Academic journal article Canadian Journal of Counselling and Psychotherapy (Online)

The Therapeutic Alliance: Clients' Categorization of Client-Identified Factors/L'alliance Thérapeutique : Catégorisation Par Les Clients Des Facteurs Identifiés Par Les Clients

Academic journal article Canadian Journal of Counselling and Psychotherapy (Online)

The Therapeutic Alliance: Clients' Categorization of Client-Identified Factors/L'alliance Thérapeutique : Catégorisation Par Les Clients Des Facteurs Identifiés Par Les Clients

Article excerpt

The therapeutic alliance refers to the working relationship that operates between the clinician and the client in counselling and psychotherapy (Bedi, Davis, & Arvay, 2005). The alliance arises from the ability of the counsellor and the client to form an effective relationship conducive to co-constructing the tasks and goals of counselling (Borclm, 1979; Horvath & Bedi, 2002) and is composed of contributions made by both the counsellor and the client. Understanding how to develop a strong therapeutic alliance with clients may be one of the most important goals for researchers and counsellors in their quest to help clients (Norcross, 2001).

It is important to note that the therapeutic alliance does not exist apart from the subjective perceptions of both the Counsellor and the client. Clients and clinic-. cians may use different language as well as different theoretical or philosophical frameworks in their descriptions and evaluations of the alliance (Horvath d£ Bedi, 2002). Reviews of contributions to the alliance often do not clearly differentiate between variables that have been constructed using client vocabulary and perceptions, and those that are created by researchers and clinicians (Elliott & James, 1989; for example, see Ackerman &t Hilsenroth, 2001, 2003). This potential disparity is rarely acknowledged in the literature. It can therefore be unclear if the clients' subjective perception is accurately represented in the creation of variables.

Although it is the client's experience of the therapeutic alliance, not the counsellor's, that is the best predictor of a successful counselling outcome (Horvath & Bedi, 2002), clients have rarely been asked to describe the alliance in their own vocabulary The covert nature of clients' experience (Elliott &¿ James, 1989), along with the tendency to censor their reactions in the counselling process (Réunie, 1994), makes it especially difficult to access accurate information. Research variables usually reflect researchers' theoretical (or pan-theoretical) bias (Bachelor, 1995; Elliott & James, 1989; Horvath & Bedi, 2002; Luborsky, 2000). Variables are constructed according to what researchers believe to be relevant and are worded in vocabulary that reflects researcher perspectives. Clients are typically invited to endorse, deny, or rate researcher- or counsellor-formulated variables. Using client vocabulary and client conceptualization in the development of variables would likely facilitate greater validity with respect to clients' subjective perspectives and ensure that client perception is accurately represented in the literature (Bedi, 2006; Bohart, 2000). Further, it could allow for identification of variables that are outside clinician and researcher awareness but critical to clients' experience of the alliance.

RELEVANT CURRENT RESEARCH INVESTIGATING CLIENTS' PERSPECTIVES

Several qualitative studies have investigated clients' perspectives on the alliance by asking clients to describe, in their own words, what they believed was helpful in establishing a therapeutic alliance (e.g., Bachelor, 1995; Bedi, Davis, & Arvay, 2005; Bedi, Davis, & Williams, 2005; Fitzpatrick, Janzen, Chamodraka, &Park, 2006). It is mteresting to note that collaboration is frequently mentioned by researchers and in counselling theories and models (Bordin, 1979', Horvath & Bedi, 2002), while clients apparently understand, or at least report, a good alliance mostly as a function of counsellor characteristics and contributions; (Bachelor, 1995). Past studies (e.g., Mohr & Woodhouse, 200 1) also show that some of the factors clients report as important inalliance development are scarcely represented in existing alliance theory and research. Further, in qualitative studies investigating clients' perspectives of the alliance, researchers organized the factors, and their vocabulary was used to label categories without direct client input, possibly constricting our understanding of clients' perspectives. …

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