Therapeutic alliance

            Therapeutic alliance pertains to the mutual relationship between a counsellor and patient seeking psychotherapy from the health professional (Botella et al., 2008).  This type of interaction has been determined to be as an essential feature of psychotherapy in the 1970’s and it is generally based on a number of features.  Firstly, a therapeutic alliance is technically an agreement between a counsellor or therapist and a patient to reach a certain treatment outcome.  Secondly, both parties on a therapeutic alliance agree on specific activities that have to be performed in order to achieve a treatment outcome.  Thirdly, an emotional link is present between the counsellor and the patient and the progress and eventually the success of the treatment is mainly based on the therapeutic alliance that has been established between the two parties.

Therapeutic alliance is therefore an essential component in psychotherapy.  Research has indicated that during individual session of patients, the most essential observation that was reported involved the positive relationship that is established early on during the treatment sessions of the patient.  Thus, a good relationship between the therapist and the patient often results in the success of a treatment regimen and ultimately, cure of the patient.  Several medical reports have indicated that such therapeutic alliances are successful, regardless of type of clinical disorders or mode of treatment that is administered to the patient, whether it is a simple drug regimen or a cessation program for a specific addiction (Lambert and Friedlander, 2008).

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            In the case of adolescent patients, psychiatrists are often confounded with obstacles associated with creating a therapeutic alliance with their young patient.  In an ideal scenario, a therapeutic alliance between a counsellor and a patient influences a unique atmosphere that allows the patients to be more aware of their habit and personalities and facilitates reflection of how their lifestyles and choices have triggered such a medical disorder.  Within such alliance, the patient easily cooperates with the counsellor or therapist and accepts any assessment that may be presented by the therapist.  It is also easier for the patient to organization any information that is presented by the therapist, as related to the specific medical disorder that is being analyzed.  More importantly, any suggestions of the therapist are rapidly internalized by the patient when a therapeutic alliance has been established right at the very start of the consultation.  The presence of a therapeutic alliance also allows the therapist to help the patient is adjusting, accepting and even coping with issues that the patient experiences during his ordeal with his disease.  It has also been observed that when a therapeutic alliance between a therapist and patient is established, any transference may be tested that may be very helpful in treating the patient.  Therapeutic alliance also allows the patient to be more observant of himself, including psychological, emotional and mental aspects of the patient.

            It should be understood that the establishment of a therapeutic alliance between a counsellor and a patient does not often occur at the first day that both parties meet each other (Constantino and Smith-Hansen, 2008).  In actuality, the patient usually has a preconception or notion of what he is about to see in his therapist.  A therapist is often preconceived in the mind of a patient and this is usually based on what their parents have imprinted during their younger years.  This may include descriptions of physicians who are stern and appear very serious and never have a funny side to their personalities.  To makes things worse, kids are psyched to think that doctors have the capability to inflict pain by what they are trained to do and this is based on the images of syringes with sharp needles, scalpels that can cut through flesh and tubes that can be inserted in any physical portal of the body.  It is actually shocking to a young patient to find a physician or therapist who is friendly, welcoming and very interactive during his visit at the clinic or hospital.

            At the same time, a physician or therapist may also carry preconceptions of his patients.  A patient may either be the incommunicative person who does not say anything that is bothering him although the patient is aware that there is something wrong with his body.  They simply will not want to admit this.  On the other extreme, the physician may keep an image of a patient who always complains about things and will express every little issue that bothers him.  Hence the first encounter of the therapist and the patient is generally filled with a sense of assessment of each other (Dales and Jerry, 2008).  This mutual action thus plays a crucial role on whether a therapeutic alliance may be established within the first visit or the subsequent visits, or never in the entire treatment regimen.  It has been determined that the success in establishing a therapeutic alliance is mainly based on how the patient presents his situation to the therapist.  The patient may not understand himself fully, hence the way he narrates his condition to the therapist will also be affected during his discourse.  At the same time, the personality of the therapist also influences the possibility of establishing a therapeutic alliance between himself and his patient.  The therapist must be open-minded, with the notion that every individual is unique in his morals, judgment and attitudes (Rozmarin et al., 2008).  In addition, the therapist must also understand and respect the different ethnic backgrounds of patients.  It is known that patients from the Eastern world such as Asians believe and follow a different path, including the roles of parents, children and other family members.  Different ethnic backgrounds also uphold different religions hence the therapist must also be aware that he can not quickly and simply suggest a treatment regimen that goes against the patient’s beliefs and principles.  The therapist should also be aware that any language he expresses, be it verbal or physical, will also be perceived by his patient and the effect of such language may be positive or negative in effect.  For example, fidgeting is often not a positive body language and this may affect the establishment of a therapeutic alliance.  Either the patient or the therapist may be the individual who is fidgeting and this may not be helpful in the interaction between both parties.

            It should also be understood that during the first few seconds or minutes of an encounter between a therapist and a patient, fear is present in the patient.  In addition, the patient also carries a sense of helplessness because he needs to consult a physician or therapist about a particular issue that he is currently experiencing.  There are patients who feel that they have lost control of their lives because they have succumbed to seeking the professional help of a physician or therapist and they are often angry at themselves for not having the ability to prevent such an occurrence.  Other patients come in with a sense of failure because they do not understand why such a medical condition is now present and they are feeling sick and not in their normal well-being.  The most destructive feeling that a patient carries during the first encounter with his therapist or a physician is fear of the unknown (Pulido et al., 2008).  They do not know what is wrong with them and they are scared of hearing the worst medical conditions that they could think of.  Thus carrying different notions of diseases, as well as connecting these notions with surgery and even worse, death, results in a patient that is scared, worried and often times angry.  Such scenario is often not an easy sight for the therapist hence it is also important that the therapist be aware of such mixture of emotions during the first encounter with a patient.  The physician or therapist should thus present himself to the patient as a relaxed and welcoming individual who is willing to help and act as a confidant and friend to the patient.  Should these issues be considered well by both therapist and patient, a therapeutic alliance may be established between the two parties and a treatment regimen will be successful.  It is thus very important that a therapeutic alliance be created between a patient and a therapist, in order for the patient to be cured of his illness or addiction.


Botella L, Corbella S, Belles L, Pacheco M, María Gómez A, Herrero O, Ribas E, Pedro N (2008):  Predictors of therapeutic outcome and process. Psychother. Res. 18(5):535-42.

Constantino M, Smith-Hansen L (2008):  Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa. Psychother. Res. 29:1-16.

Dales S, Jerry P (2008):  Attachment, affect regulation and mutual synchrony in adult psychotherapy.  Am. J. Psychother. 62(3):283-312.

Lambert JE, Friedlander M (2008):  Relationship of differentiation of self to adult clients’ perceptions of the alliance in brief family therapy. Psychother. Res. 18(2):160-6.

Pulido R, Monari M, Rossi N (2008):  Institutional therapeutic alliance and its relationship with outcomes in a psychiatric day hospital program. Arch. Psychiatr. Nurs. 22(5):277-87.

Rozmarin E, Muran JC, Safran J, Gorman B, Nagy J, Winston A (2008):  Subjective and analyses of the therapeutic alliance in a brief relational therapy. Am. J. Psychother. 62(3):313-28.


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Therapeutic alliance. (2017, Mar 02). Retrieved from