The Therapeutic Alliance

The therapeutic alliance refers to the quality of the relationship between client and therapist.  It has been defined as comprised of purposeful collaboration (the extent the therapist and client work together on agreed upon tasks and goals) and affective bond (the degree of mutual respect and trust and understanding).  In our work (e.g., Safran & Muran, 2000) we have refined the alliance concept to take into the account that it is not a static variable but rather a fluctuating, emergent property of the therapeutic relationship that is negotiated between patient and therapist at both explicit and implicit levels throughout the course of treatment. 

A number of measures have been developed based on these dimensions, and a great deal of research has been conducted demonstrating that the therapeutic alliance is one of the most robust predictors of treatment success in all forms of psychotherapy. Research has also demonstrated that therapists often struggle to develop or maintain an adequate alliance and fail to recognize problems in the alliance when they occur.  In addition, even when therapists recognize problems in the alliance, they often fail to address them in a constructive way. Failures of this type often lead to poor outcome, premature termination, or patient deterioration over the course of treatment.