Working Alliance
The alliance has been defined in a number of different ways, but the core consensus among these definitions is that the alliance is an emergent quality of partnership and mutual collaboration between therapist and client. Bordin (1994) suggests that the working alliance is built principally on a positive emotional bond between therapist and client (such as trust, respect, and liking), their ability to agree on the goals of the treatment, and their establishment of a mutual consensus on the tasks. Horvath and Greenberg (1994), postulate that the working alliance has emerged as possibly the most important conceptualization of the common elements in diverse therapy modalities and it was created to define the relationship between a client in therapy or counseling and the client's therapist. Additionally, the working alliance explains the cooperative aspects of the alliance between the two parties while looking at and examining the vagaries, expectations and commitments previously implicit in the therapeutic relationship.
Excerpt from EDPS 622
There is no agreement on how exactly to define the working alliance because different theories have their different definitions of the working alliance. For example, Yalom (1980) defines the working alliance as being the relationship between client and therapist that that generates the healing power. Narcross (2002 ) goes on and describe it as a process in which counsellor and client develop feelings and manners of expressing these feelings during the therapeutic encounter while Horvath and Greenberg (1994) defines it as “the client and therapist forming a partnership against the common foe of the client’s debilitating pain”. Martin, Garske, and & Davis (2000) refer to it as the collaborative nature of the relationship, the emotional bond between the client and therapist, and their agreement about the goals of treatment while Watson and Greenberg (1994) declare that working alliance consist of common sentiments in the interactions between counsellor and client. Gelso (2009) elaborates more on this stating that all these components “operate simultaneously, with each moving from foreground to background at certain points in the work, and with each influencing and being influenced by the other” ( p. 258). Horvath (2006) adds that among these three components, the working alliance has been the one to be most vigorously investigated empirically.
Bachelor (1995) encourages three different types of client-therapist relationships: a nurturing alliance, an insight-oriented alliance, and a collaborative alliance. Taking into consideration the type of clientele I work with, I posit that the collaborative alliance is the most appropriate as it provides "acknowledgment of the mutuality of the therapeutic endeavor" and "realization on the part of the client that she or he could actively participate in the work or conduct of therapy" (Bachelor, 1995, para. 64). Taking into consideration that the working alliance is ever-changing and dynamic, it is counsellor’s task to set realistic and attainable goals for clients that need to be periodically reviewed in order to see if they still really fit into clients' schemes of needs. In case, these goals do not fit into their schemes of needs, it is counsellor's responsibility to work in collboration with his client in order to re-adjust them.
In my day-to-day
work, I am expected to provide clients with effective and appropriate help and
in doing so, I foster a collaborative
relationship in which "each partner brings
his/her involvement to the process, in particular with regard to its tasks,
either assuming specific responsibilities or collaborating jointly in common
tasks" (Bachelor, 1995, para. 64). I
engage clients to actively participate in the therapy sessions as I would like us
to be in unison with some aspects of the therapy such the therapy goals.
Excerpt from EDPS 622
Excerpt from EDPS 622
The agreement on goals provides a clear framework to guide the counselling sessions towards what needs to be accomplished. The agreement on goals can be measured according to Amundson (1995) on the energy and enthusiasm expressed by the client in the counselling sessions. There is often a lack of mutually agreed upon counseling goals in situations where absenteeism is present as well as lack of effort and failure to complete the required tasks. Additionally, when reluctant clients do not agree to the goals, they often display negative emotions. In these situations, counselors can use reflective feeling statements in order to diffuse these emotions. Letting clients know that the counsellor empathizes with how they feel invites them to process these emotions and eventually let go of them.
In terms of goal accomplishment, clients are expected to undertake certain tasks. In order to develop an agreement on these tasks and to make sure that clients are going to go through with them, counsellors need to reach out to their clients. Besides, it is impotant that clients be given tasks that are interesting and reachable.
When clients believe that the counsellor is interested in them and want to work with them, they are more likely to cooperate and work towards accomplishing their goals. Using simple, positive, everyday language, even using certain words that the client uses, while avoiding provocative words, helps the client to join in the conversation. In dealing with difficult clients it is useful for the counsellor to adapt to client’s way of thinking and doing things and letting them be the “expert” on his problems and circumstances (Berg, 1994). For example, when engaging clients from a different culture is important to have an open mind and be accepting of what the client is saying to the counsellor, or the ways the client it explaining or seeing things, even though it might not appear logical and realistic to the counsellor. Viewing clients as active agents, letting them take responsibilities for their own behavior and avoiding the excessive nurturing, supports the alliance, decreases counsellor chances of burnout and the client’s sense of victimization (Amundson, 1995).
Therapeutic Practices
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- The development of a good alliance is essential for the success of psychotherapy, regardless of the type of treatment.
- The ability of the therapist to bridge the client’s needs, expectations, and abilities into a therapeutic plan is important in building the alliance.
- Because the therapist and client often judge the quality of the alliance differently, active monitoring of the alliance throughout therapy is recommended.
- Responding nondefensively to a client’s hostility or negativity is critical to establishing and maintaining a strong alliance.
- Clients’ evaluation of the quality of the alliance is the best predictor of outcome; however, the therapist’s input has a strong influence on the client and is therefore critical
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Bachelor, A. (1995). Clients' Perception of the Therapeutic Alliance: A Qualitative Analysis. Journal of Counseling Psychology, 42, 323-37.
Greenberg, L.S.(1994). What is real in the real relationship? Journal of Counseling Psychology, 41, 307–309, doi: 10.1037/0022-0167.41.3.307
Gelso, C. J. (2009). The real relationship in a postmodern world: Theoretical and empirical explorations. Psychotherapy Research, 19, 253– 264, doi: 10.1080/10503300802389242
Horvath, A. O. (2006). The alliance in context: Accomplishments, challenges, and future directions. Psychotherapy: Theory, Research, Practice, Training, 43, 258–263, doi: 10.1037/0033-3204.43.3.258
Horvath, A. O. & Greenberg, L.S. (1994). The Working Alliance: Theory, Research, and Practice. New York: Wiley.
Horvath, A. O., Del Re, A., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy relationships that work (2nd ed.). New York: Oxford University Press.
Martin, D. J., Garske, J. P., & Davis, K. M. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-450, doi: 10.1037/0022-006X.68.3.438
Norcross, J. C. (2002). Psychotherapy relationship that work. Therapist contributions and responsiveness to patients. Oxford: Oxford University Press.
Greenberg, L.S.(1994). What is real in the real relationship? Journal of Counseling Psychology, 41, 307–309, doi: 10.1037/0022-0167.41.3.307
Gelso, C. J. (2009). The real relationship in a postmodern world: Theoretical and empirical explorations. Psychotherapy Research, 19, 253– 264, doi: 10.1080/10503300802389242
Horvath, A. O. (2006). The alliance in context: Accomplishments, challenges, and future directions. Psychotherapy: Theory, Research, Practice, Training, 43, 258–263, doi: 10.1037/0033-3204.43.3.258
Horvath, A. O. & Greenberg, L.S. (1994). The Working Alliance: Theory, Research, and Practice. New York: Wiley.
Horvath, A. O., Del Re, A., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy relationships that work (2nd ed.). New York: Oxford University Press.
Martin, D. J., Garske, J. P., & Davis, K. M. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-450, doi: 10.1037/0022-006X.68.3.438
Norcross, J. C. (2002). Psychotherapy relationship that work. Therapist contributions and responsiveness to patients. Oxford: Oxford University Press.