Therapeutic Alliance

What is the therapeutic alliance?

The therapeutic alliance refers to the idea of a strong, productive relationship between therapist and client. This bond can take countless forms and will look different for everyone, but the basic idea is that both parties feel comfortable doing their part in the work toward the client’s therapeutic goals. The client feels generally understood by the therapist and secure sharing their thoughts and feelings, while the therapist can confidently guide the client through strategies and techniques that align with the client’s therapeutic goals. Some studies suggest that the quality of the therapeutic alliance may be the biggest factor in the overall effectiveness of one’s therapy.

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The therapeutic alliance also provides a foundation for disagreement and even argument within therapy. Sometimes, progress depends on the client’s ability to express concerns about the therapeutic work, or on the therapist’s ability to urge the client out of their comfort zone. Accordingly, the therapeutic alliance does not depend on a total absence of tension; rather, it acts as a supportive basis that allows tension to work productively as a meaningful part of therapy.

In many cases, the therapeutic alliance offers clients an opportunity to practice feeling comfortable and confident in a safe relationship, where the client is able to express themselves and have their needs met. Clients sometimes enter therapy without having experienced this kind of relationship in other areas of their lives, so the therapeutic alliance can be a powerful example that clients can draw on in other relationships.

A therapist and a client need not share similar backgrounds to form a therapeutic alliance, but over time, they should grow to feel that they are on the same page about the client’s therapy, regardless of other differences between them.

What's an example of a therapeutic alliance?

Imagine that a client comes into her weekly therapy session wanting to discuss a conflict with a coworker. The therapist gives the client space to express her thoughts and feelings around the conflict, while the client feels comfortable even when disclosing details that she feels are embarrassing; say, for example, that the client cried in her office after the coworker criticizer her work.

Because the client and the therapist have developed a therapeutic alliance, the client is able to feel safe examining uncomfortable feelings and bringing up aspects of her life that trouble her. At the same time, the therapist remains aware of the client’s overall mental health challenges and therapeutic goals and is therefor able to relate this incident back to those goals; for example, the therapist might remind the client at this about her broader lack of self-confidence at work and draw a connection between this incident and different events discussed previously.

Through this process, the client’s challenging experience becomes a part of her larger work with the therapist and can be used as a means of growth toward her goals. 

An example like this one only becomes possible when the therapist and client work from a foundation of mutual trust, respect, and agreement on the goals and processes of therapy. The idea of the therapeutic alliance refers to that essential foundation.

What are some elements of therapeutic alliance? 

  • Right level of warmth: Some therapists behave more warmly toward their clients, while others maintain more emotional distance. Either can be helpful; it’s a matter of figuring out which approach you feel most comfortable with.

  • Understanding of your challenges and goals: A therapist with whom you develop an alliance will have a clear sense of what you’re struggling with and what your goals are, and they won’t attempt to define your challenges and goals for you.

  • Consensus about how you’ll make progress and how that progress will be measured: Part of the therapeutic alliance is a shared understanding of what strategies the therapy will use and how both parties will be able to tell whether those strategies are working.

  • Verbal language: Therapeutic alliances include verbal language that is effective for both parties, including clear responses to questions, reflecting understanding of the other’s words, and prompting further response when appropriate.

  • Listening: In the therapeutic alliance, listening is just as important as talking. A strong therapeutic relationship will likely include space for silence, and you should feel that your therapist pays attention to your words while also giving you space to gather your thoughts quietly when necessary.

  • Body language: A therapist with whom you develop an alliance will use body language in a way that makes you feel comfortable and engaged, and they will also be attuned to your body language.

How can I predict whether my therapist and I will develop a therapeutic alliance? 

Early in your relationship with your therapist—even after just one session or consultation phone call—try asking yourself the following questions. If you can answer ‘yes’ to most of them, then chances are that you and your therapist have the potential to develop a strong therapeutic alliance.

  • Would I feel comfortable sharing more with this therapist?

  • Do I feel respected and heard? 

  • Do I think this therapist is knowledgeable and can really help me?

  • Does this therapist use language that reflects an understanding of my background and identities?

  • Does this therapist’s approach to my challenges and goals make sense to me?

  • Am I comfortable with the level of warmth this therapist shows?

  • Does this therapist respond clearly to my questions?

  • Does this therapist offer the amount of direction that I want? If I want therapy to be more self-directed, does this therapist seem open to this approach?

  • Do the silences in our conversation feel comfortable to me?