Encyclopedia of Psychology and Religion

2020 Edition
| Editors: David A. Leeming

Therapeutic Alliance

Reference work entry
DOI: https://doi.org/10.1007/978-3-030-24348-7_9376

What Is Therapeutic Alliance?

The concept of the therapeutic alliance originated in psychoanalytic theories (e.g., Freud 1912/1958, 1913; Greenson 1965). Now it has become a pan-theoretic concept (Ackerman and Hilsenroth 2003). Therapeutic alliance is broadly defined as the overall bond between therapist and client evolving during the process of therapy (Horvath et al. 2011). Although there are different conceptualizations of therapeutic alliance, three often-highlighted aspects include patient’s and therapist’s ability to agree on treatment goals and tasks, the collaborative nature of the relationship, and the affective bond between patient and therapist (Bordin 1979; Gaston 1990; Horvath and Symonds 1991; Saunders et al. 1989).

What Can We Learn About Therapeutic Alliance from Different Theoretical Orientations?

Different theoretical orientations in psychotherapy, such as psychoanalytic, psychodynamic, humanistic, and cognitive, have contributed to our understanding of therapeutic...

This is a preview of subscription content, log in to check access.


  1. Ackerman, S. J., & Hilsenroth, M. J. (2001). A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy: Theory, Research, Practice, Training, 38(2), 171–185.CrossRefGoogle Scholar
  2. Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1), 1–33.PubMedCrossRefGoogle Scholar
  3. American Counseling Association. (2014). ACA code of ethics. Alexandria: Author.Google Scholar
  4. Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: Historical excursus, measurements, and prospects for research. Frontiers in Psychology, 2(1), 270–280.PubMedPubMedCentralGoogle Scholar
  5. Bishop, R. D. (1992). Religious values as cross-cultural issues in counseling. Counseling and Values, 36, 179–191.CrossRefGoogle Scholar
  6. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.CrossRefGoogle Scholar
  7. Castonguay, L. G., Constantino, M. J., & Grosse Holtforth, M. (2006). The working alliance: Where are we and where should we go? Psychotherapy: Theory, Research, Practice, Training, 43, 271–279.CrossRefGoogle Scholar
  8. D’Andrea, L., & Sprenger, J. (2007). Atheism and nonspirituality as diversity issues in counseling. Counseling and Values, 51(2), 149.CrossRefGoogle Scholar
  9. Falkenström, F., Granström, F., & Holmqvist, R. (2013). Therapeutic alliance predicts symptomatic improvement session by session. Journal of Counseling Psychology, 60(3), 317–328.PubMedCrossRefGoogle Scholar
  10. Flückiger, C., Del Re, A. C., Wampold, B. E., Znoj, H., Caspar, F., & Jörg, U. (2012). Valuing clients’ perspective and the effects on the therapeutic alliance: A randomized controlled study of an adjunctive instruction. Journal of Counseling Psychology, 59(1), 18–26.PubMedCrossRefGoogle Scholar
  11. Frank, A. F., & Gunderson, J. G. (1990). The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Archives of General Psychiatry, 47, 228–236.PubMedCrossRefGoogle Scholar
  12. Freebury, D. R. (1989). The therapeutic alliance: A psychoanalytic perspective. Canadian Journal of Psychiatry, 34, 772–774.PubMedCrossRefGoogle Scholar
  13. Freud, S. (1913). On the beginning of treatment: Further recommendations on the technique of psychoanalysis. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (pp. 122–144). London: Hogarth Press.Google Scholar
  14. Freud, S. (1958). The dynamics of transference. In J. Starchey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (pp. 99–108). London: Hogarth Press. (Original work published 1912).Google Scholar
  15. Gaston, L. (1990). The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations. Psychotherapy, 27, 143–153.CrossRefGoogle Scholar
  16. Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Counseling Psychology, 41, 296–306.CrossRefGoogle Scholar
  17. Greenson, R. R. (1965). The working alliance and the transference neurosis. Psychoanalysis Quarterly, 34, 155–181.CrossRefGoogle Scholar
  18. Hayes, A. M., Laurenceau, J. P., Feldman, G., Strauss, J. L., & Cardaciotto, L. (2007). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27(6), 715–723.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Henry, W. P., & Strupp, H. H. (1994). The therapeutic alliance as interpersonal process. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research and practice (pp. 51–84). New York: Wiley.Google Scholar
  20. Hilsenroth, M. J., & Cromer, T. D. (2007). Clinician interventions related to alliance during the initial interview and psychological assessment. Psychotherapy: Theory, Research, Practice, Training, 44, 205–218.CrossRefGoogle Scholar
  21. Horvath, A. O. (2005). The therapeutic relationship: Research and theory. Psychotherapy Research, 15, 3–7.CrossRefGoogle Scholar
  22. Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychology: A meta-analysis. Journal of Counseling Psychology, 38, 139–149.CrossRefGoogle Scholar
  23. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16.PubMedCrossRefGoogle Scholar
  24. Karver, M. S., Handelsman, J. B., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26(1), 50–65.PubMedCrossRefGoogle Scholar
  25. Keating, A. M., & Fretz, B. R. (1990). Christians’ anticipations about counselors in response to counselor descriptions. Journal of Counseling Psychology, 37, 293–296.CrossRefGoogle Scholar
  26. Kivlighan, D. M., & Shaughnessy, P. (2000). Patterns of working alliance development: A typology of working alliance ratings. Journal of Counseling Psychology, 47, 362–371.CrossRefGoogle Scholar
  27. Koenig, H. G. (2007). Spirituality in patient care (2nd ed., pp. 161–174). Philadelphia: Templeton Foundation Press.Google Scholar
  28. Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64(3), 532–539.PubMedCrossRefGoogle Scholar
  29. Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357–361.CrossRefGoogle Scholar
  30. Leahy, R. (2008). The therapeutic relationship in cognitive-behavioral therapy. Behavioural and Cognitive Psychotherapy, 36(6), 769–777.CrossRefGoogle Scholar
  31. Marmar, C. R., Gaston, L., Gallagher, D., & Thompson, L. W. (1989). Therapeutic alliance and outcome in behavioral, cognitive, and brief dynamic psychotherapy in late-life depression. Journal of Nervous and Mental Disease, 177, 464–472.PubMedCrossRefGoogle Scholar
  32. Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.PubMedCrossRefGoogle Scholar
  33. McLaughlin, A. A., Keller, S. M., Feeny, N. C., Youngstrom, E. A., & Zoellner, L. A. (2014). Patterns of therapeutic alliance: Rupture-repair episodes in prolonged exposure for PTSD. Journal of Consulting and Clinical Psychology, 82(1), 112–121.PubMedCrossRefGoogle Scholar
  34. McLeod, B. D. (2011). Relation of the alliance with outcomes in youth psychotherapy: A meta-analysis. Clinical Psychology Review, 31(4), 603–616.PubMedCrossRefGoogle Scholar
  35. Meier, P. S., Barrowclough, C., & Donmall, M. C. (2005). The role of the therapeutic alliance in the treatment of substance misuse: A critical review of the literature. Addiction, 100(3), 304–316.PubMedCrossRefGoogle Scholar
  36. Morrison, J., Clutter, S., Pritchett, E., & Demmitt, A. (2009). Perceptions of clients and counseling professionals regarding spirituality in counseling. Counseling and Values, 53(3), 183.CrossRefGoogle Scholar
  37. Overholser, J. (2007). The central role of the therapeutic alliance: A simulated interview with Carl Rogers. Journal of Contemporary Psychotherapy, 37(2), 71–78.CrossRefGoogle Scholar
  38. Quackenbos, S., Privette, G., & Kelntz, B. (1985). Psychotherapy: Sacred or secular? Journal of Counseling and Development, 63, 290–293.CrossRefGoogle Scholar
  39. Richards, P. S., & Bergin, A. E. (1997). A spiritual strategy for counseling and psychotherapy. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  40. Rose, E., Westefeld, J., & Ansley, T. (2001). Spiritual issues in counseling: Clients’ beliefs and preferences. Journal of Counseling Psychology, 48(1), 61.CrossRefGoogle Scholar
  41. Safran, J. D., & Muran, J. C. (1996). The resolution of ruptures in the therapeutic alliance. Journal of Consulting and Clinical Psychology, 64(3), 447–458.PubMedCrossRefGoogle Scholar
  42. Safran, J. D., & Muran, J. C. (2000). Resolving therapeutic alliance ruptures: Diversity and integration. Journal of Clinical Psychology, 56(2), 233–243.PubMedCrossRefGoogle Scholar
  43. Safran, J. D., & Muran, J. C. (2001). The therapeutic alliance as a process of intersubjective negotiation. In J. C. Muran (Ed.), Self-relations in the psychotherapy process (pp. 165–192). Washington, DC: American Psychological Association Books.CrossRefGoogle Scholar
  44. Safran, J. D., Muran, J. C., Samstag, L. W., & Stevens, C. (2002). Repairing alliance ruptures. In J. C. Norcorss (Ed.), Psychotherapy relationships that work (pp. 235–254). New York: Oxford University Press.Google Scholar
  45. Saunders, S. M., Howard, K. I., & Orlinsky, D. E. (1989). The therapeutic bond scales: Psychometric characteristics and relationship to treatment effectiveness. Psychological Assessment, 1, 323–330.CrossRefGoogle Scholar
  46. Sharf, J., Primavera, L. H., & Diener, M. J. (2010). Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 47(4), 637–645.CrossRefGoogle Scholar
  47. Shirk, S. R., Karver, M. S., & Brown, R. (2011). The alliance in child and adolescent psychotherapy. Psychotherapy, 48(1), 17–24.PubMedCrossRefGoogle Scholar
  48. Stiles, W. B., Glick, M. J., Osatuke, K., Hardy, G. E., Shapiro, D. A., Agnew-Davies, R., Rees, A., & Barkham, M. (2004). Patterns of alliance development and the rupture-repair hypothesis: Are productive relationships U-shaped or V-shaped? Journal of Counseling Psychology, 51(1), 81–92.CrossRefGoogle Scholar
  49. Strauss, J. L., Hayes, A. M., Johnson, S. L., Newman, C. F., Brown, G. K., Barber, J. P., Laurenceau, J., & Beck, A. T. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2), 337–345.PubMedPubMedCentralCrossRefGoogle Scholar
  50. Thurer, S., & Hursch, N. (1981). Characteristics of the therapeutic relationship. Clinical practice of psychology, 62–82.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Clinical PsychologyUniversity of Massachusetts AmherstAmherstUSA
  2. 2.Clinical Psychology, Department of PsychiatryCambridge Health Alliance/Harvard Medical SchoolCambridgeUSA