The Relationship as a Working Alliance
“The alliance refers to the quality and strength of the collaborative relationship between client and therapist” (Norcross, 2011, p. 120). Although the term “working alliance” has a long history and a number of different interpretations (Horvath et al., 2011), it can be used to bring together the best of the empathic- relationship-in-itself and relationship-as-means-to-achieving-desired-outcomes. Bordin (1979) defined the working alliance as the collaboration between the client and the helper based on their agreement on the goals and tasks of counseling. Horvath and his associates (2011) add a dynamic-process touch: “The alliance represents an emergent quality of partnership and mutual collaboration between therapist and client.... Its development can take different forms and may be achieved quickly or nurtured over a longer period of time ...” (p. 11)
The collaborative nature of helping In the working alliance, helpers and clients are collaborators. Helping is not something that helpers do to clients; rather, it is a process that helpers and clients work through together (Frankel, 2007). Helpers do not “ cure” their patients. Both have work to do in the problem-management and opportunity-development stages and tasks, and both have responsibilities related to outcomes. Outcomes depend on the competence and motivation of the helper and the client, and on the quality of their interactions. Helping is a two-person team effort in which helpers need to do their part and clients theirs. If either party refuses to play or plays incompetently, then the entire enterprise can fail.
Bachelor, Laverdiere, Gamache, and Bordeleau (2007), digging down into the heart of collaboration, found three different types of client collaboration—active, mutual, and therapist-dependent, though the last of these three might better be called cooperation rather than collaboration. Active clients see themselves “as playing a significant role, or at least as making a difference, as to whether the work moves forward or not” (p. 181). The mutual-type client “acknowledges her or his role in the work of therapy and positive change but also views (and in some cases explicitly expects) the therapist to play an equally active role” (p. 183). As to dependent-collaborative clients, “collaboration refers to change-inducing or otherwise beneficial therapist interventions” (p. 184). The researchers found that a third of clients fall into this last category. The Skilled Helper will provide plenty of grist for the mill of your mind to determine what precisely collaboration means and the role it plays in the helping process.
Guiding Principles for Alliance Behavior Because the term “working alliance” is a concept, an abstraction, it takes on life and clinical significance through the behavioral principles that make it a reality. Here are some alliance-focused principles:
- * Alliances emerge. Don’t try to build an alliance. Rather make sure that everything you do in using, for instance, the problem-management process briefly mentioned in Chapter 1 and described in detail in Part III or any other approach to treatment contributes to a spirit of collaboration and partnership. When Karl and Laura interact constructively, say, in exploring Karl’s tendency to run away from closer interpersonal relationships, the alliance “emerges” and grows.
- * Track the client’s evolving needs and wants. Make an effort to understand the client’s preferences and modulate accordingly. Remember that both of you are on a collaborative search for the right relationship. When Karl summarily rejects the survey approach to monitoring the helping process and outcomes, Laura doesn’t push the issue. There are other ways to get feedback. And some clients need to get comfortable with the relationship before adding what they might see as “extras.”
- * Focus on resources. Make sure that you are getting in touch with not just the client’s problems and concerns but also the resources and expectations the client brings to the helping endeavor. Effective helpers begin focusing on the client’s strengths right from the beginning. Right from the start Laura says to herself, “This guy seems to have a lot going for him, but I’m not sure if he is in touch with his considerable resources.”
- * Don’t be surprised at differing views of the relationship. Your view of how the relationship is evolving may not be the same as the client’s view especially in the early stages of the relationship. Look for cues indicating the state of the relationship throughout the helping endeavor.
- * Ups and downs are common. Do not be surprised about ups and downs in the relationship. That happens in everyday life. For example, a client might get an insight that is upsetting (“I’ve really be acting like a jerk in my family life”). You might think that you’ve done something wrong. Even when you’re the cause of some kind of negative reaction, this does not mean that the relationship is in trouble. When Laura invites Karl to look at the consequences of being “out of community,” Karl sulks. Both of them have to work at reestablishing equilibrium. Horvath and his colleagues see these ups and downs as “normal” variations, which, if “attended to and resolved, are associated with good treatment outcomes” (p. 15).
- * Expect and deal with client negativity. Therapy is hard work for clients. When they get frustrated, they often enough lash out at their therapists. When Karl is frustrated by the fact that he keeps dreaming about the attack in which his buddies were killed, he interrupts Laura, “Laura, you know nothing, I mean nothing, about war and you never will. So stop pretending.” Laura has been responding empathically to what Karl has been saying, but her empathy is seen as ignorance. But, given the fact that their relationship has been growing stronger, she does not internalize Karl’s remarks. Rather she tries to learn from them.
The communication and relationship building skills essential to all the above are outlined and illustrated in Part II.