Therapeutic alliance: Theme and variations.

Abstract

The therapeutic alliance is often misconceived, misunderstood, or ignored in conceptualizing the therapeutic process and the therapeutic relation in analysis and other forms of therapy. Conversely, I will argue that the alliance is indispensable in all forms of therapy. After briefly outlining the nature of the alliance, I discuss some of the empirical findings regarding its utility in various therapeutic contexts. I then consider its role and function in various therapeutic settings other than adult analysis and psychotherapy, including child analysis, treating various forms of psychopathology, and related contexts like supervision, forensic psychiatry, and hospital and medical treatment. The alliance plays a definite but analogous role in all of these, with differences according to context.

Counsellor behaviours that predict therapeutic alliance: From the client's perspective

“…While many definitions of the alliance have been offered (e.g., Bordin, 1979;Gelso & Carter, 1985;Horvath & Bedi, 2002;Luborsky, 1976;Meissner, 2007), we define the alliance as the client and counsellor's subjective experience of working together towards psychotherapeutic goals in the counselling context, including the experience of an interpersonal bond that develops while engaged in this endeavour.…”

Criteria of Progress in Child Psychotherapies According to Psychotherapists

“…The criteria of change considered by the participants as most relevant in the sessions with the children, and highlighted in the responses to the questionnaire (demonstrates conflicts through games and play; demonstrates trust in the therapist; talks about fears; and establishes affective communication with the therapist), corroborate the majority of studies that shows how important the therapeutic relationship is, translated as a good therapeutic bond, which in turn is linked to the efficacy of the therapy, whichever approach is used (Deakin & Nunes, 2008;Fossum et al, 2008;Langer et al, 2011;Meissner, 2007;Oliveira, 2002;Serralta et al, 2010;Shirk et al, 2011). When it is possible to establish a good bond, the children are able to express themselves more freely with regard to their conflicts and fears, which can be understood as a demonstration of trust in the therapist.…”

“…Despite the theoretical literature that can be applied to the positive changes that occurred, these changes are always evidenced in alterations in the conduct and behavior of the child and can thus be described in behavioral and/or attitudinal terms. With this, the theoretical differences between the therapists are minimized and a common knowledge base can begin to be established (Kazdin, 2000;Meissner, 2007;Oliveira, 2002;Prebianchi & Cury, 2005;Weisz et al, 2006). …”

Personality Disorder Prevalence and Treatment Outcomes: A Literature Review

“…No matter what treatment paradigm one adopts, whether it is psychosocially or pharmacologically based, attention to alliance is indispensible, and may even be a desired primary outcome of treatment (Bender, 2005;Meissner, 2007). Bateman and Fonagy (2000) argue that initial investment in and maintenance of an alliance, and the delivery of treatment, is as important to any successful treatment outcome as the specific intervention itself.…”