The therapeutic alliance and therapeutic relationship in dialectical behavior therapy

Abstract The therapeutic alliance in dialectical behavior therapy (DBT) is a multifaceted construct thought to both facilitate change while also being curative independent from any therapeutic technique. As a mechanism of change, the therapeutic alliance in DBT can be conceptualized as it relates to the larger framework of problem-solving in DBT. The areas of the alliance most critical to change include an agreement on the goals of therapy, the development of a mutual understanding of the client consistent with DBT principles, an agreement on the tasks of therapy, and a commitment to the goals and tasks of treatment. In contrast to an emphasis on problem-solving, the therapeutic bond is thought to be effective independent from any technique directed toward change. We describe the development of the therapeutic bond as occurring through the therapists’ ability to develop the therapeutic relationship in a manner consistent with DBT principles. In each area of the alliance, we emphasize the behavioral actions necessary for the therapist to build an effective alliance. The chapter concludes with a review of the empirical literature on the therapeutic alliance in DBT along with recommendations for clinical practice and future research.