Principles of Alliance-Focused Intervention
Alliance-Focused Treatment assumes that a strong therapeutic alliance is a precondition for success in all forms of therapy, and focuses on the principles involved in building a strong alliance, and detecting and repairing strains in the alliance when they emerge. In spite of solid evidence that psychotherapy is effective, approximately 30% of people receiving psychotherapy do not benefit, around 25% drop out of treatment and up to 8% experience a worsening of their problems. In addition, the evidence indicates that therapists tend to overestimate their own success rates with patients.
Alliance-focused treatment has been empirically tested both as a distinctive form of treatment in it's own right, and as a general approach to therapy that can be integrated with other commonly practiced forms of therapy (e.g., cognitive-behavioral, psychodynamic , or emotion-focused). Detecting and repairing ruptures in the alliance is essential for purposes of working through therapeutic impasses. It can also contribute to the change process in and of itself.
Research has identified a number of principles relevant to 1) building a strong therapeutic alliance, 2) identifying problems in the alliance, and 3) repairing ruptures in the therapeutic alliance. The following is a brief list of principles relevant to maintaining and repairing strains and ruptures in the therapeutic alliance.
- Pay careful attention to the level of agreement between you and your client concerning the overall goals of treatment and the tasks necessary to achieve these goals.
- If a patient expresses concerns or complaints about a particular therapy task, reframe its meaning or modify it
- Respect your clients' defenses and explore their adaptive function collaboratively.
- Provide a therapeutic rationale for your techniques, actions and /or behaviors.
- Discuss the here-and-now of the therapeutic relationship with your client.
- Give and ask for feedback about the therapeutic relationship.
- Track your clients' responses to all interventions.
- Pay attention to subtle cues that there may be a problem with the alliance.
- Allow and encourage clients to assert their negative feelings about the relationship.
- Accept responsibility for your part in alliance ruptures.
- Explore clients’ fears about asserting negative feelings about the treatment or the therapeutic relationship.
- Pay attention to fluctuations in your own feelings as potential cues about what may be going on in the therapeutic relationship
- Use self- disclosure judiciously for purposes of both exploring and helping to resolve alliance ruptures.