The therapeutic alliance: Cultivating and negotiating the therapeutic relationship

This chapter focuses on therapeutic alliance and its theoretical perspective, and presents conceptualizations and strategies for cultivating and negotiating a healthy and strong relationship with patients. The therapeutic alliance is a prerequisite for change in all forms of psychotherapy. The alliance consists of three interdependent components: first, tasks-the specific covert and overt activities in which the patient must engage to get benefits from the treatment; second, goals-general objectives toward which the treatment is directed; and third, bonds-affective quality of the relationship between patient and therapist. The process of negotiation involves many tasks for the therapist. Therapists must be able to shift their attention between the process and the content of the session-not just what is being said, but how it is said. Awareness of the process keys the therapist into the interpersonal communication the patient is making about the relationship with the therapist. The interpersonal field should be monitored for levels of relatedness, connection, or disconnection at any given moment. Shifts in affective engagement are important clues to the patient's experience of the therapeutic material as well as the therapeutic relationship. © 2006