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The therapeutic alliance: definitions, reflections and therapeutic implications

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Angelika Apostopoulou (https://orcid.org/0000-0003-3384-1984), Theodoros Giovazolias (https://orcid.org/0000-0002-9939-4737)
Angelika Apostopoulou, Theodoros Giovazolias

Abstract


The present literature review aims to offer an in-depth examination and critical evaluation of the concept of the therapeutic alliance, as it has been historically unfolded in psychotherapy theory, research and practice. The construct of the alliance holds particular theoretical and practical significance for counselling psychologists, who are expected to demonstrate an understanding of the therapeutic relationship and alliance as conceptualised in different models (HCPC, 2015), as well as the ability to engage in relational practice (BPS, 2015). The critical literature review therefore opens with an examination of the concept of the therapeutic alliance as defined and conceptualised in the major schools of psychotherapy. Core alliance measures are also presented and critically evaluated in relation to their methodological rigour and usefulness in alliance research and practice. The relationship between the therapeutic alliance and outcome is critically reflected upon, whilst giving thorough consideration to therapist, client and interactive factors impacting the development and maintenance of the therapeutic alliance, thus possibly mediating and/ or moderating the relationship between alliance and treatment outcome. Contemporary re-conceptualisations and critiques of alliance theory and research are in turn thoroughly examined and critically discussed. Taking into account the primacy of the therapeutic relationship in Counselling Psychology (BPS, 2005), the literature review concludes with a presentation of the therapeutic implications of alliance theory and research for practitioner psychologists in general and counselling psychologists in particular, irrespective of their therapeutic orientation, in order to enhance their therapeutic skills and efficacy.


Keywords


Counselling Psychology; definitions; therapeutic alliance; therapeutic implications; therapeutic outcome

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