What is the Therapeutic Alliance?

• Includes 3 parts:

  • 1. The bond between therapist and client AKA therapeutic relationship

  • 2. Agreement on goals and objectives of therapy AKA goal consensus

  • 3. Agreement on tasks/what will be done to achieve goals

Why the Therapeutic Alliance is Important

• Effective therapy can rarely occur without a strong therapeutic alliance

• When clients feel bonded to their therapist, they are more hopeful and confident toward growth and change

• The therapeutic alliance is the greatest predictor of success in therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/

Core themes and questions to consider with the therapeutic alliance:

• What are the client’s expectations of therapy and the therapist?

• What has the client’s previous experience in therapy been like? Positive, neutral, negative? What worked? What did not work?

• What is the client’s comfort with soliciting negative, positive, or neutral feedback? What gets in the way?

• How do I as the therapist build, establish, and grow the therapeutic relationship in an ongoing manner?

• When ruptures or disagreements occur, do I as the therapist address it immediately without taking a defensive stance?

• How do I address and create collaborative goals with clients?

• How do I negotiate with clients in terms of treatment planning and goals?

• How do I handle differences such as race, ethnicity, gender, sexuality, ability status, etc. in session? How do differences show up in session?

• What sort of language do I use to convey empathy, understanding, and collaboration?

• What sort of non verbal cues do I use to empathy, understanding, and collaboration?

Statements and questions you can try out:

• Did we work on what you wanted to work on today in session? If not, what did you also want to discuss?

• Did you feel heard and understood in today’s session? If not, what did I misunderstand?

• Do you feel comfortable bringing up disagreements with me?

• How likely is it that you would bring up a disagreement with me? What prevents or gets in the way of you doing so?

• Correct me if I’m wrong, you said X…is that right?

• Just so we are on the same page for today’s session, you’re saying you’d like to work on X…is this right?

• Thank you for clarifying for me. You are saying X…

• So there are a few ways I can help you today. We could do X, Y, or Z, what would you prefer?

• And more

Things you could implement toward a strong therapeutic alliance:

• Building therapeutic alliance is an ongoing thing (not one time thing)

• Discuss goals and objectives of therapy

• Provide a written and/or verbal treatment plan

• Discuss ruptures and disagreements as they occur toward possible repair

• Check in with yourself regularly for symptoms of compassion fatigue, burn out, boredom, irritability with clients

• Check in with your own countertransference

• Use feedback measurement tools and/or check in verbally with clients for feedback

• Practice curiosity

• Ask for permission

• Ask for preferences

• Explore differences and identity factors such as race, ethnicity, gender, class, etc. and how they may impact forming and building a strong therapeutic alliance

• And more

Questions to reflect on:

• What clients do I have a greater ability to form and build strong therapeutic alliance with?

• Which clients do I struggle in forming and building a strong therapeutic alliance with?