Interpreting Therapeutic Alliance scores

This article explains the Therapeutic Alliance screening tool. Learn what it is, how it helps assess the strength of the therapeutic relationship, and how you can use the results to build trust and inform treatment decisions.

Definition and purpose

A 2 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 clinical progress and recovery.

Items and scoring

At Rula, clients are asked 2 questions specific to the alliance between therapist and client. 

  • My therapist and I agree about the things I will need to do in therapy to help improve my situation.
  • I feel that my therapist understands me.

Clients respond to each question using a Likert scale. 

0 = Strongly agree

1 = Agree

2 = Disagree

3 = Strongly Disagree

Responses are then summed for a total score of between 0 and 6.

Interpreting scores

Lower scores generally indicate a stronger therapist-client relationship. However, look at each answer individually to understand the client's experience. If a client responds with a “disagree” or  “strongly disagree” to either question, this should be addressed in session. 

For support on strengthening a weakened or ruptured alliance, see this article.

Monitoring

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 begin measuring the Therapeutic Alliance with a client at any time in the therapy process.

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