Therapeutic Alliance

A landmark meta-analysis of more that 450 studies of psychotherapy showed that the therapist’s orientation and interventions or “type of therapy” had zero effect on therapy outcome. Study after study produces the same result: non-existent or negligible differences among types of therapies. This is well summarized by Horvath and Symonds (1991) in Journal of Consulting Psychology ((38) 139-149) and by Martin, Garske, and Davis (2000) in Journal of Consulting and Clinical Psychology ((68), 438-450). In essence, it’s pointless to debate which therapy is best – across all schools of therapy there is only one main factor determining the success of therapy: the therapeutic alliance.

Exactly what is this “alliance”? It consists of two components: 1) the relationship and 2) the task set. The first focuses on the relationship between client and therapist, which should have these key qualities: trust, respect, honesty, liking, safety, positive regard, acceptance and non-judgmental attentiveness, interest and interpersonal attachment, as well as effective verbal and non-verbal communication. The second component – the task – has to do with the client and therapist establishing goals for therapy, setting clear guidelines and “blueprints” for achieving them, and mutually working toward them in a specified way, while managing time efficiently.

During the course of therapy it’s useful and necessary to visit and re-visit both components of therapy, where the client and therapist “check in” with each other in order to calibrate and make adjustments or corrections, if indicated. This keeps the work on track and fosters further openness.

Supporting the primacy of alliance, in Psychotherapy: Theory, Research, Practice, Training (44:4,371-377, 2007), researchers identified common factors contributing to the effectiveness of therapy: empathic engagement toward the development of a safe, secure, relational dynamic, creating a “strong therapeutic alliance”. Buttressing these findings, the Journal of Consulting and Clinical Psychology (66:2, 304-312, 1998) reports that effectiveness hinges on therapist responsiveness to clients’ varying requirements, i.e. interpersonal styles. Ultimately the therapist should accurately “read” or meet the client.