The Therapeutic Alliance
The relationship between therapist and client is important. How a therapist and client connect, behave, and engage with each other is one of the main tools for creating positive change in a client’s life. This relationship, called the therapeutic alliance, is a powerful component of the efficacy of psychotherapy.
What defines the therapeutic relationship?
The power of the therapeutic alliance wasn’t always present. Back in Freud’s day, clients were patients, and patients were meant to be kept at arm’s length in order to thwart transference or the projection of unconscious feelings onto the analyst. Even today, the stereotype of a distant, detached therapist scribbling notes while someone lays on a couch remains a stereotype. Over time, figures in the psychology community began to realize how beneficial an attachment could be between a client and their therapist. Freud eventually changed his tune, and with the help of other influential psychologists, like Carl Jung, more progressive ideas about the therapeutic relationship began to emerge. These ideas revealed new considerations, such as the possibility of a therapist sharing their thoughts and feelings with their client.
Enter Carl Rogers, from whom we received the theory of Person Centered Psychotherapy. He posits that there are three main ingredients to a successful therapeutic relationship: congruence, empathy, and unconditional positive regard (Baldwin, 1987).
Congruence
Congruence, or genuineness, in the therapeutic relationship asks therapists to be themselves. How a client perceives their therapist is an important indicator of the therapeutic alliance. When a therapist engages with their client in a sincere, open, and honest way, an amazing thing happens: a client is able to view themselves through the lens of being human. Therapists who embody genuineness have usually achieved a certain level of self awareness through their own work in order to be able to share their experiences in a way that is safe and beneficial to their clients.
Empathy
First, let's differentiate empathy from sympathy, which is feeling sorry for someone’s misfortune. Empathy is more complex, and accesses a deeper understanding of someone else’s experience, often expressed through the idiom of putting oneself in someone’s shoes. When a therapist makes a genuine effort to understand their client through being present and actively listening to what their client is going through, the therapeutic alliance thrives.
Unconditional Positive Regard
Unconditional positive regard happens when a therapist accepts their client for all that they are, which encompasses “good” and “bad” thoughts and emotions. Very often, clients have endured years of being in relationships where conditions have been placed upon them in order to achieve acceptance. Therapists aim to provide a safe space where clients can let their guard down and experience what a healthy, trusting relationship is like.
What does the therapeutic alliance look like?
In summary, the therapeutic alliance mediates change. In practicality, this might mean that a therapist and client come to a mutual agreement about how therapy can progress. They might also collaborate on therapeutic goals and decide what “showing up”, or active participation might look like in their work together. Oftentimes, the therapeutic alliance goes unnamed in a session, but it is still hard at work. If you haven’t done so already, bring up the idea of the therapeutic alliance with your own therapist–you might find relief, joy, and comfort in discussing your shared connection in this work.
Sources:
Baldwin, M. (1987). Interview with Carl Rogers on the use of the self in therapy. Journal of Psychotherapy and the Family, 3(1), 45–52
Kristen Lindley is a Self Space Seattle therapist who has experience working with people who are experiencing anxiety, depression, life transitions, aging, grief and loss, eating disorders, trauma, and women’s issues.