How to Make Practical Use of Therapeutic Alliance Research in Your Clinical Work

Abstract

One primary purpose for psychotherapy research is linking empirically based findings to applied treatment interventions. This use of research can potentially define optimal strategies and techniques that can help guide psychotherapy practice in the field. While caution is warranted considering the varied methodological attributes and findings across different studies, clinicians may be informed by the preponderance of extant data. Extensive prior research has consistently found a significant relationship between therapeutic alliance with therapy process and outcome [1–4]. Moreover, alliance has been found to be one of the most robust predictors of positive psychotherapy outcome regardless of the type of therapy utilized or whether assessed by therapist, client, or independent observer [1]. Thus, alliance research has the potential to significantly inform the treatment approach for a wide range of practicing therapists. With this in mind, the aim of this chapter is to review and summarize the contemporary research on the relationship between specific therapist attributes and interventions on the therapeutic alliance. The synthesized research is inclusive and incorporates varied models of psychotherapy, including humanistic, experiential, cognitive-behavioral, supportive–expressive, interpersonal, motivation-enhancing, relational, and other prevalent psychotherapy orientations. We will first summarize techniques that have been found to significantly enhance the alliance during specific, initial phases of psychotherapy and then move to therapist activities and characteristics that have been found to positively or negatively affect the alliance across treatment. Finally, we will discuss how these therapist activities and characteristics related to alliance may be related to both the initiation and resolution of treatment ruptures.

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