Therapeutic alliance: definition, components, and clinical significance

Therapeutic Alliance

In psychotherapy, the trust established between a client and therapist is extremely important for the successful outcome of the therapy. It provides a basis for the therapeutic process and helps the therapist to provide a safe environment within which the client can receive therapy. The same type of relationship should be established when working with the elderly. Care givers for the elderly should develop a trusting and caring relationship with their clients in order to provide the best possible service. As such, the concept of therapeutic alliance refers to the cooperative relationship between the care giver and client, and can be influenced by factors such as the care giver's listening skills, his or her ability to establish care giving goals, and the ability to display an attitude of understanding and care.

As mentioned, the therapeutic alliance fundamentally functions on the basis of the trust between a care giver and his or her client. This trust is based upon factors such as an agreement between the care giver and client about the goals of care and/or treatment, an agreement about the specific tasks involved in caring for the client, and the emotional bond that culminates in trust, which is developed over time during the care giver's work with the client. The basis of these agreements is the fact that the care giver and client both agree on the various aspects of his or her care. This type of collaborative function serves an empowering purpose, especially in work with the elderly. Among older people, there is often a sense of self- or society-imposed helplessness and weakness. When a care giver collaborates with such a client on important issues such as the steps of care giving, there is an immediate sense of self-worth that translates to the person's general life as well.

A good therapeutic alliance relies on several factors, including the care giver's listening skills, his or her ability to establish care giving goals, and the ability to display a caring attitude.

When initially meeting with the client, the care giver needs to establish a good relationship with the client by listening carefully to his or her concerns and challenges. The care giver must ask questions that will elicit helpful answers in establishing the goals of treatment. Good listening skills do not only refer to asking the correct questions. The care giver should also display an attitude of attentive listening while the client is speaking. He or she should do this by letting client finish what he or she is saying before speaking again, and by asking for clarification or verification where these are necessary. The client will then experience a sense that his or her problems and concerns are important to the therapist and that appropriate help will be offered.

Another influencing factor is the ability to establish good are giving goals. This should be done in collaboration with the client, based upon the initial conversation where the client's challenges were discussed. When this connection between the initial conversation and treatment goals is made, the client is made to feel that his or her well-being is a serious concern for the care giver, and that the best effort will be made on the behalf of the client. This will further enhance the trust established in the first conversation.