May is Mental Health Awareness Month and for our blog, we wanted to highlight an important aspect needed for successful therapy… therapeutic alliance.  Here is what our own, Susie Schrader, M.Ed, MA, LPCC, had to share.

We are hurt in relationships with others, we can heal in relationships with others. This is one of the fundamental assumptions of modern psychotherapy and the foundation of the development of a sound therapeutic alliance. In fact, a healthy relationship with one’s therapist is one of the strongest predictors for positive therapeutic outcome (Ardito & Rebellion, 2011).

What is the Therapeutic Alliance?

The therapeutic alliance is simply defined as the “trust” developed between the therapist and client which allows the client to engage in the process of change (Cabaniss, 2012). Having a willingness to examine old behaviors from a new perspective and being willing to change one’s self requires trust. Letting go of a “protective” long-term behavior or cognition can cause an individual to feel vulnerable or unsafe. It is the “trust” in the relationship with one’s therapist that allows an individual to take the risk required for change to occur. The relationship or alliance between the therapist and client acts as a sort of “safety net” which lessens the feeling of risk as the client considers change.

Why is the Therapeutic Alliance important?

The therapeutic alliance is important because in therapy, change is important. According to John Norcross in the book “The Heart and Soul of Change”, a strong positive therapeutic alliance is the strongest predictor of positive change in therapeutic treatment. He states that clients who have established a strong, positive alliance with their therapists experience fewer symptoms and less severe symptoms than clients who have not established strong positive therapeutic alliances with their therapists. In addition, these positive changes increase the strength of the therapeutic alliance which supports even greater change. Unfortunately, he found the inverse also true. So a weaker alliance creates less change which creates an even weaker alliance.

Do I have a healthy therapeutic alliance with my therapist?

Dr. Deborah Cabaniss suggests you ask yourself questions specifically about your relationship with your therapist. These questions can include:

  • Do I feel comfortable with my therapist?
  • Do I want to go back?
  • Can I talk about anything?
  • Do I feel relieved after meeting with my therapist?

Other questions might include:

  • Does my therapist ask me about my perspective on our therapy and our relationship?
  • Do I feel cared about and understood in therapy?
  • Do we work on creating therapeutic goals together?
  • Do I feel supported in making changes?

If you answered “yes” to these questions you and your therapist have probably formed a positive therapeutic alliance. If you didn’t, talk with your therapist about your concerns. They want the best for you and understand that not all therapeutic relationships are a good fit.
Remember, relationships are key to healing wounds. Is your relationship with your therapist a safe place to explore your desire for change?

Or perhaps you don’t yet have a therapist and are ready to find one?  Contact Us and we will do what we can to connect you with the a therapist for your needs.


Duncan, B.L., Miller, S.D., Wampold, B.E., & Hubble, M.A. (2010) Heart & soul of change: delivering what works in therapy. Washington D.C.: American Psychological Association.

Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects of research. Frontiers in psychology, Oct. 2011; 2/270.