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The Therapeutic Alliance

Writer's picture: dr.ssa Elizabeth Mooredr.ssa Elizabeth Moore

Un fiore viola parzialmente nascosto nell'erba, simboleggiando la difficoltà e la possibilità di trovare l'alleanza terapeutica

The Therapeutic Alliance:A Fundamental Component of Successful Psychotherapy

The therapeutic alliance in adults has long been recognized as a fundamental component of successful psychological therapy. It serves as a unifying concept in a field where clinicians and researchers have historically been aligned with particular approaches. Over the years, researchers have defined the alliance in various ways, such as therapeutic bond, therapeutic alliance, or working alliance. Each term has led to a slightly different definition.


Bordin's Tripartite Model of the Alliance

Much of the current understanding of the therapeutic alliance stems from the work of Bordin (1979), who was the first to provide a definition that could be applied across different theoretical orientations. Bordin conceptualized a tripartite model of the alliance, composed of three distinct but interconnected dimensions: the bond, the tasks, and the goals.

  • The bond refers to the emotional aspects of the therapist-client relationship.

  • Tasks involve the agreement and participation in the therapeutic activities.

  • Goals represent the mutual agreement between the client and therapist regarding the objectives and changes to be pursued in treatment.

Bordin viewed the alliance as a common factor in all psychotherapies, regardless of their theoretical and operational model. Current definitions emphasize the emotional elements, such as liking, respect, and trust, as well as the quality of collaboration between therapist and client in establishing the tasks and goals of therapy.


The Therapeutic Alliance: A Collaborative Path to Healing

The therapeutic alliance is seen as a shared working relationship, a path that can guide patients toward healing. To make this happen, many elements are necessary, including the readiness of both the patient and the therapist, who must both desire and be ready to accept the alliance, with its pros and cons.

Operationally, the therapeutic alliance becomes the center of multiple dynamics. On one hand, it represents open communication between the therapist and the client, and on the other, it must effectively support, uphold, and reinforce the therapeutic techniques, becoming itself a tool for healing. Finally, it is something that continually evolves over the course of therapy.


The Therapeutic Alliance with Adults

Research on adult psychotherapy has established that the alliance is a common factor that helps promote positive clinical outcomes across various therapeutic approaches. In fact, hundreds of studies in the adult field have assessed the relationship between the alliance and treatment outcomes. The results from these studies consistently show that the quality of the therapist-client alliance is a reliable predictor of psychotherapy success across a variety of psychotherapy orientations and outcome measures.


The Therapeutic Alliance with Children

The therapeutic alliance has a long history in the context of working with children, dating back to the work of Anna Freud (1946), who emphasized the importance of “affectionate attachment” in treating children as a prerequisite for all subsequent work.Similarly, Rogers (1957) referred to therapy with children not as something done for the child, but rather as an opportunity for the child’s growth. The relational conditions of empathy, genuineness, and positivity were postulated as the active principles of therapy.

In terms of studies, it has been highlighted that with children, the emotional bond enables them to actively engage in therapeutic activities. The relationship is not considered curative, but rather a catalyst for promoting therapeutic work. The alliance can thus facilitate the child’s involvement in therapy tasks, ranging from work done during sessions to completing homework assignments.

The bond appears to be a fundamental component of the alliance with children, a perspective that has shaped recent approaches to evaluating the alliance with children and adolescents.


The Therapeutic Alliance with Adolescents

Currently, most definitions of the alliance in adolescent psychotherapy focus on the emotional and collaborative aspects of the therapist-client relationship as outlined by Bordin. Research on the alliance in adolescent therapy, however, is relatively new. Until recently, many studies in the youth psychotherapy field primarily centered around the broad category of the therapeutic relationship.

For further insights into the relationship with adolescents, refer to articles in the SECTION: ADOLESCENTS.


The therapeutic relationship includes a wide range of variables, including involvement in treatment and the therapist’s responsiveness.

Nonetheless, studies provide strong preliminary evidence of a positive correlation between the therapeutic relationship and treatment outcomes, suggesting that therapeutic relationship variables are predictors of treatment results for adults, as well as for children and adolescents.

In other words, the therapeutic alliance with each age group is a fundamental and necessary component for building an effective therapeutic journey.


Conclusion

The Therapeutic Alliance emerges as a foundational pillar in the field of psychotherapy, whether working with adults, children, or adolescents. Defined through various terminologies over the years, it has been brought to the forefront due to the pioneering work of Bordin in 1979.

Current definitions highlight the emotional aspects of the therapeutic relationship, such as liking, respect, and trust, as well as the quality of collaboration in defining therapeutic goals. Solid research findings demonstrate that the quality of the Therapeutic Alliance is a significant predictor of psychotherapy success with adults, children, and adolescents, promoting positive clinical outcomes across a variety of therapeutic approaches.

Ultimately, the Therapeutic Alliance stands as an essential element for building an effective therapeutic path, providing fertile ground for collaborative work between therapist and client towards the achievement of psychological well-being and healing.




 Written by

Dr Elizabeth Moore, Psychologist

(consultation only in Italian)

 

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Bibliography


  • Jeremy D. Safran, J. Christopher Muran, Teoria e pratica dell'alleanza terapeutica, Ed. Laterza

  • André Green, La clinica psicanalitica contemporanea, Raffaello Cortina Ed.

  • Shirk e Karver, Prediction of Treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review, 2003

  • McLeod, Quality Research in Counseling and Psychotherapy, 2011


External resources

If you wish to explore the topic of psychological manipulation further and find relevant articles and studies, consider these important academic and institutional resourc

  1. American Psychological Association (APA)Link: American Psychological Association


  2. Journal of Clinical PsychologyLink: Journal of Clinical Psychology


  3. The Psychotherapy NetworkerLink: The Psychotherapy Networker



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