The therapeutic alliance:How to measure the relationship between the therapist and client.

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The therapeutic relation or alliance defines the relation between the client and the therapist.The client therapist relationship affects the treatment outcomes. Several researchers have assessed this relationship and used different tools to measure the impact of this relation on the treatment outcome.

Defining the therapeutic relationship and a review of Helping Alliance Scale used to measure the client-therapist relationship.

The therapeutic relation or alliance defines the relation between the client and the therapist. The success of the therapy depends on many factors including client-therapist relationship and the treatment methods applied. The client therapist relationship affects the treatment outcomes. (Hall,n.d).Therefore it is important to find a good therapist for the client and for the therapist it is important to develop rapport with the client. For the alliance or the relationship to move forward progressively it is important that the client and the therapist agree on the goals they have set out to achieve and that they agree on the task to be carried out during the therapy.
Several researchers have assessed this relationship and used different tools to measure the impact of this relation on the treatment outcome. In order to measure the relationship between the therapist and the client scales and inventories have now been designed. These include: the Working Alliance Inventory (WAI), California Psychotherapy Alliance Scales (CALPAS), Helping Alliance questionnaire (HAq.), the Barret-Lennard relationship inventory, The Scale to Assess Relationships (STAR) and the Vanderbilt Scales. (Fenton, 2001)
The results obtained by the above mentioned questionnaires and inventories are varied. There is no denying the importance of client-therapist alliance but there is disagreement among psychologists about the instruments to use to measure this relationship. (Aps. Org, n.d). A research can be carried out to measure the effectiveness of these instruments. In order to do that the alliance measures need to be compared. It has been observed that there is medium to high correlation between these scales. The most commonly used alliance scales measure the collaboration between the therapist and the client and the bond between them.
Lester Luborsky (1976) believed that the therapist and client’s relation develops in two phases. The first phase involves the client’s trust in the therapist and the support given by the therapist. The second phase relies on the client’s trust in the therapy. (Norcross, 2002). He developed the Helping Alliance scale. The scale is designed to measure the two phases proposed by Luborsky. This scale collects data from both the therapist and the client. The Helping Alliance scale has now been revised and consists of a 19-item questionnaire. ("The revised helping alliance questionnaire,",n.d ) There are three types of Helping Alliance measures including the Helping Alliance Global Rating Method, the Self Report Helping Alliance questionnaire and the Helping Alliance Counting Sign method. The Helping Alliance questionnaire includes five items suggesting collaboration between the therapist and the client, five items relate to how a client perceives the therapist, other items relate to client’s motivation and how the client believes the therapist perceives him. Each item is rated on a 6 point Likert scale.
The Helping Alliance scale was used by Luborsky on patients suffering from Substance use Disorders. ((Ojehagen, 1997) Alcohol & alcoholism, 1997).He found out that an early alliance between the therapist and the client led to a positive outcome. It has been discovered that the Helping Alliance questionnaire can suggest the level of satisfaction the client feels and therefore is a good predictor of treatment outcomes. The Helping Alliance scale and WAI are the most commonly used instruments.
In conclusion, a comparison between the instruments used to measure the therapist client relationship reveals that all of them measure the bond between the client and the therapist. These alliance measures have proven helpful in predicting the treatment outcomes of various disorders.

References
Apa .Org. (n.d.). Comparison and relationship to outcome of diverse dimensions of the helping alliance as seen by client and therapist. . Retrieved from http://psycnet.apa.org/journals/pst/28/4/534/
Norcross, J. (2002). psychotherapy relationships that work. New York: oxford university press.
Ojehagen, A. (1997). Alcohol and alcoholism. (3 ed., Vol. 32, pp. 241-249). Oxford University Press. Retrieved from http://alcalc.oxfordjournals.org/
The Revised Helping Alliance Questionnaire. (n.d.). Retrieved from http://www.med.upenn.edu/cpr/documents/Luborskyetal1996_HAQ-II.pdf
Hall, A. (n.d.). The influence of therapist-patient relationship on treatment outcome in physical rehabilitation. Physical Therapy, Retrieved from ptjournal.apta.org
Fenton, L. (2001). Journal of psychotherapy practice and research. perspective is everything:the predictive validity of six working alliance instruments, Retrieved from http://jppr.psychiatryonline.org/