The therapeutic alliance is an essential component in any care provider-client relationship. The American Psychological Association defines the therapeutic alliance as “a cooperative working relationship between client and therapist, considered by many to be an essential aspect of successful therapy.”
Upon entering graduate school, aspiring clinicians are taught about the therapeutic alliance and the importance of not only establishing rapport with clients, but of creating an environment in which those seeking help feel seen, heard and cared for. Future therapists are taught to be aware of and work through any overwhelming feelings or reactions (also known as countertransference) they may experience towards their clients. The ultimate goal is to provide a safe and supportive space in which clients feel they are approached with unconditional positive regard.
Although American physician and psychoanalyst Elizabeth Zetzel first coined the term “therapeutic alliance” in 1956, the actual concept was first described in 1912 by Sigmund Freud, the Austrian neurologist and founder of psychoanalysis. Interestingly, and despite understanding the importance of the human connection between therapist and client, Freud believed in “maintaining a professional distance at all times” and kept his patients at arm’s length for the majority of his psychoanalytic career. Several anecdotes from the time indicate that Freud often turned his back to clients during sessions. It wasn’t until later in his career that Freud began to question the efficacy of this approach. Later psychoanalysts, such as Carl Jung and Carl Rogers, were more open with patients and felt that the therapeutic alliance played a crucial role in helping clients meet their stated goals, a notion that is strongly supported by more recent research.
It has been determined that the therapeutic alliance is one of the strongest predictors of clinical outcomes, second only to a client’s self-motivation. A strong alliance paves the way for mutual respect, understanding and collaboration on client-centered goals. Given that many clients lack a genuine, compassionate, non-judgmental support system, it is imperative for the therapeutic process that they are able to forge this kind of bond with their care provider, especially from the beginning.
According to the National Institutes of Health, “Studies suggest that patients tend to view the alliance relationship as stable, whereas therapists and observers tend to indicate more change over time in their alliance ratings. Because patients tend to view the alliance consistently throughout treatment, they are more likely to view the alliance as positive at termination if their initial assessment was positive. Thus, therapists must be effective at establishing positive alliances with their patients early in the therapy process.”
The Care Predictor Index is an assessment tool that aims to predict a care provider’s ability to form a strong therapeutic alliance. By assessing 24 different character traits determined necessary to create and enhance rapport, the CPI offers insight into a care provider’s areas of strength and areas of improvement. When implemented effectively within an organization across the appropriate departments, the CPI is an effective tool that aids with smart hiring decisions as well as employee growth and development initiatives.
Ultimately, the most important hallmark of a successful client-clinician relationship is the therapeutic alliance and how early it is formed in the treatment episode. A strong therapeutic bond consists of trust, respect, empathy, flexibility, collaboration and engagement, all of which lead to positive outcomes for the client.
