What is a therapeutic alliance and how do we develop and maintain an alliance, even with difficult patients? The therapeutic alliance is a COLLABORATION between patient and therapist in which there is an agreement about the problems to be addressed, the goals to be achieved and the therapeutic tasks involved. It also involves the development of trust - the patient's perception of therapist as knowledgeable and skillful - someone who is a resource for them. It is not about the patient liking you, but trusting you to help them.

We often need to help patient's confront difficult, anxiety provoking and painful realities and feelings. If we are too concerned about them liking us, we can't tolerate the pain involved in the process and will undermine it. The best therapists are interpersonal masters who are able to develop and sustain alliances with difficult patients.

Read my book, Maximizing Effectiveness in Dynamic Psychotherapy, and visit both my website and Jon Frederickson's site, www.istdpinstitute.com for more detailed videos on this important topic.

Consider coming to the IEDTA (www.iedta.net) to watch videos of master clinicians establishing collaborative alliances by dealing deftly with obstacles, defenses and resistances to closeness.

Bruce Wampold has written extensively on the characteristics of the best therapists, as have Duncan and Miller. Bordin was the first to define the therapeutic alliance as an agreement about goals, tasks and problems, as well as the development of an emotional bond.

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