What is a Therapeutic Alliance?

A Strong Therapeutic Alliance Can Make a Big Difference During Treatment

therapist talking to patient
Blend Images/Ned Frisk Brand/X Pictures/Getty Images

If you have a mental illness like borderline personality disorder (BPD), you are likely used to a whole way of feeling and reacting. For those with BPD, that may mean intense emotions, destructive actions, rapid mood swings and feelings of abandonment. You may have gone years feeling this way and do not know any other way of living. 

If you are considering going to therapy, it can be overwhelming, scary and frustrating.

Psychotherapy sessions ask you to completely change how you think and rationalize behaviors. It can be a stressful and emotional experience, but a strong therapeutic alliance can help you through it. 

What is a Therapeutic Alliance?

The foundation for any course of therapy is the therapeutic alliance, the strong bond designed to help you through your recovery.It is the relationship you have with your therapist and the level of trust you have in her. This is what keeps you moving during therapy, even when it's difficult or painful, because you know she has your best interests in mind. This connection be hard to build but involves the following components:

  • Genuine interest: A good therapist gives you her undivided attention. She listens to what you have to say and asks clarifying questions. She does not seem preoccupied, does not sift through emails and she doesn't only give you her thoughts or opinions. 
  • Specialization: Your therapist needs to have an understanding of what you're going through in order to help you. This means she should have a background studying BPD and working with patients who have BPD. 
  • Comfort: You need to be comfortable telling your therapist anything, even if it's embarrassing. She should put you at ease and ensure you know your conversations are confidential
  • Common Goals: You both should have the same goals so that you are working towards the same endpoint. 

Building a Therapeutic Alliance

A strong therapeutic alliance does not happen over night and may not be possible with just any therapist. Many people with BPD will visit several healthcare providers or psychiatrists before they find one they can "click" with. 

When you are beginning therapy, it's perfectly okay to have consultations with several mental health professionals. Ask questions about their approaches to therapy, what techniques and theories they often use, their background in BPD and other personality disorders and how available they are; many people with BPD who engage in self-harm or have suicidal thoughts will often need to be able to call their therapist at odd hours during an emergency. 

Your potential therapist should be happy to answer your questions. If he seems annoyed, impatient, defensive or keeps checking his watch, it's time to move on and find someone else. A good therapist is worth the extra homework in order to help you on the path to long-term recovery.


If you're having trouble finding a therapist with a background with BPD, talk to your general practitioner or primary care physician to see if he has any recommendations. He will likely have many different therapists, counselors, psychiatrists and psychologists on file he can refer you to. 


Meyers, L. "Connecting With Clients". Counseling Today, 2014. 

Continue Reading