What Is the Therapeutic Alliance in Psychology?

Melissa Madeson, Ph.D.219-03-2021 / positivepsychology.com

Research examining outcomes of psychotherapy and counseling have found that only 15% of treatment success can be attributed to the type of therapy or the techniques administered (Hubble, Duncan, & Miller, 1999).

Therapeutic Relationship

More important than technique or type of therapy are therapist qualities and the overarching therapeutic alliance.

For the past 80 years, psychotherapists have advocated that nonspecific common factors are responsible for the success of their work (Groth-Marnat, 2009). Within the field of psychology, the therapeutic alliance is foundational to these common factors.

The concept of therapeutic alliance can be traced back to Freud’s (1913) idea of transference, which was initially thought to be completely negative. Later, Freud considered the idea of a beneficial attachment between therapist and client rather than merely labeling it as a problematic projection.

Zetzel (1956) later defined the therapeutic alliance as a non-neurotic, non-transferential relationship component between a patient and therapist that allows the patient to understand the therapist and the therapist to understand interpretations of the client’s experience.

Rogers (1951) is probably best known for emphasizing the therapist’s role in the relationship, leading to what we now know as client-centered therapy. The active components of a therapeutic relationship, according to Rogers (1951), are empathy, congruence, and unconditional positive regard.

We also know the therapeutic relationship as the therapeutic alliance, the helping alliance, and the working alliance, all referring to the relationship between a healthcare professional (counselor/therapist) and the client or patient.

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It is the collaborative relationship between these two parties engaged in the common fight to overcome the patient’s suffering and self-destructive thoughts and behaviors, and effect beneficial change.

Research on the power of the therapeutic relationship has accumulated over 1,000 findings that include its ability to predict adherence, compliance, concordance, and outcomes across a wide range of diagnoses and treatment settings (Orlinsky, Ronnestad, & Willutski, 2004).

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