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Is There Evidence to Support the Emphasis on the Treatment Relationship at the Austen Riggs Center?

A major contributing factor to any successful treatment is the sustained relationship between the patient and therapist. There is a great deal of scientific evidence to support this claim.

Evidence Supporting the Value of the Treatment Relationship

Originally referring to the positive feelings a patient develops for a therapist (Freud 1913); (Frieswyk et al. 1986), the term “therapeutic alliance” later came to mean the conscious and active collaboration between the patient and therapist. Contemporary ideas about the therapeutic alliance are based in part on the work of (Bordin 1979), who defined the alliance as including “three features: an agreement on goals, an assignment of a task or a series of tasks, and the development of bonds” (Bourdin 1979, 253).  

The relationship between the alliance and therapy outcome has been the focus of a great deal of empirical research (Ackerman et al. 2000); (Blatt et al. 1996); (Connolly et al. 1999); (Frieswyk et al. 1986); (Gaston et al. 1998); (Hillard et al. 2000); (Horvath and Symonds 1991); (Horvath and Louborsky 1993); (Horvath and Greenberg 1994); (Levy, Hilsenroth, and Owens 2015); (Martin, Garske, and Davis 2000); (Stiles et al. 1998).

The research published in this area reveals that a therapist’s personal attributes are correlated with the development and maintenance of a positive alliance between patient and therapist. These attributes may influence the development of an alliance early and late in treatment. Significant relationships were found between early alliance and a therapist’s attributes such as being trustworthy (Horvath and Greenberg 1989); affirming (Najavits and Strupp 1994); flexible (Kivlinghan et al. 1993); interested, alert, relaxed, confident (Hersoug et al. 2001); (Saunders 1999); warm (Mohl et al. 1991); and experienced (Hersoug et al. 2001); (Mallinckrodt and Nelson 1991).

In addition, a patient’s perception of a therapist as competent and respectful (Bachelor 1995) early in the treatment process was found to be characteristic of a positive alliance. The therapist’s helping and protecting behaviors were found to be significantly related to alliance ratings taken later in the treatment process. The therapist’s personal qualities such as dependability, benevolence, responsiveness, and experience help patients have confidence and trust in their therapist, and his/her ability to both understand and help them cope with the issues that brought them to therapy. 

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