What is Therapeutic Alliance?

Posted on in Clinical, News
Therapeutic Alliance

Therapeutic alliance is “a general construct that usually includes theoretical definition the collaborative nature, the affective bond, and the goal and task agreement between patients and clinicians”.1 Developing the therapeutic relationship between the patient and clinician is so important to be able to help guide the individual through the course of their episode of care.

There are many components that influence therapeutic alliance. Therapeutic alliance is influenced reciprocally between the individual and the clinician by biological, social, and psychological contributing factors.2 As clinicians, we need to be able to identify these factors to further the development of building therapeutic alliance with our patients.

There are three components that contribute to a strong therapeutic alliance: (1) agreement on goals (collaborative goal setting, (2) agreement on interventions (shared decision making), and (3) effective bond between the patient and the clinician (the therapeutic relationship).3

Can we measure therapeutic alliance?

It can be challenging to objectively know if we are developing therapeutic alliance.  However, there are objective instruments we can utilize to guide us more.  Some objective instruments include the Working Alliance Theory of Change Inventory (WATOCI), Therapeutic Alliance in Physiotherapy Questionnaire (CAF-P), Physiotherapy Therapeutic RElationship Measure (P-TREM), and the Person-Centered Therapeutic Relationship in Physiotherapy Scale (PCTR-PT).4-7 Recognizing how to measure therapeutic alliance can help build the patient/practitioner relationship.

What can we do to strengthen therapeutic alliance?

Active listening and communication are crucial when it comes to developing therapeutic alliance. Effective communication can help enhance therapeutic alliance with an emphasis on patient-center focus and active listening with focus on emotional health.8 Communication may act as a catalyst in operationalizing therapeutic alliance.2

Higher levels of therapeutic alliance were associated with greater improvements in perceived effect of treatment, function, and reductions in pain and disability.9 Strong therapeutic alliance during treatment appears to facilitate adherence to exercise and general physical activity.10

There are many strategies available, but it becomes important to find the right strategy that works best for you and your patient.

To learn about more strategies to build therapeutic alliance with your patient, click here.

Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT


  1. Martin DJ, Garske JP, Davis MK (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology 68: 438–450.
  2. Søndenå P, Dalusio-King G, Hebron C. Conceptualisation of the therapeutic alliance in physiotherapy: is it adequate? Musculoskelet Sci Pract. 2020 Apr;46:102131. doi: 10.1016/j.msksp.2020.102131. Epub 2020 Feb 14. PMID: 32217276.
  3. Bordin E. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice. 1979;16(3):252-260.
  4. Horvath A, Greenberg L. Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology. 1989;36(2):223-233.
  5. McCabe E, Miciak M, Roberts MR, Sun H, Kleiner MJ, Holt CJ, and Gross DP. Development of the physiotherapy therapeutic relationship measure. European Journal of Physiotherapy, 2021: 1-10.
  6. Linares-Fernandez MT, La Touche R, and Pardo-Montero J. Development and validation of therapeutic alliance in physiotherapy questionnaire for patients with chronic musculoskeletal pain. Patient Education and Counseling, 2020, Volume 104(3):524-531.
  7. Rodrıguez-Nogueira O´, Morera Balaguer J, Nogueira Lo´pez A, Rolda´n Merino J, Botella-Rico J-M, Del Rı´o-Medina S, et al. (2020) The psychometric properties of the person-centered therapeutic relationship in physiotherapy scale. PLoS ONE 15(11): e0241010. https://doi.org/ 10.1371/journal.pone.0241010.
  8. Pinto RZ, Ferreira ML, Oliveria VC, Franco MR, Adams R, Maher CG, and Ferreira PH. (2012). Patient-centered communication is associated with positive therapeutic alliiance: a systematic review. Australian Physiotherapy Association, Volume 58, 77-87.
  9. Ferreira PH, Ferreira ML, Oliveria VC, Franco MR, Adams R, Maher CG, and Ferreira PH. (2012). Patient-centered communication is associated with positive therapeutic alliance: a systematic review. Australian Physiotherapy Association, Volume 58, 77-87.
  10. Moore AJ, Holden MA, Foster NE, Jinks C (2020) Therapeutic alliance facilitates adherence to physiotherapy-led exercise and physical activity for older adults with knee pain: a longitudinal qualitative study. Journal of Physiotherapy 66:45–53