Process / Middle
Therapeutic alliance
The working relationship between client and practitioner, often described as agreement on goals and tasks together with an emotional bond.
Overview
The therapeutic alliance, also called the working alliance, is the collaborative relationship between a client and a practitioner. It is a way of describing how the two people work together, rather than a technique that belongs to one approach.
Core ideas
Edward Bordin described the working alliance as having three parts: agreement on the goals of the work, agreement on the tasks that make up the work, and a bond between the two people. On this view an alliance is built and renegotiated over time. It is not a fixed quality present or absent from the first meeting.
Carl Rogers described conditions in the relationship, such as empathy and unconditional positive regard, that he considered necessary for change. Writers in other traditions use different words for related ideas.
What it can look like in practice
Practitioners may check that a client understands what the sessions are for, ask what the client makes of the way they are working, and adjust. A client may notice whether they feel able to disagree, ask questions or say that something is not helping.
A constructed example
Constructed for learning. Not a real case.
A client says they want to feel less anxious at work. The practitioner suggests keeping a short diary between sessions. The client says they would rather talk through a recent meeting first. The practitioner agrees to start there and to return to the diary later. In Bordin's terms the goal is shared, the task has been discussed and adjusted, and the exchange itself contributes to the bond.
What research examines
Research reviews, including Horvath and colleagues (2011), examine how the quality of the alliance relates to outcome in individual psychotherapy. An association between alliance and outcome does not by itself show that the alliance causes change. This entry does not compare approaches or say which works better, and it does not report effect sizes because the review's text has not yet been read for this site.
UK and US
The concept is used in research and training in both countries. No difference between the UK and the US is described here.
Limits and open questions
Alliance is measured in different ways, often by questionnaire, and different raters can see the same relationship differently. A 2024 review identified 48 self-report measures for individual adult psychotherapy, 46 for face-to-face work and two for online work. The authors noted that patients' and practitioners' perspectives were not sufficiently represented in current concepts and measures. How alliance and change influence each other over time is debated. A strong alliance does not remove the need for clear agreements and boundaries.
History
Bordin's account of the working alliance appeared in 1979, building on earlier psychoanalytic uses of the term. Rogers's paper on conditions for change was published in 1957.
Sources and inspection notes
Supports: The existence and date of Bordin's account of the working alliance. Bibliographic record confirmed through Crossref; the full text was not read.
Supports: That the alliance has been reviewed in relation to outcome in individual psychotherapy. Bibliographic record confirmed through Crossref; the full text was not read.
Supports: The existence and date of Rogers's account of conditions for change in therapy. Bibliographic record confirmed through Crossref; the full text was not read.
Supports: A review of alliance concepts, including Bordin’s three components and earlier psychoanalytic accounts, and 48 self-report measures in individual adult psychotherapy. The authors discuss limitations in the representation of patients’ and practitioners’ perspectives.