ESSENTIAL ALLIANCE INGREDIENTS
A very large and significant segment of the empirical psychotherapy process – outcome
literature that has been produced over the past sixty years clearly demonstrates the primary
relevance of several putative therapist ingredients in effective psychotherapy. These ingredients
constitute the essential therapeutic ingredients in efficacious psychotherapy relationships and, are
more specifically, constitute the therapeutic alliance component of the therapeutic relationship.
The essential core conditions or ingredients in effective and efficacious therapeutic
alliances include non-possessive warmth or positive regard (originally referred to as
“unconditional positive regard” by Carl Rogers, [1942, 1957], empathy, and genuineness
(originally referred to as “congruence” by Rogers). Successful therapeutic alliances and
outcomes are also related to effective communication or therapeutic concreteness (Turax and
Carkhuff, 1967), and more generally and nefariously by a number of additional therapeutic
alliance dynamics including transference, countertransference, therapist – client self-disclosure,
and a diversity of other potentially significant and personal factors which may impact the
therapist, patient, therapeutic relationship, alliance and process and outcome of therapy in a
myriad of ways.
General Definential Parameters of: Non-possessive Warmth, Empathy,
Genuineness, Concreteness, Transference, Countertransference, Self-Disclosure,
and other therapeutic alliance factors.
Tillman (2013) indicates that “there is a vast amount of research on the therapeutic
relationship variables of empathy, unconditional positive regard (acceptance), and congruence
(genuineness) in the psychotherapy literature. Furthermore “the contributions of these
relationship variables were found to account for as much, if not more, of successful treatment
outcomes than specific interventions or treatment methods.” She also states
“While it is clear that the therapeutic relationship (alliance) is an important factor in
the success of any form of therapy, client-centered relational variables may play an
especially important role when addressing the problem domains that mental illness has
shown the most success with, addictive and health behaviors…furthermore, empathy
and acceptance may also be more likely to flow from a positive view of human nature
consistent with mental illness, making a self-assessment of a clinician’s assumptions
about human nature especially important in this regard.” p. 50-51.
In sum, historic and contemporary research, and clinical practice data consistently
demonstrate the compellingly positive roles and therapeutic impact of these alliance ingredients
in the process and outcome of psychotherapy.