Relationships

Abstract:

The therapeutic alliance, or working alliance, has been shown to be reliably predictive of therapy outcome. The therapy relationship is, conceivably, the most significant variable in the treatment process. This appears to be so regardless of theoretical orientation or treatment method. As an area research studies have focused on defining the construct, methods of measurement, issues of validity and reliability and development of proper research designs. While much work is still needed in all of these areas, consensus does exits that there is a high correlation between the quality of the therapy relationship and a successful conclusion to treatment.

As would be expected, identifying the complex elements of the therapy relationship has been the subject of much examination in the literature. For the purposes of this chapter the components have been limited to the influence of: therapist/client variables, attachment styles, cultural variables, theoretical orientations, relationship congruence, alliance ruptures and the focus of relational analysis. Attention is also paid to crucial non-verbal elements.

The overall quality of the relationship, e.g., whether or not the therapy participants are able to establish and maintain feelings of mutual trust, fondness and respect, is vital to the formation of a strong therapeutic bond. As is true in any relationship, the therapy alliance is an interactive phenomenon that is difficult to define and precisely measure, however, certain relational skills and competencies have been identified as essential to alliance formation. Basic competencies include self-awareness, empathic and genuine responding, maintaining relationship congruence and proper role boundaries, and interpersonal styles. Expert competencies include cultural competencies, knowledge of how to identify and repair alliance ruptures, negotiating treatment impasses, and how to utilize analysis of the relationship as part of the treatment. Case examples are offered to illustrate each of the Basic and Expert competencies.