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 understood and secure

The client feels generally understood by the therapist and secure sharing their thoughts and feelings. The therapist, also, feels confident – they’re able to guide the client through strategies and techniques that align with the client’s therapeutic goals.

Both parties feel comfortable engaging in constructive disagreement

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.

The client can practice feeling confident in a safe relationship

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.

The therapeutic alliance may be the most important factor in the effectiveness of therapy

Some studies suggest that the quality of the therapeutic alliance may be the biggest factor in the overall effectiveness of one’s therapy. [1]

You don’t have to share a background with your therapist in order to develop a therapeutic alliance

However, over time, you should both grow to feel that you are on the same page about your therapy, regardless of other differences.


Elements necessary for a therapeutic alliance

Therapeutic alliance: An example

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.

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.

If, after an initial call, you do not feel that you would be able to establish a therapeutic alliance with a therapist, you can call another therapist to assess fit! Similarly, if you’re already in treatment but haven’t developed an alliance after significant sessions, you can tell your therapist it’s not working. The right fit is out there!