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Therapeutic Alliance Essay

The Therapeutic Relationship Essay

In the assigned chapter, Bohart and Tallman (2010) discussed clients and their effect on therapy. They argued that client and extratherapeutic influences are the single most important factor in determining therapy outcome. In fact, up to 87% of the variance in therapeutic outcome is attributable to the client, factors that occur outside therapy, and unexplained variance (Bohart & Tallman, 2010, p. 84). Bohart and Tallman further argued that approximately 40% of variance can be ascribed to client factors while only 13% can be accounted for by treatment (e.g., the therapeutic relationship, interventions, therapist, model of therapy). Unfortunately, traditional conceptualizations of psychotherapy have largely ignored these client factors (Bohart & Tallman, 2010, pp. 92-84). Instead, the focus has been on the therapeutic process, the therapist, and his or her interventions, which do not contribute as much to therapeutic outcome as client factors. According to Bohart and Tallman, it is clear that more attention must be given to the critical effect clients have on the outcome of therapy (pp. 94-95).
First, Bohart and Tallman (2010) discussed the role of the medical model in psychotherapy (pp. 92-94). The medical model focuses on diagnosis and specific treatment based on that diagnosis. Bohart and Tallman said that the medical model of psychotherapy is not supported by research. They said that research shows that “all bona fide therapeutic approaches work about equally well, regardless of diagnosis… Research also challenges the importance of technique” (Bohart & Tallman, 2010, p. 92). They also discussed the inconsistent findings regarding professional training and therapeutic outcome. Last, they pointed out that, although both the person of the therapist and the therapeutic alliance have been shown to contribute to positive therapeutic outcome, positive change can occur without a therapist. Bohart and Tallman even cited research showing that therapy and self-help were about equally effective.
While I agree that more traditional conceptualizations of psychotherapy are not always beneficial to clients, I believe the authors over-simplified this discussion. For example, EMDR and CBT have been proven effective in treating Post-Traumatic Stress Disorder, significantly more so than other types of therapy. In other words, while Bohart and Tallman (2010) made a valid point, they overlooked other valid research that contradicts their position. Even their brief discussion about the “exceptions” to their argument served to support their conclusions about people’s capacity for change.
A second key point that Bohart and Tallman (2010) made pertained to listening (pp. 98-99). “You are not listening until the client says you are” (Bohart and Tallman, 2010, p. 99). That quote made me think about how important it is to make sure the client feels understood. The focus should not be on my understanding of the client, but rather on if...

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Essay on Establishing a Therapeutic Alliance

1107 Words5 Pages

Research has shown that a strong therapeutic alliance is necessary for establishing a beneficial contact between the therapist and the client. If the therapist does not encourage the creation of a reliable therapeutic alliance from the beginning of the treatment, it will be hard to develop a constructive relationship with the client later. Establishing the therapeutic alliance will increase the chances of achieving the goal of the treatment because the clients will be willing to cooperate if they trust and respect the therapist. Clients are not likely to cooperate with therapists who impose their authority aggressively. Instead of imposing their authority on the patient, therapists should develop work with their patients by…show more content…

With these attributes, they will have the fundamentals of creating a strong therapeutic alliance with their clients. The therapists should be encouraged in “treating new cases as unique and constructing new theories to fit them, rather than depending on categories of established theory and technique” (Safran & Muran, 2000). Although this does not mean that standard techniques are useless, flexibility and creativity in application of these theories is considered the most important skill of a good therapist. In addition, it is impossible to generalize the structure of the therapeutic alliance because it will depend on the goals and tasks of the therapy. All therapists have different methods for achieving different goals, so the course of development of the therapeutic alliance will vary. For example, in classical psychoanalysis, the patient needs to say anything that comes to mind without filtering the undesirable thought. On the other hand, cognitive behavioral therapy (CBT) requires time and effort, so the client can slowly face the problem and replace the dysfunctional behavior or cognition pattern, with a reasonable behavior or cognition pattern. The difference in requirements from the patients will influence the course of development of the therapeutic alliance, but all approaches rely on a reliable therapeutic alliance created from the beginning of the therapeutic process. A research made by Hersoug,

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