The Working Alliance: Theory, Research, and Practice

A. O. HORVATH AND LESLIE S. GREENBERG, EDS.: The Working Alliance: Theory, Research, and Practice. John Wiley & Sons, New York, 1994, 304 pp., $35.00. Most clinicians recognize that, beyond any technique they utilize, in many cases it is the relationship between patient and therapist that is curative. But what are the mechanisms by which the therapeutic alliance catalyzes emotional and psychological healing? This is the topic of the present volume, which should be considered one of the definitive reference works on the therapeutic alliance for years to come. The Working Alliance synthesizes findings from numerous research studies and various theoretical perspectives to arrive at definitions of the alliance, to determine how it can be measured, to demonstrate that the quality of the alliance is closely linked with treatment outcomes, and to suggest how a strong, effective alliance can be promoted by clinicians. The book features contributions from an extremely distinguished group of clinicians and researchers, many of whom have made important contributions to this field of study for decades. Thus in addition to being an important synthesis this book reveals that there are many points on which leading investigators of this topic are in essential agreement. This is a rich, thought-provoking volume that cannot be quickly summarized. Here I can describe just a few of this book's many highlights. Edward Bordin summarizes his extensive research on the alliance, in which the therapeutic alliance is seen as an important factor contributing to the client's ability to achieve change. He discusses the therapeutic impact of the therapist's selecting therapeutic goals in collaboration with the client, illuminates the relationship between bonding and transference, and discusses how dealing with strains or ruptures contributes to the process of change. Therapeutic collaboration demands active participation by the therapist. The therapist must search with the client for the most essential change goals; and the two must enter into a mutual commitment to the patient's change goals with a clear understanding of the tasks entailed. In his view, the therapist's ability to negotiate goals and tasks with the client is the key to building an initial alliance and helping the client attain the strength needed to overcome strains and ruptures. The key elements of building a strong therapeutic alliance are the power of therapeutic tasks, the analysis of strains in the therapeutic relationship at different stages of treatment, and mutual understanding of the change goals. A later chapter by Alan Horvath offers empirical validation of Bordin's model of the alliance using the Working Alliance Inventory. Horvath shows that Bordin's contention that a positive working alliance early in therapy is a reliable indicator of final therapeutic success. Bordin's idea that therapy involves a continuous rupturerepair cycle is also supported, as is the concept that helping the client work through problems in the alliance enables the client to make progress in handling other central life dilemmas more effectively. Lester Luborsky's analysis of alliance-outcome trends shows that the alliance is only one type of instance of the broader category of positive relationship qualities, all of which are positively related to treatment outcome. …