Academic journal article Journal of Cognitive Psychotherapy

The Therapeutic Alliance in Marital Therapy

Academic journal article Journal of Cognitive Psychotherapy

The Therapeutic Alliance in Marital Therapy

Article excerpt

This article considers the nature of the therapeutic alliance in marital therapy and suggests that it is not particularly useful to consider the alliance as a uniform phenomenon across forms of therapy, such as therapies that focus upon cognitive interventions as opposed to therapies that use more affectively oriented interventions. In different forms of therapy and at different times, different aspects of the alliance may be crucial in facilitating change.

INTRODUCTION

The alliance between client and therapist has emerged as a key component of the process of therapeutic change (Greenberg & Pinsof, 1986). It has been stressed as one of the general change factors that may account for change across different modalities and treatment approaches (Frank, 1978). One of the ingredients shared by all approaches is the collaborative nature of the therapeutic relationship. From the safety of the client-centered relationship through Beck's collaborative empiricism to Ellis' rational disputation, what stands out is that unless client and therapist are engaged in a collaborative working alliance, the therapy has very little chance of creating change. Although humanistic and psychodynamic theorists have written extensively about the role of the relationship in therapeutic change, its role in cognitive therapies has only recently begun to be addressed (Mahoney & Gabriel, 1987). In cognitive therapy in particular, the clients' compliance with the therapeutic task is an essential ingredient for engaging in the process of therapy. The establishment of a collaborative alliance is one of the best means of obtaining such compliance with therapist suggestions or directions. A collaborative alliance is achieved, according to Bordin (1979), by agreement on goals, perceived relevance of tasks, and a bond appropriate to the demands of the task. An important feature of this view is that the alliance is seen as arising from the interaction between client and therapist; rather than being a therapist or client factor, it is an interactional product.

Marital and family therapy, involving as it does the provision of directions and homework tasks, shares certain features with the relationship required in other directive therapies such as cognitive therapy. Here too then, one of the best means of obtaining compliance is through the establishment of a collaborative working alliance.

In the marital and family field, the alliance has been addressed on a pragmatic clinical level in terms of the necessity for the therapist to join with the client system (Minuchin, 1974) and the necessity for the therapist to be aware of how coalitions are operating in the process of therapy. However, a theoretical and research perspective on the alliance in marital and family therapy has been slow to develop. This paper will consider the therapeutic alliance in marital therapy, particularly as it is operationalized in Emotionally Focused Marital Therapy (EFT; Johnson & Greenberg, 1987).

CONCEPTUALIZATION OF THE ALLIANCE

The first issue to be addressed is that of conceptualization, that is, how the concept of the alliance has been operationalized. In the initial empirical work on the alliance, Alexander and Luborsky (1986) separated the alliance into perceived helpfulness of the therapist and collaboration or bonding with the therapist and found that these factors correlated with positive outcome. Bordin's theoretical conceptualization of the alliance suggested that the alliance is essentially an integration of bond, task, and goal elements (1979). In this latter view, relationship context and technical skill are intertwined. A positive alliance is then one in which the client sees the therapist as appropriately warm and supportive, views the tasks presented as relevant (which implies that the therapist is seen as competent and able to help the client), and shares the same therapeutic goals as the therapist. In spite of different conceptualizations there seems to be a general consensus that the primary effect of a positive alliance is to facilitate client involvement, collaboration, and participation in the therapy process (Suh, Strupp, & Samples O'Malley, 1986), and therefore to enhance the possibility of positive outcomes. …

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