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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.

What is the most important factor in the therapeutic alliance?

The most important factor in the therapeutic alliance is trust. The client must trust that the therapist will tell the truth and that the therapist will create an environment of safety and progress. Trust requires factors such as empathy, acceptance, compassion, and collaboration. Therapy is an inherently collaborative process, and requires both client and therapist to communicate honestly.

How can you assess the strength of your relationship with your therapist?

The therapeutic alliance is a relationship, so part of how you judge the strength of the relationship is intuitive. How does it feel to you? Do you feel safe? Or do you feel nervous? Nevertheless, questions like these can help you clarify your feelings, if you’re not sure:

"Do I feel comfortable during therapy sessions?"

"Do I engage with and believe what my therapist says to me?"

"Is it a struggle for me to talk about difficult topics during therapy?

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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 has their best interest at heart at all times, 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.
What do you do when a therapeutic relationship breaks down?

Ruptures happen in therapy with some frequency. A rupture is when the relationship between the therapist and client is broken or weakened. They can happen when the therapist says something that hurts the client, the client feels they’re not being listened to, or for many other reasons. While a natural first reaction may be to end therapy and look for another therapist, it may be worthwhile to address the issue with the therapist first. If the therapist is open and welcoming of a client’s concerns, it can reset a relationship, and inform changes to treatment. If a therapist reacts in a way that’s uncomfortable or negative, then it might be time to look for someone new. 

My therapist doesn’t disclose much about themselves. Could this make it harder to build an alliance?

Not necessarily. A strong therapeutic bond can be built with an attentive and empathetic therapist, even if they do not share aspects of their own lives. Many therapists have been trained to reveal as little about themselves as possible during the course of treatment. This can be frustrating at times for clients, and make them feel as if the therapist is not engaging in the relationship. Called “countertransference” in the field of psychology, it is believed that therapists who overshare or bring their own problems into session run the risk of disrupting the therapeutic alliance by taking the focus off the patient. This is not to say that therapists shouldn’t empathize with patients.

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