What is Therapeutic Alliance and Why it is Important in 2024?

Someone seeking therapy is often told that it takes a bit of trial and error to find a good match. The therapist’s expertise, availability, affordability, and modality are a part of this. But, an important factor this cautionary advice entails is the therapeutic alliance. Just like finding a good pair of jeans, it takes a bit of time to find a therapist who feels like a good fit. 

The heart of this ‘good fit’ is the relationship you share with your therapist - the level of comfort and collaboration. Most clinicians and academics agree that a good therapeutic alliance - also called a ‘therapeutic relationship’ - is crucial for success in therapy. 

But, if it’s the relationship that heals, why not talk to your best friend? This is a common and understandable question. 

However, just like your relationship with your best friend is different from your relationship with your mother, your relationship with your therapist is unique in its own way. A therapeutic alliance has many elements to it. 

What is Therapeutic Alliance? 

In my quest to find a good enough therapist, I have worked with three therapists over the years. My last and current therapist offered me something my previous two could not - a relationship where I feel safe, seen, and remembered. I first began seeing her almost nine years ago, when I was still in my 20s. 

We met regularly for almost a year, at the end of which I felt better and didn’t need to meet on a weekly basis anymore. Then, a few years later, I felt the need to see her again. During the long gap, both of us had gotten married, and she had also had a baby and moved to a different city. 

While I wanted to meet in person, I settled for online sessions because of the therapeutic alliance and relationship we had built over the years. 

So, what is this alliance that made me loyal to her despite my personal preference for offline sessions? 

A therapeutic alliance is a measure of how well the therapist and the client are engaged in the work they do together. It is a measure of the ‘bond’ they share. While a good rapport is a part of it, a good therapeutic alliance is more than that. 

#4 Components of a Therapeutic Alliance in 2024

It is generally agreed that a good therapeutic alliance has the following elements: 

1.The relationship is collaborative: 

This means that the therapist and client work together to untie the mental and emotional knots. The therapist does not dictate or advise the client on how they should live their life, or what they should do. Instead, together, they work on gaining a deeper understanding of the client’s concerns as well as strengths and resources. 

2.There is an emotional bond between the therapist and client:

If you believe that a therapist is an unemotional blank slate, you may have fallen for an age-old myth. Therapists and clients share an intimate relationship where both are emotionally invested. The therapist, too, should care about your well-being and be open to feedback as well as updating their offerings and interventions as your relationship evolves. And yes, your therapist does think about you outside of sessions, too! 

3.There is agreement on treatment goals: 

A good therapeutic alliance is formed based on inputs from both, the therapist and client. Agreeing on the goal of the treatment, including when it’s time to stop, is a part of the collaborative process of therapy. 

4.A good therapeutic alliance also has boundaries: 

Boundaries play a crucial role in establishing a feeling of safety in a therapeutic relationship. Some common boundaries that therapists put in place include: having a time limit on the sessions, no contact outside of the sessions and not having dual relationships with clients. These boundaries not only help the client feel safe but also allow an opportunity for the client to integrate the work they do in sessions into their personal life. 

To sum it up, the therapeutic alliance is the working relationship between a therapist and their client wherein they collaborate to establish shared goals. This is done within professional boundaries, which helps create a sense of safety in the relationship, and empowers the client to apply what they have learned in therapy. 

What Is The Concept Of Therapeutic Alliance?

The concept of the therapeutic alliance began, of course, with Sigmund Freud. Or, broadly speaking, the concept has its origins in psychodynamic practices which focus on the relationship shared between the therapist and the client. It has now found home in other schools of thought of therapy as well. 

The concept of the therapeutic alliance rests on the importance of forming a safe emotional bond between the therapist and the client. A safe bond helps the client explore their concerns in a deeper way, without feeling threatened or overwhelmed. 

Of course, the therapy process is not smooth, and sometimes difficult feelings are evoked as one explores their inner life. A strong therapeutic alliance helps to contain these difficult feelings as and when they arise so that the client is able to process and make sense of them. 

A therapeutic alliance, then, is essential to help the client use the space and relationship for exploration and insight. Think about it - if you didn’t feel safe with your therapist, would you be able to share your deepest wounds with them? This is what the concept of therapeutic alliance is - to create a space for the client to feel safe enough to share their deepest, most vulnerable thoughts. 

#5 Types of Therapeutic Alliance in 2024

Based on the specific goals and treatment modalities, alliances can be of different types. These are: 

1. Directive: In this, the therapist takes a more prescriptive approach and may give suggestions, assignments, or homework aimed at changing behaviour. 
2. Non-directive: This is a reflective relationship in which the therapist plays a more passive role, allowing the client to explore their concerns at their own pace. 
3. Facilitative: A facilitative alliance is also reflective but is oriented toward growth as opposed to awareness.
4. Supportive: In many situations, a therapist’s role may be limited to providing emotional support and guidance.
5. Task-oriented: This is focused on a particular task or dilemma and can help the client problem-solve and achieve certain personal or professional goals.

Why a Therapeutic Alliance Is Important in Therapy?

1.Safety:  

Safety in the therapeutic relationship is of utmost importance. In a good therapeutic alliance, both the client and the therapist feel safe to have a dialogue with each other.  

2.Accountability: 

A therapeutic alliance creates a sense of accountability in the client. Boundaries like showing up and ending sessions on time help the client take ownership. No contact with the therapist between the sessions helps clients integrate the work into their day-to-day life.  It also assigns responsibility to the client to use the session time well. 

3.Active participation: 

A therapeutic alliance encourages the active participation of both, the therapist and the client. A common misconception about therapy is that one may receive advice or suggestions. On the contrary, therapy focuses on how the client makes sense of their lives and builds their capacity to make their own decisions.  

Predictability and reliability: A therapist alliance creates a feeling of predictability and reliability in the relationship. This comes from the ‘frame’ - adhering to the time and schedule, and minimal contact outside the sessions. Most therapists work with clients on a weekly basis. A weekly slot is fixed, and the client can expect the therapist to be there - at the same time, week after week. This helps create predictability, reliability, and a sense of safety.  

4.It honours the readiness of the client: 

Being able to talk about deeper issues takes time, even when you’re talking to a professional. A therapeutic alliance places emphasis on building a good rapport and allowing the client time and space to go at their own pace. 

5.It provides clarity: 

Since a therapeutic alliance establishes shared goals, and there is ongoing feedback and re-evaluation of these goals, it creates clarity and manages expectations between the client and therapist.  

6.It reduces dropout: 

As I shared above, I didn’t want to go looking for a new therapist after having found one with whom I shared a good therapeutic alliance. I had already shared so much of my life with her. She had also seen me through different phases and states. 

Finding a new therapist felt like having to start all over again, both in terms of sharing my story with them, and establishing a sense of safety. Because the safety and comfort of the relationship are so important to the process, once established, clients usually remain with the same therapist.  

What Are The Benefits Of A Good Therapeutic Alliance?

Both, the client and the therapist benefit from a good therapeutic alliance. 

For the client, a good therapeutic alliance means the following: 

1. Safety in the relationship 
2. A sense of agency over the process 
3. Improved outcome

For a therapist, a good therapeutic alliance means: 

1. Improved outcome
2. Lower dropout rates 
3. Predictability in the relationship enables the therapist to deliver high-quality care. 

How To Find A Good Therapeutic Alliance?

Finding a therapist with whom you match well takes time. Sometimes, you may have to see a few therapists till you find the one who makes you feel comfortable. 

Having said that, since an alliance takes time to build, it’s advisable to give it at least 3-4 sessions before you decide if a therapist is a good fit for you or not. 

Additionally, based on your presenting concerns, you can narrow down your search in terms of the type of psychologist you are looking for. Would a clinical psychologist work best for you or a counselling psychologist? This article talks about the different types of mental health professionals in India who cater to diverse mental health needs. 

We, at Mave Health, have a team of qualified mental health professionals. Check out our Therapy Club to get started on your search for a therapist with whom you can build a good therapeutic alliance! 

In conclusion…

A therapeutic alliance is the foundational brick for successful outcomes in therapy. A good alliance has shared responsibility and goals and is established collaboratively. Good rapport and safety are important elements of a good therapeutic alliance. This in itself can be an empowering experience for an individual seeking therapy. 

References: 

• Boundaries in therapy. (n.d.). Www.counselling-Directory.org.uk. 
• Cuncic, A. (2023, May 26). Why a Therapeutic Alliance Is Important in Therapy. Verywell Mind. 
• Four Types of Psychologists | Mave Health. (n.d.). 
• Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561–573. 
• ‌Jacobson, S. (2019, June 11). What is the therapeutic alliance and why is it so important? Harley TherapyTM Blog. 
• Therapeutic Alliance - The Key To Improving Outcomes | Greenspace (US). (2023, January 30). 
• Stubbe, D. E. (2018). The therapeutic alliance: The fundamental element of psychotherapy. FOCUS, 16(4), 402–403.