The therapeutic relationship
, also called the helping alliance, the therapeutic alliance, and the working alliance, refers to the relationship between a healthcare professional and a client
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
(or patient). It is the means by which the professional hopes to engage with, and affect change in a client.
While much early work on this subject was generated from a psychodynamic perspective, researchers from other orientations have since investigated this area. It has been found to predict treatment adherence (compliance) and concordance and outcome
In a clinical research trial, a clinical endpoint generally refers to occurrence of a disease, symptom, sign or laboratory abnormality that constitutes one of the target outcomes of the trial, but may also refer to any such disease or sign that strongly motivates the withdrawal of that individual...
across a range of client/patient diagnoses and treatment settings. Research on the statistical power of the therapeutic relationship now reflects more than 1,000 findings.
Components of the therapeutic relationship
The therapeutic relationship has been theorized to consist of three parts: the working alliance, transference
Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another. One definition of transference is "the inappropriate repetition in the present of a relationship that was important in a person's childhood." Another definition is "the...
Countertransferenceis defined as redirection of a psychotherapist's feelings toward a client—or, more generally, as a therapist's emotional entanglement with a client.-Early formulations:...
, and the real relationship. Evidence on each component's unique contribution to outcome has been gathered, as well as evidence on the interaction between components.
Also known as the therapeutic alliance, working alliance is not to be confused with the therapeutic relationship, of which it is theorized to be a component.
The working alliance may be defined as the joining of a client's reasonable side with a therapist's working or analyzing side. Bordin conceptualized the working alliance as consisting of three parts: tasks, goals, and bond.
Goals are what the client hopes to gain from therapy, based on his or her presenting concerns. Tasks are what the therapist and client agree need to be done to reach the client's goals. The bond forms from trust and confidence that the tasks will bring the client closer to his or her goals.
Research on the working alliance suggests that it is a strong predictor of psychotherapy or counseling client outcome. Also, the way in which the working alliance unfolds has been found to be related to client outcomes. Generally, an alliance that experiences a rupture that is repaired is related to better outcomes than an alliance with no ruptures, or an alliance with a rupture that is not repaired. Also, in successful cases of brief therapy, the working alliance has been found to follow a high-low-high pattern over the course of the therapy.
Operationalization and measurement
Several scales have been developed to assess the patient-professional relationship in therapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, including the Working Alliance Inventory (WAI), the Barrett-Lennard Relationship Inventory, and the California Psychotherapy Alliance Scales (CALPAS). The Scale To Assess Relationships (STAR) was specifically developed to measure the therapeutic relationship in community psychiatry, or within care in the community
Care in the Community is the British policy of deinstitutionalization, treating and caring for physically and mentally disabled people in their homes rather than in an institution...