Therapeutic alliance

The therapeutic relationship (also therapeutic alliance, the helping alliance, or the working alliance) refers to the relationship between a healthcare professional and a client (or patient). It is the means by which a therapist and a client hope to engage with each other, and effect beneficial change in the client.

While much early work on this variable 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 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. Informal coercion is common, and may be unintentional on the part of the therapist.

In the humanistic approach, Carl Rogers identified a number necessary and sufficient conditions that are required for therapeutic change to take place. These include the three core conditions: congruence, unconditional positive regard and empathy.

In psychoanalysis, the therapeutic relationship has been theorized to consist of three parts: the working alliance, transference/countertransference, 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. In contrast to a social relationship, the focus of the therapeutic relationship is on the client's needs and goals.

The concept of therapeutic relationship was described by Freud (1912) as "friendly affectionate feeling" in the form of positive transference.

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