The Role of the Therapeutic Alliance in Affecting Treatment Outcome

• Therapeutic Alliance and Treatment Outcome by Brian O'Neill, 1/28/97
  
  

The therapeutic alliance is fundamental to the treatment out come of psychotherapy, regardless of the type of therapy involved. Over the last thirty years, the concept of alliance has been examined in psychotherapy with the growing recognition of its role across schools of psychotherapy. Even in pharmacotherapy its relevance as a factor influencing compliance has been postulated. A growing body of evidence has emerged supporting the association of alliance with outcome, although there has been insufficient reductionist analysis or empirical investigation. The therapeutic alliance is a key concept and "quintessential variable" whose importance is commonly acccepted (Gaston, 1990, 143). The therapeutic alliance is seen as a multi-dimensional concept. Emerging trends indicate four dimensions, namely: the patient's affective relationship to the therapist; the patient's capacity to purposefully work in therapy; the therapist's empathic understanding and involvement; the client/therapist agreement on the goals and tasks of treatment. This cannot be an exhaustive particularization of the concept, as an analysis of Freud's writings brings forward at least five aspects of the therapeutic alliance which encompass trhe above conceptualizations within one or other of them. These are the transference, countertransference, analytic pact and, from Jung's writings, no transference at all (as when a client simply retells a dream -- "the dream brings out everything that is necessary" -- Fordham, 1974, 1-21). Zetzel (1956) considered therapeutic alliance as stemming from "the patient's attachment to and and identification with the analyst," being a repetition of the good aspects the mother/child relationship. In Gaston's paper there is no distinction between realistic or distorted feelings toward the therapist or vice versa. In June 1882, Freud's colleague, Josef Breuer, abruptly terminated his treatment of Bertha Pappenheim (Anna O) stating that the patient was cured. Freud's versio

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