Interpreting Therapeutic Alliance Scores

This article explains the Therapeutic Alliance screening tool. Learn what it is, how it helps assess therapeutic alliance, and how you can use the results to track the therapist-client relationship, build trust, and guide treatment decisions.

Definition and purpose

This is a three-question screener used to measure the level of collaboration, partnership, and alignment between the therapist and client. In practice, a strong therapeutic alliance promotes a shift from a one-sided  “How are YOU doing?” to a collaborative “How are WE doing?”

Research has shown that strong therapist-client relationships are key to successful therapy, regardless of the client's presenting problem or treatment approach. These relationships are built on empathy, genuineness, and unconditional support. Collaboration and agreement on goals are also crucial for progress and healing.

Items and scoring

At Rula, clients are asked 3 questions specific to the alliance between therapist and client.  

  • I feel I am working together with my provider on mutual goals in treatment.
  • I am confident in my provider's ability to help me.
  • My provider and I understand each other.  


Clients respond to each question using a 5-point Likert scale. 

0 = Strongly disagree

1 = Disagree

2 = Neither agree nor disagree

3 = Agree

4 = Strongly agree


Responses are then summed for a total score of between 0 and 12.

Interpreting scores

Higher scores generally mean a better therapist-client relationship. However, look at each answer individually to understand the client's experience. If a response suggests a problem (like a “strongly disagree”, “disagree” or “neither agree nor disagree” response to one or more of the 3 questions), the therapist may need to address it to strengthen the alliance.

For more on repairing a weak alliance, see this article.


Strong therapist-client relationships are key! Regularly checking in with clients about their satisfaction with therapy helps build trust and keeps everyone on the same page. You can always start measuring this, even with long-term clients.

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