Behavioral Working Alliance

Description of Strategy

A good working alliance sets the stage for effective cognitive-behavioral therapy. Without it, it is unlikely that clients will cooperate with therapy assignments or even continue in treatment. Thus, it is as important for therapists to establish a collaborative working alliance with their clients as it is for them to know cognitivebehavioral change techniques. Perhaps the most widely accepted definition is Bordin's pantheoretical conceptualization of the working alliance as clienttherapist agreement on the goals of therapy and the tasks to be performed to reach those goals coupled with a strong relational bond. This definition is a good fit for cognitive-behavioral therapists, because our theoretical orientation is goaland task oriented, with an emphasis on close client-therapist collaboration.

Establishing a working alliance is not always easy. While some clients begin therapy with knowledge that they must change their behavior to alleviate their problems, others do not. Some clients blame others for their difficulties, and most have a story to tell about how hard their lives have been. While therapists may have very different formulations of clients' problems, it is not advisable to begin treatment by immediately confronting clients about their behaviors. Clients must first become engaged in the therapeutic process. Such engagement is a precursor of the working alliance.

To become engaged, clients first must believe that therapists truly understand their problems. Therapists can convey understanding to clients by listening closely to what they have to say and responding empathically to their concerns. This initial interaction is one of positive complementarity. The behaviors of clients and therapists complement each other, with therapists following the clients' leads. Clients present their complaints, and therapists seek information and clarification about these concerns. This process may take up much of the initial session. Near the end of the session, therapists summarize clients' concerns and indicate how these problems might be addressed. This interaction is still a complementary one, but at this later juncture, therapists take the lead. Until the end of the session, therapists and clients continue to discuss these initial treatment plans and how they fit with clients' concerns. Clients leave these engagement sessions feeling that therapists understand their concerns and will be able to teach them what to do to ameliorate these problems. The foundation has been set for a good working alliance.

In contrast, a nonengagement session is characterized by symmetrical, rather than complementary, interactions in which both therapists and clients take the lead, but neither follows the other. Sometimes [Page 172]these symmetrical interactions have a negative tone, as well. For example, clients may present concerns that are immediately confronted, challenged, or ignored by therapists. These sessions may conclude with little or no agreement about the clients' problems or the way to address them. This is not the basis for a good working alliance, and, indeed, clients may not even continue in treatment. It should be clear from this discussion that therapists must assume the bulk of the responsibility for initial engagement of clients. They must demonstrate to clients understanding of and sympathy for their concerns. While this is important, the engagement process does not stop with this demonstration. After all, many clients have sympathetic listeners in their lives who have not been able to take away their problems. Therapists must also demonstrate their potential helpfulness by reformulating clients' concerns within a cognitive-behavioral framework and indicating procedures that can be undertaken to address them. Successful engagement sessions may even conclude with homework assignments for clients. These homework assignments should be made in conjunction with clients, thus ensuring agreement on goals and the tasks to achieve them—two components of the working alliance.

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