What is Therapeutic Alliance? On the Value of Building Rapport

In this article we will explore how this key factor of perceived equality between therapist and client helps to create a strong therapeutic alliance, and how its underlying tenet aligns with some of the oldest known wisdom in the western world. In other words, the key to a good therapeutic alliance ought to be no secret!

Let’s dive further into the specific qualities that foster a strong therapeutic alliance.

Therapeutic success: a meeting of equally devoted minds

Psychologist Carl Rogers, the pioneer of person-centered psychotherapy, was among the first to explore the importance of the therapeutic alliance (which he referred to as the client-therapist relationship).

Contemporary research confirms Rogers’ belief that the quality of the therapeutic alliance is as important as any other factor, including the specific theoretical orientation of the therapist. Ardito & Rabinello state:

The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures.

Ardito & Rabinello (2011)

Ingredients for a strong therapeutic alliance

Rogers identified three factors that contribute to a successful therapeutic alliance:

• empathy
• unconditional positive regard
• openness

Empathy is the ability to understand and experience the feelings of others; unconditional positive regard is the unwavering acceptance of another person’s innate dignity and worth along with a willingness to assume the client is doing the best they can; and openness is the willingness to explore new ideas.

These three factors, Rogers concludes, are biproducts of a shared belief in equality. When these values are embraced by both the client and therapist, they create the harmonic circumstances in which therapeutic healing can occur.

Ardito & Rabinello (2011) give us three additional factors to a successful therapeutic alliance:

• agreement on the goals of treatment
• agreement on the tasks of treatment
• a personal bond developed by positive reciprocal feelings

The tenet underlying these three factors is not only a sense of social harmony, but also a harmony or congruence relating to the goals and objectives of the therapeutic process.

Collaboration in the therapeutic alliance

The therapeutic alliance begins when both the client and the therapist chose to engage in a therapeutic relationship. When this happens, the two parties become connected by this mutual decision. This decision alone, however, will not ensure success. The client and therapist must also hold harmonious beliefs about the therapeutic alliance. When this occurs, the shared beliefs between client and therapist brings a certain geometric shape to the therapeutic alliance and thus completes the connection.

When the client and therapist maintain a mutual belief in the shared collaboration of the two parties, and when this mutual belief in turn leads to mutual decision-making regarding the therapeutic process, then the therapeutic alliance well on its way to being a success.

How to create a strong therapeutic alliance

Now that we’ve reviewed the aspects of a successful therapeutic alliance, let’s take a look at how to put them into practice.

For the client

The most important things the client can do are:

• know your goal(s) for therapy
• express your goal(s) for therapy

As simple as it sounds, it can be a lot harder in practice to articulate these things. Engaging in genuine dialogue is difficult. If you know your goals for therapy on day one, that’s great . . . but it isn’t necessary. Maybe at this point you just know that you want to change something. In that case, be open with your therapist about your process of discovering your goals, and your thoughts and feelings about the direction that may be offered by your therapist as you clarify your goals.

Finally, be sure to provide ongoing feedback to your therapist about how you think the therapeutic process is going, and whether you’d like to alter or end the course of treatment. Both of these are natural and normal parts of treatment.

For the therapist

The most important things the therapist can do to forge a strong therapeutic alliance are:

• help the client to feel comfortable with and in the therapeutic process and environment
• help the client to feel like he or she is an equal participant in his or her treatment through the mutual creation and augmentation of treatment goals and objectives
• Elicit feedback from the client about his or her experience in therapy.

It is beyond the scope of this article to dive into specific strategies to achieve the above listed goals. Some great strategies can be found here.

Conclusion

In this article we’ve explored the nature of the successful therapeutic alliance: when the therapist demonstrates empathy, unconditional positive regard, and openness toward the client, and when the client and therapist have similar beliefs about the therapeutic process as a collaborative process, the therapeutic alliance itself can become a powerful medium of healing.

References

Ardito, R., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in psychology, 2, 270. https://doi.org/10.3389/fpsyg.2011.00270

Overholser, J. (2007). The central role of the therapeutic alliance: A simulated interview with Carl Rogers. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 37(2), 71–78. https://doi.org/10.1007/s10879-006-9038-5