Building the Working Alliance in Brief Psychotherapies

  • Christa Zimmermann
  • Hanneke De Haes


Psychotherapy is unconceivable without communication between the healthcare provider and the client. Thus, good communication is essential for effective treatment in mental health care. Yet, what actually happens during the psychotherapy encounter has been given limited attention in the literature to date.


Bulimia Nervosa Therapeutic Relationship Therapy Session Communicative Behavior Working Alliance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ackerman, S. J., Hilsenroth, M. J., Baity, M. R., & Blagys, M. D. (2000). Interaction of therapeutic process and alliance during psychological assessment. Journal of Personality Assessment, 75, 82–109.CrossRefPubMedGoogle Scholar
  2. Ackerman, S. J., & Hilsenroth, M. J. (2001). A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy, 38, 171–185.Google Scholar
  3. Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1–33.CrossRefPubMedGoogle Scholar
  4. Andrusyna, T. P., Tang, T. Z., De Rubeis, R. J., & Luborsky, L. (2001). The factor structure of the working alliance inventory for cognitive behavioural therapy. Journal of Psychotherapy Research and Practice, 10, 173–178.Google Scholar
  5. Bachelor, A. (1995). Clients’ perception of the therapeutic alliance: A qualitative analysis. Journal of Counseling Psychology, 42, 323–337.CrossRefGoogle Scholar
  6. Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance–outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842–852.CrossRefPubMedGoogle Scholar
  7. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.Google Scholar
  8. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.CrossRefGoogle Scholar
  9. Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision making in the medical encounter: What does it mean? Social Science and Medicine, 44, 681–692.CrossRefPubMedGoogle Scholar
  10. Chiu, A. W., McLeod, B. D., Har, K., & Wood, J. J. (2009). Child–therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders. Journal of Child Psychology and Psychiatry, 50, 751–758.CrossRefPubMedGoogle Scholar
  11. Costantino, M. J., Arnow, B. A., Blasey, C., & Agras, W. S. (2005). The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa. Journal of Consulting and Clinical Psychology, 73, 203–211.CrossRefGoogle Scholar
  12. Creed, T. A., & Kendall, P. C. (2005). Therapist alliance-building behavior within a cognitive-behavioral treatment for anxiety in youth. Journal of Consulting and Clinical Psychology, 73, 498–505.CrossRefPubMedGoogle Scholar
  13. Crits-Christoph, P., Conolly Gibbons, M. B., Crits-Christoph, K., Narducci, J., Schamberger, M., & Gallop, R. (2006). Can therapists’ be trained to improve their alliances? A preliminary study of alliance fostering psychotherapy. Psychotherapy Research, 16, 268–281.CrossRefGoogle Scholar
  14. De Haes, H., & Bensing, J. (2009). Endpoints in medical communication research, proposing a framework of functions and outcomes. Patient Education and Counseling, 74, 287–294.CrossRefPubMedGoogle Scholar
  15. Elvins, R., & Green, J. (2008). The conceptualization and measurement of therapeutic alliance. Clinical Psychology Review, 28, 1167–1187.CrossRefPubMedGoogle Scholar
  16. Fitzpatrick, M. R., Stalikas, A., & Iwakabe, S. (2001). Examining counselor interventions and client progress in the context of the therapeutic alliance. Psychotherapy, 38, 160–170.Google Scholar
  17. Freud, S. (1913). On the beginning of treatment: Further recommendations on the technique of psychoanalysis. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (pp. 122–144). London: Hogarth Press.Google Scholar
  18. Gastonguay, L. G., Goldfried, M. R., Wiser, S., Raue, P. J., & Hayes, A. M. (1996). Predicting the effects of cognitive therapy for depression: A study of unique and common factors. Journal of Consulting and Clinical Psychology, 64, 497–504.CrossRefGoogle Scholar
  19. Goldfried, M. R., & Davila, J. (2005). The role of relationship and technique in therapeutic change. Psychotherapy, 42, 421–430.Google Scholar
  20. Harmon, S. C., Lambert, M. J., Smart, D. M., Hawkins, E., Nielsen, S. L., Slade, K., et al. (2007). Enhancing outcome for potential treatment failures: Therapist–client feedback and clinical support tools. Psychotherapy Research, 17, 379–392.CrossRefGoogle Scholar
  21. Hawley, L. L., Ringo Ho, M. H., Zuroff, D. C., & Blatt, S. J. (2006). The relationship of perfectionism, depression, and therapeutic alliance during treatment for depression: Latent difference score analysis. Journal of Consulting and Clinical Psychology, 74, 930–942.CrossRefPubMedGoogle Scholar
  22. Hilsenroth, M. J., & Cromer, T. D. (2007). Clinical interventions related to alliance during the initial interview and psychological assessment. Psychotherapy: Theory, Research, Practice, Training, 44, 205–218.CrossRefGoogle Scholar
  23. Hilsenroth, M. J., Peters, E., & Ackerman, S. (2004). Effects of structured clinical training on patient and therapist perspectives of alliance in early psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 39, 309–323.CrossRefGoogle Scholar
  24. Horvath, A. O. (2005). The therapeutic relationship: Research and theory. Psychotherapy Research, 15, 3–7.CrossRefGoogle Scholar
  25. Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.CrossRefGoogle Scholar
  26. Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561–573.CrossRefPubMedGoogle Scholar
  27. Janzen, J., Fitzpatrick, M., & Drapeau, M. (2008). Processes involved in client-nominated relationship building incidents: Client attachment, attachment to therapist, and session impact. Psychotherapy: Theory, Research, Practice, Training, 45, 377–390.CrossRefGoogle Scholar
  28. Kivlighan, D. M. (2007). Where is the relationship in research on the alliance? Journal of Counseling Psychology, 54, 423–433.CrossRefGoogle Scholar
  29. Klein, D. N., Schwartz, J. E., Santiago, N. J., Vivian, D., Vocisano, C., Castonguay, L. G., et al. (2003). Therapeutic alliance in depression treatment: Controlling for prior change and patient characteristics. Journal of Consulting and Clinical Psychology, 71, 997–1006.CrossRefPubMedGoogle Scholar
  30. Knaevelsrud, C., & Maercker, A. (2006). Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients? Journal of Medical Internet Research, 8, e31.CrossRefPubMedGoogle Scholar
  31. Leahy, R. L. (2008). The therapeutic relationship in cognitive behavioural therapy. Behavioural and Cognitive Psychotherapy, 36, 769–777.CrossRefGoogle Scholar
  32. Lejuez, C. W., & Hopko, D. R. (2006). The therapeutic alliance in behaviour therapy. Psychotherapy: Theory, Research, Practice, Training, 42, 456–468.CrossRefGoogle Scholar
  33. Loeb, K. L., Wilson, G. T., Labouvie, E., Pratt, E. M., Hayaki, J., Walsh, B. T., et al. (2005). Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: A study of process and outcome. Journal of Consulting and Clinical Psychology, 73, 1097–1107.CrossRefPubMedGoogle Scholar
  34. 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, 438–450.CrossRefPubMedGoogle Scholar
  35. Mohl, P. C., Martinez, D., Ticknor, C., Huang, M., & Cordell, L. (1991). Early drop outs from psychotherapy. Journal of Nervous and Mental Diseases, 172, 417–423.Google Scholar
  36. Obegi, J. H. (2008). The development of the client-therapist bond through the lens of attachment theory. Psychotherapy, 45, 431–446.Google Scholar
  37. Rector, N. A., Zuroff, D. C., & Segal, Z. V. (1999). Cognitive change and the therapeutic alliance: The role of technical and nontechnical factors in cognitive therapy. Psychotherapy, 36, 320–328.Google Scholar
  38. Rhodes, R. H., Hill, C. E., Thompson, B. J., & Elliot, R. (1994). Client retrospective recall of resolved and unresolved misunderstanding events. Journal of Consulting and Clinical Psychology, 41, 473–483.Google Scholar
  39. Rogers, C. R. (1951). Client-centered therapy. Cambridge, MA: Riverside Press.Google Scholar
  40. Rumpold, G., Doering, S., Smrekar, U., Schubert, C., Koza, R., Schatz, D., et al. (2005). Changes in motivation and the therapeutic alliance during pre-therapy diagnostic and motivation-enhancing phase among psychotherapy outpatients. Psychotherapy Research, 15, 117–127.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, 347–458.CrossRefGoogle Scholar
  42. Sexton, H. C., Hembre, K., & Kvarme, G. (1996). The interaction of the alliance and therapy microprocess: A sequential analysis. Journal of Consulting and Clinical Psychology, 64, 471–480.CrossRefPubMedGoogle Scholar
  43. Sexton, H., Littauer, H., Sexton, A., & Tommeras, E. (2005). Building an alliance: Early process and the client therapist connection. Psychotherapy Research, 15, 103–116.CrossRefGoogle Scholar
  44. Strauss, J. L., Hayes, A. M., Johnson, S. L., Newman, C. F., Brown, G. K., Barber, J. P., et al. (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, 337–345.CrossRefPubMedGoogle Scholar
  45. Taft, C. T., Murphy, C. M., King, D. W., Musser, P. H., & DeDeyn, J. M. (2003). Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men. Journal of Consulting and Clinical Psychology, 71, 812–820.CrossRefPubMedGoogle Scholar
  46. Tryon, G. S. (1990). Session depth and smoothness in relation to the concept of engagement in counseling. Journal of Consulting and Clinical Psychology, 37, 248–263.Google Scholar
  47. Tryon, G. S., Blackwell, S. C., & Hammel, E. F. (2008). The magnitude of client and therapist working alliance ratings.Psychotherapy, 45, 546–551.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Public Health and Community MedicineUniversity of VeronaVeronaItaly

Personalised recommendations