Therapeutic Alliance Essay

The Therapeutic Relationship Essay

In the assigned chapter, Bohart and Tallman (2010) discussed clients and their effect on therapy. They argued that client and extratherapeutic influences are the single most important factor in determining therapy outcome. In fact, up to 87% of the variance in therapeutic outcome is attributable to the client, factors that occur outside therapy, and unexplained variance (Bohart & Tallman, 2010, p. 84). Bohart and Tallman further argued that approximately 40% of variance can be ascribed to client factors while only 13% can be accounted for by treatment (e.g., the therapeutic relationship, interventions, therapist, model of therapy). Unfortunately, traditional conceptualizations of psychotherapy have largely ignored these client factors (Bohart & Tallman, 2010, pp. 92-84). Instead, the focus has been on the therapeutic process, the therapist, and his or her interventions, which do not contribute as much to therapeutic outcome as client factors. According to Bohart and Tallman, it is clear that more attention must be given to the critical effect clients have on the outcome of therapy (pp. 94-95).
Evaluation
First, Bohart and Tallman (2010) discussed the role of the medical model in psychotherapy (pp. 92-94). The medical model focuses on diagnosis and specific treatment based on that diagnosis. Bohart and Tallman said that the medical model of psychotherapy is not supported by research. They said that research shows that “all bona fide therapeutic approaches work about equally well, regardless of diagnosis… Research also challenges the importance of technique” (Bohart & Tallman, 2010, p. 92). They also discussed the inconsistent findings regarding professional training and therapeutic outcome. Last, they pointed out that, although both the person of the therapist and the therapeutic alliance have been shown to contribute to positive therapeutic outcome, positive change can occur without a therapist. Bohart and Tallman even cited research showing that therapy and self-help were about equally effective.
While I agree that more traditional conceptualizations of psychotherapy are not always beneficial to clients, I believe the authors over-simplified this discussion. For example, EMDR and CBT have been proven effective in treating Post-Traumatic Stress Disorder, significantly more so than other types of therapy. In other words, while Bohart and Tallman (2010) made a valid point, they overlooked other valid research that contradicts their position. Even their brief discussion about the “exceptions” to their argument served to support their conclusions about people’s capacity for change.
A second key point that Bohart and Tallman (2010) made pertained to listening (pp. 98-99). “You are not listening until the client says you are” (Bohart and Tallman, 2010, p. 99). That quote made me think about how important it is to make sure the client feels understood. The focus should not be on my understanding of the client, but rather on if...

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In the assigned chapter, Bohart and Tallman (2010) discussed clients and their effect on therapy. They argued that client and extratherapeutic influences are the single most important factor in determining therapy outcome. In fact, up to 87% of the variance in therapeutic outcome is attributable to the client, factors that occur outside therapy, and unexplained variance (Bohart & Tallman, 2010, p. 84). Bohart and Tallman further argued that approximately 40% of variance can be ascribed to client factors while only 13% can be accounted for by treatment (e.g., the therapeutic relationship, interventions, therapist, model of therapy). Unfortunately, traditional conceptualizations of psychotherapy have largely ignored these client factors…show more content…

Bohart and Tallman even cited research showing that therapy and self-help were about equally effective.
While I agree that more traditional conceptualizations of psychotherapy are not always beneficial to clients, I believe the authors over-simplified this discussion. For example, EMDR and CBT have been proven effective in treating Post-Traumatic Stress Disorder, significantly more so than other types of therapy. In other words, while Bohart and Tallman (2010) made a valid point, they overlooked other valid research that contradicts their position. Even their brief discussion about the “exceptions” to their argument served to support their conclusions about people’s capacity for change.
A second key point that Bohart and Tallman (2010) made pertained to listening (pp. 98-99). “You are not listening until the client says you are” (Bohart and Tallman, 2010, p. 99). That quote made me think about how important it is to make sure the client feels understood. The focus should not be on my understanding of the client, but rather on if the client believes I have accurately grasped his or her story. It also pointed out the importance of keeping the client at the center of therapy. If the client is not the center, than I am not truly going to care if he or she feels understood. Instead, I will be focusing on other factors that may not be as pertinent to making therapy successful.

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