Reflection on Therapeutic Alliance

This conceptual reflection on therapeutic alliance will use Rolfe et al.’s Framework for
Reflexive Learning (2001).

What?

“Therapeutic alliance is achieved when patient and therapist share beliefs with regard
to the goals of the treatment and view the methods used to achieve these as efficacious and
relevant” (Ardito and Rabellino 2011, p. 2). This requires both the therapist and the client to
follow through on specific tasks and also the development of a trusting, confident,
collaborative relationship. The trusting relationship supports the client to believe that the
therapist has the skills and knowledge to assist himself/herself (Ardito and Rabellino 2011).
Ackerman and Hilsenroth (2003) identified attributes and techniques in order to effectively
implement a therapeutic alliance. To positively implement a therapeutic alliance attributes of
the therapist such as being adaptable, honesty, respectfulness, trustworthiness, being
approachable and confident are beneficial. Additionally, techniques that have been reported
as supportive of a therapeutic alliance include reflection, noting of previous therapy
successes, accurate interpretation, and recognising the patient’s experiences (Ackerman and
Hilsenroth 2003).

So what?

A therapeutic alliance has an impact on client engagement in therapy and treatment

outcomes of pain, physical and mental health, and disability. Hall et al.’s (2010) systematic
review on 13 studies of people in physical rehabilitation highlights that a therapeutic alliance
improves treatment adherence, treatment satisfaction and treatment outcome. In addition, a
study focused on the impact of a therapeutic alliance on psychotherapy outcomes
acknowledges that a positive therapeutic alliance is linked with positive outcomes for
people’s psychological health and wellbeing (Horvath 2001). Trust is built as a result of a
therapeutic alliance. Hence, clients are more willing to self-report their health status, which in
turn correlates with stronger outcome expectations (Lee and Lin 2009). Therefore, trust
enables the client to accept, adhere and have confidence in the treatment.

Adopting a therapeutic alliance with clients as a healthcare professional supports a

quality healthcare system as a therapeutic alliance supports client-centredness, due to its
emphasis on building a trusting relationship between the client and therapist in which goals

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and interventions are mutually agreed. Additionally, this concept supports effectiveness and
efficiency of the healthcare system as it links with improved outcomes and client satisfaction.
Therefore, developing a therapeutic alliance with my future clients will have positive
implications for both client’s health and wellbeing and also at the wider systems level,
namely, the healthcare system.

What next?

With the knowledge of the benefits of therapeutic alliance in mind, as well as the
identified attributes and techniques to effectively adopt this concept, in practice I will be
mindful that a trusting relationship takes time, requires the therapist to display competence
and confidence, and involves the use of interpersonal skills, including actively listening and
eliciting of the client’s experiences. I will ensure that I communicate with clients in an
inclusive manner and use language that is understood by the client in order for the client to
understand and mutually agree on goals and interventions. I will be confident and competent
in the situation that I am dealing with through engaging with evidence-based resources and
continuous professional development opportunities so I am updated with new research
relevant to my scope of practice. Finally, I will develop a relationship with clients through
identifying their interests and providing an opportunity for them to share their experiences
and life stories.

References

Ackerman, S. J. and Hilsenroth, M. J. (2003) ‘A review of therapist characteristics and

techniques positively impacting the therapeutic alliance’, Clinical Psychology

Review, 23(1), 1–33, available: https://doi.org/10.1016/s0272-7358(02)00146-0

Ardito, R.B. and Rabellino, D. (2011) ‘Therapeutic alliance and outcome of psychotherapy:

historical excursus, measurements, and prospects for research’, Frontiers in

Psychology, 270(2), 1-11, available: https://doi.org/10.3389%2Ffpsyg.2011.00270.

Hall, A.M., Ferreira, P.H., Maher, C.G., Latimer, J. and Ferreira, M.L. (2010) ‘The influence

of the therapist-patient relationship on treatment outcome in physical rehabilitation: a

systematic review’. Physical Therapy, 90(8), 1099-1110, available:
https://doi.org/10.2522/ptj.20090245.

Horvath, A.O. (2001) ‘The alliance’. Psychotherapy: Theory, research, practice, training,

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 38(4), 365-372, available: https://psycnet.apa.org/doi/10.1037/0033-3204.38.4.365.

Lee, Y.Y. and Lin J.L. (2009) ‘The effects of trust in physician on self-efficacy, adherence
and

diabetes outcomes’, Soc Sci Med, 68(6), 1060 –1068, available:

https://doi.org/10.1016/j.socscimed.2008.12.033.

Rolfe, G., Freshwater, D. and Jasper, M. (2001) Critical reflection in nursing and the helping

professions: a user’s guide. Basingstoke: Palgrave Macmillan.