‘The vehicle of success’: Theoretical and empirical perspectives on the therapeutic alliance in psychotherapy and psychiatry
Abstract
The importance of the 'therapeutic alliance' has long been recognized in psychotherapeutic theory and research, but is also increasingly researched in psychiatry. This paper examines the clinical and empirical literature on the alliance and asks, first, whether the concept is unrecognizably distorted when it travels from the psychoanalytic context to other therapies and to psychiatry, or when translated into research instruments; and, second, how we are to understand the apparent anomaly whereby its proponents have defined it as a 'vehicle' for treatment rather than curative, whereas quantitative research increasingly associates it with outcome. This paper reviews the evolution of the concept in clinical theory, traces the development of empirical research on the subject and considers its use in psychiatry. It argues that the empirical research misleadingly suggests a curative paradigm, and that it may be unable to illuminate some of the clinical controversies, although its implications for theory demand consideration. It argues for the retention of the alliance concept in psychiatry distinct from the broader spectrum of the 'relationship'. Finally, it argues that the debate about the concept's curative properties may, paradoxically, be more pressing within psychotherapy than psychiatry, and endorses calls for more theoretically driven empirical research into the alliance.
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A potentially important explanation for the lack of significant impact of therapeutic games is the lack of a therapeutic alliance as commonly developed in traditional psychotherapeutic delivery.
“Potentially, the most important is the lack of a therapeutic alliance developed as is commonly effective within traditional psychotherapeutic delivery (Catty, 2004).”
From Therapeutic games to reduce anxiety and depression in young people: A systematic review and exploratory meta‐analysis of their use and effectiveness. (2024) · cites this paper as Catty, 2004
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- Authors
- Catty, J.
- Affiliations
- St George's, University of London (GB)
- Corresponding author
- Catty, Jocelyn
- ORCID
- Catty, Jocelyn
- Venue
- Psychology and Psychotherapy: Theory, Research and Practice
- Publisher
- Wiley
- Published
- 2004-06
- Volume
- 77
- Issue
- 2
- Pages
- 255-272
- ISSN
- 1476-0835 (ISSN-L)
- 2044-8341
- OpenAlex
- W2153640284
- Cited by
- 111
- References
- 0
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 19 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 4 · 2013: 9 · 2012: 8
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychology and Psychotherapy Theory Research and Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Keywords
- therapeutic relationship, psychotherapy, psychiatry, psychoanalytic theory, treatment outcomes
- MeSH terms
- Humans, Models, Psychological, Professional-Patient Relations, Psychotherapeutic Processes, Transference, Psychology, Treatment Outcome, Biomedical Research
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