Ask a room of counsellors what makes therapy work and you will hear about models: CBT, ACT, narrative, solution-focused. Ask the research and a quieter answer keeps coming back. Across hundreds of studies, the quality of the working relationship between client and practitioner is one of the most consistent predictors of outcome.
What the evidence shows
A large meta-analysis drawing on nearly 300 studies found a moderate, reliable link between the alliance and client outcomes, across different therapy approaches, client groups and ways of measuring the relationship (Flückiger et al., 2018). The link held whether the alliance was rated by the client, the therapist or an observer.
The alliance is more than rapport. Bordin (1979) described it as three linked parts: agreement on the goals of the work, agreement on the tasks that will get there, and the bond between the people doing it. A warm relationship that is unclear about goals is only part of an alliance.
Why it matters for who stays
Around one in five adults stop therapy early (Swift & Greenberg, 2012). Some leave because they feel better. Many leave because something in the fit is not working and nobody asked.
Routine feedback changes that. When practitioners collect brief outcome and feedback measures and use them to adjust their approach, outcomes improve, especially for clients who are not on track (Lambert et al., 2018). Asking is not a sign of insecurity; it is one of the more evidence-based things we can do.
Try this
- Spend part of the first session agreeing on goals in the client's words, and come back to them regularly.
- Explain how you will work and why, so the tasks make sense to the client.
- End each session with a short check: what was helpful, what was not, and what should we do differently?
- Treat a rupture, such as a missed session or a flat response, as information to explore rather than a problem to ignore.
- Track progress with a brief measure and look at it together.
None of this replaces skill in a particular approach. But if technique is the vehicle, the alliance is the road it travels on. It is worth checking the road as often as we check the vehicle.
Related resources
- Session Opening Check-In Card
- End-of-Session Reflection
- What to Expect from Counselling
- Counselling Goals Agreement
References
- Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885
- Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
- Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520–537. https://doi.org/10.1037/pst0000167
- Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559. https://doi.org/10.1037/a0028226
This article is general information for practitioners. It is not clinical advice: use your professional judgement and follow your organisation's procedures.