Working together is an important part of the psychotherapeutic relationship between the client and the therapist. Building solid, mutually trusting connections is the cornerstone of successful treatment. Clients must have a sense of safety that allows them to express their most private thoughts and feelings for therapy to be effective. This often entails exploring hidden corners of their psyche, of which they may not be quite aware. As a result, the therapeutic alliance provides a haven where clients feel at ease and can embrace their inherent complexity and wholeness.
Why is a therapeutic alliance so important?
The first contributions to distinguishing what a therapeutic alliance is and its importance came from psychoanalytic authors. For example, some authors define it as a more evolved pattern of relationship where clients’ participation and therapists’ collaboration are very much highlighted. This would mean that the client must have positive motivation for transformation and change, and that a strong alliance must include rational interchange between the therapist and the client. More recent research in psychodynamic approaches shows that the therapeutic alliance, transference, and resistance are central elements of the therapeutic relationship, and that from these concepts one can anticipate the ongoing life experience of the client.
Narrative approaches insist on a multi-step approach to treatment, where in the first phase the emphasis should be on forming therapeutic alliances and normalizing clients’ feelings, followed by the second phase (narrative integration by learning through countertransference), and the third phase, in which the focus of treatment should be on strengthening the client’s agency if “the conditions for autonomy are met.” On a similar note, existential therapists insist on using the phenomenological method, where attention to the client’s lived experience in a value-free way will create a safe space for processing existential anxiety and making steps toward authenticity, first in the therapy room and then in other relationships.
So, from the very beginning of this concept, it was remarkably clear that good collaboration and a strong alliance between the therapist and the client are necessary ingredients for meaningful and long-lasting change. In the words of a famous humanistic psychologist, Carl Rogers:
“In my early professional years, I was asking the question: How can I treat, cure, or change this person? Now I would rephrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?”
Nowadays, research shows that there is enough evidence that the quality of the therapeutic alliance is associated with the success of psychotherapeutic treatment with different types of clients, treatment modalities used, presenting problems, contexts, and measurements. Scholars define it differently, but there are three most common themes in their definitions:
- The collaborative nature of the relationship
- The affective bond between client and therapist
- The client’s and therapist’s ability to agree on treatment goals and tasks
It does not matter what kind of psychotherapy is in question—these three themes emerge in every therapeutic process, and they are included in every successful outcome. A meta-analytic review showed that the overall relationship between therapeutic alliance and outcome is moderate but consistent. In fact, despite the modest proportion of total variance in treatment outcome, therapeutic alliance is one of the most robust and strongest predictors of treatment success. Further, the therapeutic alliance might be the “holy grail” of psychotherapy competence (it is clearly defined, easily measured, and may have educational and training value).
The importance of therapeutic alliances for successful outcomes cannot be overstated. It is a necessary element of psychotherapy and must be included and reflected on as part of the process. But what about the client’s own perspective on the relationship? How would that be different from the therapists’ and researchers’ viewpoints?
Therapeutic alliance from the client’s perspective
When they initially start psychotherapy, clients find it difficult to trust the stranger sitting in front of them. Even though this individual is a qualified mental health professional, they are seeing this person for the first time in their lives, and they find it difficult to trust them. This is particularly true for certain traumatized individuals who struggle with a variety of attachment issues.
Trust is critically important to the development of healthy and secure relationships. Being a trustworthy psychotherapist is not only about working hard and knowing things; it is also about developing one’s human capacities for empathy. It was shown that “differences between therapists contribute more to treatment outcomes than do differences among treatment methods.” As aforementioned, Carl Rogers emphasized that empathy, positive regard, and genuineness are cornerstones of therapeutic relationships.
Clients are usually more interested in these qualities than in the specifics of different methods and techniques. The client could feel insecure and burdened with her problems, sometimes coming with elevated levels of anxiety and distress. Applying certain techniques is often not the right way to earn the client’s trust. Of course, the therapist will have to know techniques and gain a large amount of knowledge even before he or she starts to collaborate with people in the therapy room. But the importance of human connection is often underrated. Psychotherapy is not only a well-established method or a protocol; it is also a craft. It takes years and years for one person to become good at this craft, but it also takes courage, open-mindedness, and a warm and tender heart.
Establishing a secure attachment is a crucial factor in fostering trust within the therapeutic process. Conversely, an insecure attachment can breed distrust towards the therapist. Many clients still experience the effects of early childhood attachment traumas, which show themselves as challenges in building meaningful relationships, establishing trust, and establishing a connection with others. These difficulties frequently surface in the therapeutic setting, impacting the therapeutic alliance. The development of capacities for mentalization, or the ability to “think about thinking,” is a fundamental aspect of nearly every therapeutic approach, irrespective of modality. This skill set is particularly important since it can help rebuild and foster trust. These recently learned abilities have practical applications outside of the treatment setting, impacting everyday life and encouraging healthy connections with others.
As clients begin to shift, they may encounter novel experiences, form relationships in many kinds of ways, and develop new perspectives on who they are. They begin to see themselves differently. Their perception of the entire universe can occasionally shift. Similar to how therapy is a slow, controlled transformation, trust in the therapeutic relationship is developed through it. Clients’ perception of improvement in their daily lives increases their trust in the therapist and their relationship with them, improving the therapeutic alliance. Once more, a solid relationship would provide a secure environment for their feelings and ideas, increasing the possibility of diverse behavioral experiments and creating new avenues for therapeutic change.
Transference and countertransference
While transference is the redirection of feelings about a specific person onto someone else, countertransference is the redirection of a therapist’s feelings toward the client. These phenomena occur in the therapy room, in the interaction between the therapist and the client, where emotions are transferred and mirrored between two people involved in the process.
Transference in psychotherapy is an act of projecting the client’s feelings about someone from the past onto the therapist. This phenomenon occurs in everyday situations. The therapeutic relationship is no exception. But in the beginning, it was something detrimental to the therapy process by default. Freud believed that transference is an unconscious feeling or set of feelings that develop in a therapeutic relationship; it is always pathological, repetitive, and unreflective of the present relationship between the client and the therapist. Modern psychology does not agree with that; it notes that the therapeutic relationship can be good or bad, beneficial or harmful to the client; thus, transference is multilayered, and it can be employed as a vehicle for change.
Countertransference, on the other hand, might be viewed as the therapist’s reaction to projections of the client onto the therapist. It is a kind of emotional entanglement in which unconscious motivations start to emerge. In the past, it was considered that countertransference had always been dangerous, while today, therapists are more likely to understand it as an important part of the process. Self-disclosure by the therapist is of great need here; if used gradually and skillfully, sharing the therapist’s feelings with the client might facilitate the process and can be quite beneficial for the client. Similar to transference, there has been a noticeable change in the perception of countertransference in psychotherapy, with many now viewing it as an asset rather than a barrier.
Transference and countertransference are unconscious phenomena, so the key issue here is to raise awareness and to understand and analyze the mental content that is part of the process. In the words of Carl Jung, ‘Until you make the unconscious conscious, it will direct your life, and you will call it fate.’ Both transference and countertransference, when recognized and understood, can be beneficial. The client and the therapist learn to know one another, form a genuine relationship, find strength in that relationship, and build an effective therapeutic partnership.
Duality, intersubjectivity, and therapeutic alliance
Transference and countertransference are phenomena firmly rooted in intersubjectivity. All the essential components of therapeutic change occur in the “space between” the therapist and the client.
Constructivist psychotherapists tend to emphasize that we construe our experience in the relationship between two subjects, where dualities are not present anymore—they simply melt in the presence of the two people interacting.
Only in the ‘I-Thou’ relationship can we become persons. Buber states that ‘through the Thou, a man becomes I.’ When we deal with people, it does not necessarily mean that we truly have a relationship with them. On the contrary, only by really meeting them, including mutual sacrifices, promises, and risks, can we truly engage with one another. Two subjects, the therapist and the client, create a unique relationship in which they actualize their own personalities and emerge as people with specific lived experience. Therefore, I and Thou are two poles of an inter-personal relationship—love is between I and Thou. Without the acceptance of others, there is no social process and no authentic interaction possible at all. This is maybe the best argument for unconditional positive regard (showing complete support and acceptance of a person no matter what that person says or does) as the only available perspective for the therapist.
We, as therapists, must always be aware that there are two perspectives on psychotherapy: the client’s and the therapist’s. Sometimes these perspectives differ a lot. Having a ‘binocular view’ of the process helps us to deeply appreciate the liveness of the client. He or she is not simply a passive recipient of standardized treatment. He or she is a human being, primarily, with many unique and distinctive qualities, reaching out to the therapist and establishing a deep connection that has the potential to bring about change.
Connection, acceptance, and personal growth
In every interpersonal connection, individuals undergo transformations and development, and the therapeutic relationship is no exception. The strength of the alliance forged between the therapist and the client is not only beneficial for the client but also contributes to the growth of the therapist. Recognizing the ineffectiveness of a ‘one-size-fits-all’ therapeutic approach, the therapist customizes each treatment to cater to the unique needs of the client. Through each distinct relationship, the therapist undergoes professional and personal evolution.
As individuals navigate the intricacies of their inner worlds, the therapist plays a pivotal role in fostering change and facilitating movement within the client’s personal system of meanings. The connection established between the therapist and the client is crucial; without it, the entire process remains stagnant. This connection provides a secure space for individuals in psychotherapy to confront their challenges within a nurturing relationship where they are fully accepted for who they are.
It takes time and effort to embrace one’s real, authentic self; it is an inner journey. There is no exclusive trajectory that could be followed on this non-linear path. Intertwined with self-discovery and self-reflection, it can be quite frustrating, with lots of difficulties. Mind patterns start to emerge, and connections between thoughts, emotions, and behaviors are being discovered. But the journey is not about eradicating challenges—it is much more about developing inner strength, capacities, and skills that foster psychological resilience and personal growth.
The dynamic between the client and the therapist seems to naturally lead to personal progress. True healing occurs in this delicate dance. The journey toward a more authentic life continues with commitment, love, and joy long after the active psychotherapy process finishes, and the seeds sown during that time will continue to flourish.
Vladimir Mušicki, PhD 