Has the concept of the therapeutic alliance outlived its usefulness?

Safran, Jeremy D.; Muran, J. Christopher

doi:10.1037/0033-3204.43.3.286

Cited by 311Psychotherapy Techniques and ApplicationsCounseling Practices and SupervisionPsychoanalysis and Psychopathology Research

Has the concept of the therapeutic alliance outlived its usefulness?

Safran, Jeremy D., Muran, J. Christopher·2006·Psychotherapy: Theory, Research, Practice, Training

DOI 10.1037/0033-3204.43.3.286

Open this paper in CoChat — free account

Abstract

In this article, we provide a brief summary of our current thinking about the constructs of the therapeutic alliance and ruptures in the therapeutic alliance. We speculate about some of the factors that have led to sustained interest in these constructs by psychotherapy researchers and discuss some of the conceptual problems associated with them. We also consider the question of whether the therapeutic alliance continues to be a meaningful construct, and we delineate more and less promising avenues of research for the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Integrity signals

Registry

Crossref · 10.1037/0033-3204.43.3.286

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

The focus on repairing alliance ruptures may be seen as one of the most important assignments in psychotherapeutic courses, because ruptures challenge active cooperation and thus also recovery.
“The focus on repairing alliance ruptures may be seen as one of the most important assignments in psychotherapeutic courses, because ruptures challenge active cooperation and thus also recovery [28].”
From "It's not a life of war and conflict": experienced therapists' views on negotiating a therapeutic alliance in involuntary treatment (2019) · cites this paper as [28]
A rupture in the working alliance could be a small tension or a severe breakdown in the cooperative relationship between patient and therapist.
“This could be a small tension or a severe breakdown in the cooperative relationship between patient and therapist [28].”
From "It's not a life of war and conflict": experienced therapists' views on negotiating a therapeutic alliance in involuntary treatment (2019) · cites this paper as [28]
In the last decades, research on therapeutic alliances has focused on processes involved in alliance ruptures and their repairs.
“In the last decades, research on therapeutic alliances has focused on processes involved in alliance ruptures and their repairs [28, 29].”
From "It's not a life of war and conflict": experienced therapists' views on negotiating a therapeutic alliance in involuntary treatment (2019) · cites this paper as [28]
Alliances might experience ruptures, and repairing these ruptures might serve as useful interventions in therapy.
“Building on contemporary research on therapeutic alliances, alliances might experience ruptures and reparation of these might serve as useful interventions in therapy [28, 29].”
From "It's not a life of war and conflict": experienced therapists' views on negotiating a therapeutic alliance in involuntary treatment (2019) · cites this paper as [28]

The generalizability of the psychoanalytic concept of the working alliance.
Bordin, E. S. (1979) · Psychotherapy: Theory, Research & Practice · doi:10.1037/h0085885 · Cited by 5,238 · see citing works
Bergin and Garfield's Handbook of Psychotherapy and Behavior Change
Lambert, M. J. (2003) · Cited by 3,383 · see citing works
Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review
Martin, D. J., Garske, J. P., & Davis, M. K. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.3.438 · Cited by 3,355 · see citing works
Relation between working alliance and outcome in psychotherapy: A meta-analysis
Horvath, A. O., & Symonds, B. D. (1991) · Journal of Counseling Psychology · doi:10.1037/0022-0167.38.2.139 · Cited by 2,673 · see citing works
Negotiating the Therapeutic Alliance: A Relational Treatment Guide
Safran, J. D., & Muran, J. C. (2000) · Cited by 1,088 · see citing works
Self-citation
Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research.
Robinson, L. A., Berman, J., & Neimeyer, R. (1990) · Psychological bulletin · doi:10.1037/0033-2909.108.1.30 · Cited by 691 · see citing works
Untitled work
(1994) · Medical Entomology and Zoology · Cited by 674 · see citing works
Current concepts of transference 1
Zetzel, E. R. (2018) · Routledge eBooks · doi:10.4324/9780429475931-8 · Cited by 661 · see citing works
Relational psychoanalysis: The emergence of a tradition.
Mitchell, S. Α., & Aron, L. (1999) · Cited by 602 · see citing works
Relational Concepts in Psychoanalysis
Mitchell, S. Α. (2009) · Harvard University Press eBooks · doi:10.2307/j.ctvk12rmv · Cited by 595 · see citing works
The resolution of ruptures in the therapeutic alliance.
Safran, J. D., & Muran, J. C. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.64.3.447 · Cited by 524 · see citing works
Self-citation
An outline of intersubjectivity: The development of recognition.
Benjamin, J. (1990) · Psychoanalytic Psychology · doi:10.1037/h0085258 · Cited by 422 · see citing works
The fate of the ego in analytic therapy.
Sterba, R. (1934) · The International Journal of Psychoanalysis · Cited by 377 · see citing works
Like Subjects, Love Objects
Burke, E. K. (2017) · Yale University Press eBooks · doi:10.12987/9780300156829 · Cited by 374 · see citing works
The Evocative Power of Enactments
Chused, J. F. (1991) · Journal of the American Psychoanalytic Association · doi:10.1177/000306519103900302 · Cited by 207 · see citing works
Working Alliance, Therapeutic Alliance, and Transference
Brenner, C. H. (1979) · Journal of the American Psychoanalytic Association · doi:10.1177/000306517902701s01 · Cited by 160 · see citing works
The therapeutic alliance
Meissner, W. W. (1996) · Medical Entomology and Zoology · Cited by 148 · see citing works
Breaches in the therapeutic alliance: An arena for negotiating authentic relatedness.
Safran, J. D. (1993) · Psychotherapy · doi:10.1037/0033-3204.30.1.11 · Cited by 134 · see citing works
Self-citation
The use of the self: countertransference and communication in the analytic situation
(1991) · Choice Reviews Online · doi:10.5860/choice.29-2395 · Cited by 121 · see citing works
Therapists' Views of Treatment Alliance and Collaboration in Therapy
Hatcher, R. L. (1999) · Psychotherapy Research · doi:10.1093/ptr/9.4.405 · Cited by 89 · see citing works
Self-relations in the psychotherapy process.
(2001) · American Psychological Association eBooks · doi:10.1037/10391-000 · Cited by 59 · see citing works
Faith, Despair, Will, and the Paradox of Acceptance
Safran, J. D. (1999) · Contemporary Psychoanalysis · doi:10.1080/00107530.1999.10746378 · Cited by 26 · see citing works
Self-citation
The therapeutic alliance
Levy, S. T. (2000) · Medical Entomology and Zoology · Cited by 4 · see citing works

Flagged first, then by citations

1 of the 24 references couldn’t be matched to a known paper.

Sorted by citations

Processing the therapeutic relationship
Hill, C. E., & Knox, S. (2009) · Psychotherapy Research · doi:10.1080/10503300802621206 · Cited by 211 · see citing works
Alliance ruptures, impasses, and enactments: A relational perspective.
Safran, J. D., & Kraus, J. (2014) · Psychotherapy · doi:10.1037/a0036815 · Cited by 192 · see citing works
Self-citation
Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review
Roos, J., & Werbart, A. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.775528 · Cited by 177 · see citing works
A meta-analysis of the relation between patient adult attachment style and the working alliance
Bernecker, S. L., Levy, K. N., & Ellison, W. D. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.809561 · Cited by 152 · see citing works
The working alliance: Where have we been, where are we going?
Doran, J. M. (2014) · Psychotherapy Research · doi:10.1080/10503307.2014.954153 · Cited by 130 · see citing works
How collaboration in therapy becomes therapeutic: The therapeutic collaboration coding system
Ribeiro, E., Ribeiro, A. P., Gonçalves, M. M., Horvath, A. O., & Stiles, W. B. (2012) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/j.2044-8341.2012.02066.x · Cited by 128 · see citing works
The Reciprocal Relationship Between Alliance and Symptom Improvement Across the Treatment of Childhood Anxiety
Marker, C. D., Comer, J. S., Abramova, V., & Kendall, P. C. (2013) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2012.723261 · Cited by 123 · see citing works
A framework for treating DSM‐5 alternative model for personality disorder features
Hopwood, C. J. (2018) · Personality and Mental Health · doi:10.1002/pmh.1414 · Cited by 124 · see citing works
Microaggressions and Perceptions of Cultural Humility in Counseling
Davis, D. E., DeBlaere, C., Brubaker, K., Owen, J. J., Jordan, T. A., Hook, J. N., & Tongeren, D. R. V. (2016) · Journal of Counseling & Development · doi:10.1002/jcad.12107 · Cited by 121 · see citing works
The Collaborative Interactions Scale: A new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in psychotherapy
Colli, A., & Lingiardi, V. (2009) · Psychotherapy Research · doi:10.1080/10503300903121098 · Cited by 116 · see citing works
The Working Alliance Inventory for guided Internet interventions (WAI‐I)
Gómez Penedo, J. M., Berger, T., grosse Holtforth, M., Krieger, T., Schröder, J., Hohagen, F., Meyer, B., Moritz, S., & Klein, J. P. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22823 · Cited by 100 · see citing works
The therapeutic alliance in treatment of traumatized youths: Relation to outcome in a randomized clinical trial.
Ormhaug, S. M., Jensen, T. K., Wentzel-Larsen, T., & Shirk, S. R. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0033884 · Cited by 113 · see citing works
Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review
Tong, F., Lederman, R., D'Alfonso, S., Berry, K., & Bucci, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.819623 · Cited by 106 · see citing works
“Some researchers have questioned the importance of TA in therapy, and have criticized Bordin’s conceptual model (56, 109, 110).”
Background
Youth Working Alliance: A Core Clinical Construct in Need of Empirical Maturity
Zack, S., Castonguay, L. G., & Boswell, J. F. (2007) · Harvard Review of Psychiatry · doi:10.1080/10673220701803867 · Cited by 97 · see citing works
The effect of alliance-focused training on a cognitive-behavioral therapy for personality disorders.
Muran, J. C., Safran, J. D., Eubanks, C. F., & Gorman, B. S. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000284 · Cited by 99 · see citing works
Self-citation
Culture-infused counselling: A fresh look at a classic framework of multicultural counselling competencies
Collins, S., & Arthur, N. M. (2010) · Counselling Psychology Quarterly · doi:10.1080/09515071003798204 · Cited by 97 · see citing works
Confessions of a New York rupture researcher: An insider’s guide and critique
Muran, J. C. (2017) · Psychotherapy Research · doi:10.1080/10503307.2017.1413261 · Cited by 79 · see citing works
Self-citation
Integrative cognitive therapy for depression: A randomized pilot comparison.
Constantino, M. J., Marnell, M. E., Haile, A. J., Kanther-Sista, S., Wolman, K., Zappert, L. N., & Arnow, B. A. (2008) · Psychotherapy · doi:10.1037/0033-3204.45.2.122 · Cited by 78 · see citing works
The therapeutic relationship in action: How therapists and clients co-manage relational disaffiliation
Muntigl, P., & Horvath, A. O. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.807525 · Cited by 77 · see citing works
Executive coaching
Baron, L., Morin, L., & Morin, D. (2011) · Journal of Management Development · doi:10.1108/02621711111164330 · Cited by 75 · see citing works
Alliance, Negotiation, and Rupture Resolution
Safran, J. D., Muran, J. C., & Proskurov, B. (2008) · Humana Press eBooks · doi:10.1007/978-1-59745-444-5_9 · Cited by 71 · see citing works
Self-citation
Investigating the impact of alliance-focused training on interpersonal process and therapists' capacity for experiential reflection
Safran, J. D., Muran, J. C., DeMaria, A. P., Boutwell, C., Eubanks, C. F., & Winston, A. (2014) · Psychotherapy Research · doi:10.1080/10503307.2013.874054 · Cited by 69 · see citing works
Self-citation
Long-Term Psychodynamic Psychotherapy
Gabbard, G. O. (2017) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615371471 · Cited by 66 · see citing works
The Action of Verbal and Non-verbal Communication in the Therapeutic Alliance Construction: A Mixed Methods Approach to Assess the Initial Interactions With Depressed Patients
Giacco, L. D., Anguera, M. T., & Salcuni, S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00234 · Cited by 63 · see citing works
Does the working alliance mediate the effect of routine outcome monitoring (ROM) and alliance feedback on psychotherapy outcomes? A secondary analysis from a randomized clinical trial.
Brattland, H., Koksvik, J. M., Burkeland, O., Klöckner, C. A., Lara‐Cabrera, M. L., Miller, S. D., Wampold, B. E., Ryum, T., & Iversen, V. C. (2019) · Journal of Counseling Psychology · doi:10.1037/cou0000320 · Cited by 73 · see citing works
Therapists’ recognition of alliance ruptures as a moderator of change in alliance and symptoms
Chen, R., Atzil–Slonim, D., Bar‐Kalifa, E., Hasson‐Ohayon, I., & Rafaeli, E. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1227104 · Cited by 61 · see citing works
Enhancing Reflective Practice in Multicultural Counseling Through Cultural Auditing
Collins, S., Arthur, N. M., & Wong‐Wylie, G. (2010) · Journal of Counseling & Development · doi:10.1002/j.1556-6678.2010.tb00031.x · Cited by 59 · see citing works
The impact of alliance-focused and facilitative interpersonal relationship training on therapist skills: An RCT of brief training
Perlman, M. R., Anderson, T., Foley, V. K., Mimnaugh, S., & Safran, J. D. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1722862 · Cited by 56 · see citing works
Self-citation
The relationship between the therapeutic alliance in psychotherapy and suicidal experiences: A systematic review
Huggett, C., Gooding, P. A., Haddock, G., Quigley, J., & Pratt, D. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2726 · Cited by 55 · see citing works
Youth Expectations about Therapeutic Alliance in a Residential Setting
Manso, A., Rauktis, M. E., & Boyd, A. S. (2008) · Residential Treatment for Children & Youth · doi:10.1080/08865710802209826 · Cited by 53 · see citing works
Impact of Therapist Emotional Intelligence on Psychotherapy
Kaplowitz, M. J., Safran, J. D., & Muran, C. J. (2011) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3182083efb · Cited by 55 · see citing works
Self-citation
Alliance ruptures and repairs in psychotherapy in primary care
Larsson, M. H., Falkenström, F., Andersson, G., & Holmqvist, R. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1174345 · Cited by 54 · see citing works
Transference and countertransference: A review
Parth, K., Datz, F., Seidman, C., & Löffler‐Stastka, H. (2017) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2017.81.2.167 · Cited by 54 · see citing works
One more time with less jargon: An introduction to “Rupture Repair in Practice”
Muran, J. C., Eubanks, C. F., & Samstag, L. W. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23105 · Cited by 51 · see citing works
Self-citation
Therapeutic collaboration and resistance: Describing the nature and quality of the therapeutic relationship within ambivalence events using the Therapeutic Collaboration Coding System
Ribeiro, A. P., Ribeiro, E., Loura, J., Gonçalves, M. M., Stiles, W. B., Horvath, A. O., & Sousa, I. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.856042 · Cited by 51 · see citing works
The therapeutic alliance in offending behavior programs: A necessary and sufficient condition for change?
Kozar, C., & Day, A. (2012) · Aggression and Violent Behavior · doi:10.1016/j.avb.2012.07.004 · Cited by 71 · see citing works
Patient–therapist convergence in alliance ratings as a predictor of outcome in psychotherapy for generalized anxiety disorder
Coyne, A. E., Constantino, M. J., Laws, H. B., Westra, H. A., & Antony, M. M. (2017) · Psychotherapy Research · doi:10.1080/10503307.2017.1303209 · Cited by 51 · see citing works
Autonomous and controlled motivation and interpersonal therapy for depression: Moderating role of recurrent depression
McBride, C., Zuroff, D. C., Ravitz, P., Koestner, R., Moskowitz, D. S., Quilty, L. C., & Bagby, R. M. (2009) · British Journal of Clinical Psychology · doi:10.1348/014466509x479186 · Cited by 49 · see citing works
Deconstructing the Therapeutic Alliance: Reflections on the Underlying Dimensions of the Concept
Krause, M., Altimir, C., & Adam, H. (2011) · Clínica y Salud · doi:10.5093/cl2011v22n3a7 · Cited by 51 · see citing works
What facilitates countertransference management? The roles of therapist meditation, mindfulness, and self-differentiation
Fatter, D. M., & Hayes, J. A. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.797124 · Cited by 47 · see citing works
Investigating the personality disorder psychotherapy process: The roles of symptoms, quality of affects, emotional dysregulation, interpersonal processes, and mentalizing
Dimaggio, G., Nicolò, G., Semerari, A., & Carcione, A. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.845921 · Cited by 44 · see citing works
Patient and Clinician Perceptions of Therapeutic Alliance as Predictors of Improvement in Depression
Bolle, M. D., Johnson, J. G., & Fruyt, F. D. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000320895 · Cited by 39 · see citing works
Research on Therapeutic Impasses and Ruptures in the Therapeutic Alliance
Safran, J. D., Muran, J. C., & Shaker, A. (2014) · Contemporary Psychoanalysis · doi:10.1080/00107530.2014.880318 · Cited by 43 · see citing works
Self-citation
Stigma for Seeking Therapy
Owen, J. J., Thomas, L., & Rodolfa, E. R. (2012) · The Counseling Psychologist · doi:10.1177/0011000012459365 · Cited by 43 · see citing works
Observing therapeutic interaction in the “Lisa” case
Lepper, G., & Mergenthaler, E. (2008) · Psychotherapy Research · doi:10.1080/10503300701442001 · Cited by 41 · see citing works
Impact of confrontations by therapists on impairment and utilization of the therapeutic alliance
Moeseneder, L., Ribeiro, E., Muran, J. C., & Caspar, F. (2018) · Psychotherapy Research · doi:10.1080/10503307.2018.1502897 · Cited by 40 · see citing works
Self-citation
The Alliance Negotiation Scale: Psychometric construction and preliminary reliability and validity analysis
Doran, J. M., Safran, J. D., Waizmann, V., Bolger, K. W., & Muran, J. C. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.709326 · Cited by 40 · see citing works
Self-citation
Alliance theory and measurement.
Hatcher, R. L. (2010) · Cited by 37 · see citing works
How experienced therapists introduce the technical aspects in the initial alliance formation: Powerful decision makers supporting clients' agency
Oddli, H. W., & Rønnestad, M. H. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.633280 · Cited by 35 · see citing works
Describing therapeutic projects across sequences: Balancing between supportive and disagreeing interventions
Weiste, E. (2015) · Journal of Pragmatics · doi:10.1016/j.pragma.2015.02.001 · Cited by 35 · see citing works
Relational Turn and Psychotherapy Research
Lingiardi, V., Holmqvist, R., & Safran, J. D. (2016) · Contemporary Psychoanalysis · doi:10.1080/00107530.2015.1137177 · Cited by 34 · see citing works
Self-citation
Therapeutic Chatbots as Cognitive-Affective Artifacts
Grodniewicz, J. P., & Hohol, M. (2024) · Topoi · doi:10.1007/s11245-024-10018-x · Cited by 33 · see citing works
A rational model for maximizing the effects of therapeutic relationship regulation in personality disorders with poor metacognition and over‐regulation of affects
Dimaggio, G., Carcione, A., Salvatore, G., Semerari, A., & Nicolò, G. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x485256 · Cited by 33 · see citing works
The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists
Núñez, L., Midgley, N., Capella, C., Álamo, N., Mortimer, R., & Krause, M. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.1876946 · Cited by 33 · see citing works
A Systematic Review of Potential Mechanisms of Change in Psychotherapeutic Interventions for Personality Disorder
Berthollier, C. F. N. (2014) · Journal of Psychology & Psychotherapy · doi:10.4172/2161-0487.1000133 · Cited by 33 · see citing works
Alliance in Common Factor Land: A view through the research lens
Horvath, A. O. (2011) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2011.45 · Cited by 31 · see citing works
Care and Control: Working Alliance Among Adolescents in Authoritarian Settings
Orsi, M. M., Lafortune, D., & Brochu, S. (2010) · Residential Treatment for Children & Youth · doi:10.1080/0886571x.2010.520637 · Cited by 31 · see citing works
Trusting emotional support from generative artificial intelligence: a conceptual review
Volpato, R., DeBruine, L. M., & Stumpf, S. (2025) · Computers in Human Behavior Artificial Humans · doi:10.1016/j.chbah.2025.100195 · Cited by 46 · see citing works
The corrective emotional experience: A relational perspective and critique.
Christian, C., Safran, J. D., & Muran, J. C. (2012) · American Psychological Association eBooks · doi:10.1037/13747-004 · Cited by 29 · see citing works
Self-citation
Psychodynamic psychotherapy, insight, and therapeutic action
Lacewing, M. (2014) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12065 · Cited by 27 · see citing works
The development of the therapeutic alliance and the emergence of alliance ruptures. [El desarrollo de la alianza terapéutica y la aparición de rupturas en la alianza]
Coutinho, J. F. P., Ribeiro, E., Fernandes, C., Sousa, I., & Safran, J. D. (2014) · Anales de Psicología · doi:10.6018/analesps.30.3.168911 · Cited by 27 · see citing works
Self-citation
A longitudinal study of the turning points and trajectories of therapeutic relationship development in occupational and physical therapy
Horton, A., Hebson, G., & Holman, D. J. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06095-y · Cited by 26 · see citing works
You can't step into the same river twice, but you can stub your toes on the same rock: Psychotherapy outcome from a 50-year perspective.
Horvath, A. O. (2013) · Psychotherapy · doi:10.1037/a0030899 · Cited by 26 · see citing works
An exploration of the therapeutic alliance within a telephone‐based cognitive behaviour therapy for individuals with experience of psychosis
Mulligan, J., Haddock, G., Hartley, S., Davies, J., Sharp, T., KELLY, J. A., Neil, S. T., Taylor, C. D. J., Welford, M., Price, J., et al. (2014) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12018 · Cited by 26 · see citing works
Misalignment as a Therapeutic Resource
Voutilainen, L., Peräkylä, A., & Ruusuvuori, J. (2010) · Qualitative Research in Psychology · doi:10.1080/14780880902846411 · Cited by 26 · see citing works
Changes in rigidity and symptoms among adolescents in psychodynamic psychotherapy
Atzil-Slonim, D., Shefler, G., Gvirsman, S. D., & Tishby, O. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.602753 · Cited by 25 · see citing works
Discourse-voice regulatory strategies in the psychotherapeutic interaction: a state-space dynamics analysis
Tomicic, A., Martìnez, C., Pérez, J. C., Hollenstein, T., Angulo, S., Gerstmann, A., Barroux, I., & Krause, M. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00378 · Cited by 24 · see citing works
Howrealis the “real relationship”?
Horvath, A. O. (2009) · Psychotherapy Research · doi:10.1080/10503300802592506 · Cited by 24 · see citing works
The sound of change: A study of the psychotherapeutic process embodied in vocal expression. Laura Rice's ideas revisited
Tomicic, A., Martìnez, C., & Krause, M. (2014) · Psychotherapy Research · doi:10.1080/10503307.2014.892647 · Cited by 23 · see citing works
A comparison of pre-dropout and temporary rupture sessions in psychotherapy
Gülüm, İ. V., Soygüt, G., & Safran, J. D. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1246765 · Cited by 23 · see citing works
Self-citation
Trajectories of alliance ruptures in the psychotherapy of adolescents with borderline personality pathology: timing, typology and significance
Schenk, N., Zimmermann, R., Fürer, L., Krause, M., Weise, S., Kaess, M., Schlüter-Müller, S., & Schmeck, K. (2019) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2019.348 · Cited by 23 · see citing works
Meeting in difference: Revisiting the therapeutic relationship based on patients′ and therapists′ experiences in several clinical contexts
Altimir, C., Capella, C., Núñez, L., Abarzúa, M., & Krause, M. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22525 · Cited by 22 · see citing works
The Working Alliance in Teaching and Learning: Theoretical Clarity and Research Implications
Rogers, D. T. (2009) · International Journal for the Scholarship of Teaching and Learning · doi:10.20429/ijsotl.2009.030228 · Cited by 22 · see citing works
The Relation Between Children’s Perceived Group Climate and Therapeutic Alliance with Their Mentor in Residential Care: A Prospective Study
Strijbosch, E., Stams, G. J. J. M., Wissink, I. B., van der Helm, P., & Roest, J. J. (2018) · Residential Treatment for Children & Youth · doi:10.1080/0886571x.2018.1455560 · Cited by 21 · see citing works
Psychotherapy in Psychosis: Experiences of Fully Recovered Service Users
Bjørnestad, J. R., Veseth, M., Davidson, L., Joa, I., Johannessen, J. O., Larsen, T. K., Melle, I. S., & Hegelstad, W. T. V. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01675 · Cited by 21 · see citing works
Case Formulation and the Therapeutic Relationship: The Role of Therapist Self‐Reflection and Self‐Revelation
Tufekcioglu, S., & Muran, J. C. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22183 · Cited by 20 · see citing works
Self-citation
COVID-19 Related Traumatic Distress in Psychotherapy Patients during the Pandemic: The Role of Attachment, Working Alliance, and Therapeutic Agency
Doorn, K. A., Békés, V., & Luo, X. (2021) · Brain Sciences · doi:10.3390/brainsci11101288 · Cited by 20 · see citing works
Zone of proximal development ( ZPD ) as an ability to play in psychotherapy: A theory‐building case study of very brief therapy
Zonzi, A., Barkham, M., Hardy, G. E., Llewelyn, S. P., Stiles, W. B., & Leiman, M. (2014) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12022 · Cited by 19 · see citing works
DIALOGIC DISCOURSE ANALYSIS OF PSYCHOTHERAPEUTIC DIALOGUE: MICROANALYSIS OF RELEVANT PSYCHOTHERAPY EPISODES
Medina, L., Martìnez, C., & Tomicic, A. (2012) · Cited by 19 · see citing works
The Alliance Negotiation Scale: A psychometric investigation.
Doran, J. M., Safran, J. D., & Muran, J. C. (2015) · Psychological Assessment · doi:10.1037/pas0000222 · Cited by 19 · see citing works
Self-citation
Working Alliances in College Classrooms
Meyers, S. A. (2008) · Teaching of Psychology · doi:10.1080/00986280701818490 · Cited by 19 · see citing works
Repairing Alliance Ruptures in Emotionally Focused Couple Therapy: A Preliminary Task Analysis
Swank, L. E., & Wittenborn, A. K. (2013) · American Journal of Family Therapy · doi:10.1080/01926187.2012.726595 · Cited by 19 · see citing works
Interpersonal Biofeedback in Psychodynamic Psychotherapy
Kleinbub, J. R., Mannarini, S., & Palmieri, A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01655 · Cited by 19 · see citing works
New visions of social control? Young people's perceptions of community penalties
Cox, A. L. (2012) · Journal of Youth Studies · doi:10.1080/13676261.2012.697136 · Cited by 18 · see citing works
Questioning the couch: Historical and clinical perspectives.
Lingiardi, V., & Bei, F. D. (2011) · Psychoanalytic Psychology · doi:10.1037/a0024357 · Cited by 18 · see citing works
What are the Experiences of Therapeutic Rupture and Repair for Clients and Therapists within Long‐Term Psychodynamic Therapy?
Haskayne, D., Larkin, M., & Hirschfeld, R. (2014) · British Journal of Psychotherapy · doi:10.1111/bjp.12061 · Cited by 17 · see citing works
The Emotional Literacy Support Assistant (ELSA) programme: ELSAs’ and children’s experiences
McEwen, S. (2019) · Educational Psychology in Practice · doi:10.1080/02667363.2019.1585332 · Cited by 17 · see citing works
Alliance rupture and repair processes in psychoanalytic psychotherapy: multimodal in-session shifts from momentary failure to repair
Mylona, A., Avdi, E., & Paraskevopoulos, E. (2022) · Counselling Psychology Quarterly · doi:10.1080/09515070.2021.2013162 · Cited by 17 · see citing works
The role of interpersonal coordination dynamics in alliance rupture and repair processes in psychotherapy—A systematic review
Høgenhaug, S. S., Kongerslev, M., & Telléus, G. K. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1291155 · Cited by 19 · see citing works
Measuring Therapeutic Alliance With Children in Residential Treatment and Therapeutic Day Care
Roest, J. J., van der Helm, P., Strijbosch, E., van Brandenburg, M., & Stams, G. J. J. M. (2014) · Research on Social Work Practice · doi:10.1177/1049731514540478 · Cited by 17 · see citing works
Exploring the relational aspects of patient and doctor communication
Hovey, R. B., & Massfeller, H. F. (2012) · Journal of Medicine and the Person · doi:10.1007/s12682-012-0123-0 · Cited by 17 · see citing works
The Search for Common Factors in Psychotherapy: Two Theoretical Models with Different Empirical Implications
Lundh, L. (2014) · Psychology and Behavioral Sciences · doi:10.11648/j.pbs.20140305.11 · Cited by 17 · see citing works
Interpersonal profiles in emotional disorders predict the importance of alliance negotiation for early treatment outcome.
Penedo, J. M. G., Zilcha‐Mano, S., & Roussos, A. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000417 · Cited by 16 · see citing works
Therapeutic Alliance and Alliance Ruptures and Resolutions: Theoretical Definitions, Assessment Issues, and Research Findings
Lingiardi, V., & Colli, A. (2014) · Springer eBooks · doi:10.1007/978-3-7091-1382-0_16 · Cited by 16 · see citing works
Emotion Regulation: Processes, Strategies, and Applications to Group Work Training and Supervision
Champe, J., Okech, J. E. A., & Rubel, D. J. (2013) · The Journal for Specialists in Group Work · doi:10.1080/01933922.2013.834403 · Cited by 16 · see citing works
Verbal and nonverbal expressions of mutual regulation in relevant episodes of psychotherapy / Manifestaciones verbales y no verbales de la regulación mutua en episodios relevantes de psicoterapia
Morán, J., Martìnez, C., Tomicic, A., Pérez, J. C., Krause, M., Guzmán, M., Martín, D. S., Angulo, S., Barroux, I., Gerstmann, A., et al. (2016) · Studies in Psychology Estudios de Psicología · doi:10.1080/02109395.2016.1204784 · Cited by 16 · see citing works
Using Interpersonal Dimensions of Personality and Personality Pathology to Examine Momentary and Idiographic Patterns of Alliance Rupture
Luo, X., Hopwood, C. J., Good, E. W., Turchan, J. E., Thomas, K. M., & Levendosky, A. A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.711109 · Cited by 15 · see citing works
Therapeutic alliance and childhood interpersonal trauma: The role of attachment, cultural humility, and therapeutic presence
Grad, R. I. (2021) · Journal of Counseling & Development · doi:10.1002/jcad.12423 · Cited by 17 · see citing works
Does it make a difference to be more “on the same page”? Investigating the role of alliance convergence for outcomes in two different samples
Nissen‐Lie, H. A., Solbakken, O. A., Falkenström, F., Wampold, B. E., Holmqvist, R., Ekeblad, A., & Monsen, J. T. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1823030 · Cited by 17 · see citing works
Collaborative Empiricism: A Cognitive Response to Exposure Reluctance and Low Distress Tolerance
Clark, D. A. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.06.001 · Cited by 14 · see citing works

Therapeutic Alliance and Alliance Ruptures and Resolutions: Theoretical Definitions, Assessment Issues, and Research Findings
Lingiardi, V., & Colli, A. (2014) · Springer eBooks · doi:10.1007/978-3-7091-1382-0_16 · Cited by 16 · see citing works
Psychotherapy Research
Gelo, O. C. G. G., Pritz, A., Rieken, B., Gelo, O. C. G., Alfred, P., & Rieken, B. (2014) · Springer eBooks · doi:10.1007/978-3-7091-1382-0 · Cited by 130 · see citing works
A brief overview of the therapeutic alliance: historical, theoretical and contemporary debates
Öz, T. (2024) · Journal of Nursing Care Research · doi:10.51271/jncr-0020 · Cited by 1 · see citing works
Η θεραπευτική συμμαχία: ορισμοί, αναστοχασμοί και θεραπευτικές προεκτάσεις
Apostopoulou, A., & Giovazolias, T. (2021) · Psychology the Journal of the Hellenic Psychological Society · doi:10.12681/psy_hps.26870 · Cited by 1 · see citing works
The alliance in context: Accomplishments, challenges, and future directions.
Horvath, A. O. (2006) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/0033-3204.43.3.258 · Cited by 189 · see citing works

Authors: Safran, J. D., & Muran, J. C.
Affiliations: The New School (US)
Mount Sinai Beth Israel (US)
ORCID: Muran, J. Christopher
Venue: Psychotherapy: Theory, Research, Practice, Training
Publisher: American Psychological Association (APA)
Published: 2006
Volume: 43
Issue: 3
Pages: 286-291
ISSN: 0033-3204 (ISSN-L)
1939-1536
DOI: 10.1037/0033-3204.43.3.286
OpenAlex: W2043568664
Cited by: 311
References: 24
Citations by year: 2026: 9 · 2025: 11 · 2024: 12 · 2023: 8 · 2022: 46 · 2021: 13 · 2020: 18 · 2019: 24 · 2018: 16 · 2017: 21 · 2016: 20 · 2015: 17 · 2014: 26 · 2013: 14 · 2012: 10
FWCI: 6.64
Type: journal article
Language: en
Open access: closed
Locations: Psychotherapy (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: therapeutic relationship, psychotherapy research, conceptual difficulties, construct validity, future research directions

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Has the concept of the therapeutic alliance outlived its usefulness?

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks