The therapeutic alliance between the child, parents, and health professionals

Handb Clin Neurol. 2020;174:323-332. doi: 10.1016/B978-0-444-64148-9.00023-5.


Therapeutic alliance (TA), a term first used by Zetzel (1956), refers to the collaborative relationship between a patient and a therapist, leading to the development of an affective bond during the process of treatment/therapy and an agreement on treatment/therapy-related tasks and goals. Over time, it became clear that therapeutic alliance has a bidirectional nature, not unique to any one form of therapy but universal in all forms of helping relationships. Engagement of both patient and therapist is essential to its development. Trust, empathy, acceptance, and honesty are among the many constituents of a TA. Alongside this, characteristics of healthcare professionals influence TA, with a warm, empathic, gentle, and accepting therapist enhancing positive TA and a rigid, critical, and less involved therapist posing a hindrance to the development of TA. Literature is sparse for TA in children, and it also essentially involves multiple relationships, namely child alliance, caregiver alliance, and child-parent relationship, which need to be taken into account. Developmental aspects should also be kept in mind while dealing with children and adolescents. It is seen that a strong and positive caregiver alliance influences the development of child alliance. There are ways to foster TA with the child and parent/caregiver to maximize benefits from therapy.

Keywords: Child psychotherapy; Relationship; Therapeutic alliance; Treatment outcome; Working alliance.

MeSH terms

  • Adolescent
  • Child
  • Empathy
  • Humans
  • Parents
  • Professional-Patient Relations
  • Psychotherapy
  • Therapeutic Alliance*