about any relationship, such as ones between family, friends, or colleagues. If you trust others, you can truly be yourself around them, and tend to learn and grow more around them as you are relaxed. All of which is, of course, useful in the therapy room.
And yet many who seek therapy actually don’t trust or feel comfortable around others, even family and friends. We come from upbringings where we did not have the chance to be loved for being ourselves or to rely on others. hence we end up needing support in the first place.
And that’s why the therapeutic relationship can be not just valuable, but might be the most powerful part of therapy of all – it offers a chance to finally experience what healthy relating actually is. For the first time, you can drop the mask and the games and feel safe just being who you are, and learn what a trusting, authentic relationship feels like.
In summary, the therapeutic relationship can be a container to:
learn what a trusting relationship feels like.
try new ways of relating in a safe space.
be your authentic self without having to impress or please someone.
share things with someone who is impartial and wants the best for you.
But aren’t therapists aloof? (A brief history of the therapeutic alliance)
If you had an idea of a therapist as an aloof doctor, nodding and taking notes as a ‘patient’ sprawls on a couch, you would be in good company. It’s a cliche as old as photos of Freud himself, frowning and bespectacled.
Freud did believe in keeping patients at arm’s length. He felt that a patient’s desire for a relationship was ‘transference‘ (when patients project repressed wishes from the past onto the therapist) and it was best to stay rational and “maintain a professional distance at all times”.
But in his later life Freud actually questioned this theory, considering the possibilities of a beneficial attachment between therapist and patient, instead of delegating any attempt at connecting as projection.
Jung, Freud’s main competitor, was more open with patients than Freud, feeling he should freely share his thoughts and feelings with them. It was after all Jung who said, ‘the meeting of two personalities is like contact of two chemical substances. If there is any reaction, both are transformed”.
But it wasn’t until Carl Rogers, the founder of humanistic or ‘person-centred’ therapy, came along, that therapy’s actual capacity to produce beneficial results was connected directly to the relationship a therapist fostered.
Person-centred therapy recognised that better results were gained if a therapist was empathic, genuine (called ‘congruent’), and truly believed in their clients (called ‘unconditional positive regard‘).
(Note the use of ‘client’ – it was also humanistic therapy who made the move away from the unfriendly term ‘patients’.)
Since humanistic therapy and its theories came along, the therapeutic alliance has been focussed on by all forms of counselling and psychotherapy as an essential focus.
The elements of the therapeutic alliance – it’s not a one way street!
As a client you will have a different view of what is important in the client-therapist relationship compared to what your therapist will hope for. You might seek a therapist who is:
understanding and able to ‘connect’
a good listener
experienced and skilled
warm (or the right level of warmth for you)
Your therapist might, however, be looking for the following in your relationship:
that you can agree on how the therapy can progress
that you can work collaboratively
that you show up and actively participate.
So a good therapeutic alliance will involve all these factors, and doesn’t just rely on the therapist but also on you as a client to do your part.
What does research have to say about the therapeutic relationship?
There is by now a huge body of research around the positive affects of the therapeutic alliance. A comprehensive 2011 overview of previous studies on the subject found that “the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures.”
One of the most recent studies in 2014 looked at the affect of a good therapeutic alliance on clients seeking help for dissociative disorders, showing it resulted in less distress and PTSD symptoms . A worry about previous studies on the therapeutic relationship is that results were therapist-led, but in this study, it was the clients who ranked the therapeutic alliance as effective even more so than the therapists involved.
I would like a therapy that really focuses on the therapeutic relationship
Some modern forms of therapy now make the therapeutic relationship a central aspect and focus on it as a main tool of transformation.
It’s important to keep in mind that therapists are people, and who suits you is unique to you. In this way finding a good therapist is a bit like dating. You might have to consult with a few first until you find the right ‘click’.
If in doubt, keep in mind Carl Rogers’ three main components a good therapeutic alliance – empathy, congruence, and unconditional positive regard. In other words,
Is the therapist supportive and understanding?
Is the therapist genuine and themselves over pretending to be a ‘guru’?
Do they see your value as a person?
If so, stick it out and see where the relationship takes you.
Do you have a story to share with our audience about your experience of the therapeutic alliance? Do so below.