ABSTRACT

This chapter reviews aspects of the ongoing therapeutic relationship that develops between clinician and the client. The physical and emotional safety of both clinician and client are essential to a productive treatment relationship, and treatment cannot proceed until safety is established. It offers suggestions on maintaining the treatment alliance, responding to changes in the client's symptoms and disclosure of new information, managing obstacles that arise, and maintaining professional boundaries. The quality of the therapeutic alliance is a strong predictor of treatment effectiveness. The client's attitude of cooperativeness or hostility toward treatment is a primary factor in establishing a therapeutic alliance. The therapeutic alliance is more difficult to establish and maintain with clients who have limited coping strategies and are inflexible in their responses to interpersonal situations. Critical and judgmental attitudes can present a challenge to professional boundaries when they lead to actions that are punitive rather than serving to support the client's therapeutic goals.