May 5, 2021  |   2 minute read

How strong is your alliance with clients? You might be surprised.

Whether you are a psychologist, a social worker, or a psychotherapist, most mental health clinicians recognize the importance of the therapeutic alliance. Yet, research suggests that there are often inconsistencies in therapists’ perception of the strength of the alliance when compared to clients’ perception of the alliance (Hartmann, Joos, Orlinsky, and Zeeck, 2012). Given the fact that the therapeutic alliance accounts for 30% of therapeutic outcomes (Lee, 2005), such inconsistencies in therapist vs patient perceptions of alliance could pose a barrier to positive outcomes in therapy (Coyne, Constantino, Laws, Westra, and Antony, 2017).

Interestingly, a 2013 study found that clinicians who were most likely to overestimate the strength of the alliance were therapists with more extensive experience, while therapists with less experience tended to underestimate the strength of the therapeutic alliance (Manne, Kashy, Rubin, Hernandez, and Bergman, 2013). This suggests that there are inconsistencies in perception of alliance irrespective of the therapist’s level of experience. Accordingly, all therapists could benefit from client feedback regarding the strength of the alliance, in order to better align their understanding of the alliance with their clients.

The next logical question is – How do therapists improve their ability to accurately understand clients’ perceptions of the therapeutic alliance? According to a 2018 report by the Canadian Psychological Association, using progress measurement tools to monitor the strength of the therapeutic alliance after each session can improve therapist awareness of the strength of the alliance and, in turn, improve patient outcomes. Furthermore, research shows that a weaker therapeutic alliance is associated with higher patient drop out (Sharf, Primavera, and Diener, 2010). Therefore, if therapists use progress measurement tools to detect weaker alliances, they may be better equipped to address alliance issues early on in the therapeutic process. Accordingly, using progress measurement tools not only improves therapeutic outcomes, but also reduces the risk of patient drop out.

It’s clear that using progress measurement tools in therapy can significantly improve client outcomes, but there is often concern from therapists about the difficulty of implementing progress measurement in practice. This is where Greenspace can help. Greenspace gives therapists access to a wide variety of progress measurement tools, making it simple and efficient to track progress in symptom severity and therapeutic alliance with patients.

Begin using evidence based progress measurement tools in your practice by booking a demo or scheduling a call with one of our Implementation Experts.


  • Canadian Psychological Association. (2018). Outcomes and progress monitoring in psychotherapy. Retrieved March 6, 2019 from
  • Coyne, A., Constanino, M.J., Laws, H.B., Westra, H.A., & Antony, M.M. (2017). Patient-therapist convergence in alliance ratings as a predictor of outcome in psychotherapy for generalized anxiety disorder. Journal of Psychotherapy Research, 28(6). DOI: 10.1080/10503307.2017.1303209
  • Hartmann, A., Joos, A., Orlinsky, D.E., & Zeeck, A. (2012). Accuracy of therapist perceptions of patients’ alliance: Exploring the divergence. Journal of Psychotherapy Research 25(4). DOI: 10.1080/10503307.2014.927601
  • Lee, C. (2005). An exploratory study of the therapeutic alliance and client outcomes in a voluntary counselling agency. Retrieved on March 6, 2019 from
  • Manne, S., Kashy, D.A., Rubin, S., Hernandez,E., & Bergman, C. (2013). Therapist and patient perceptions on alliance and progress in psychological therapy for women diagnosed with gynecological cancers. Journal of Consulting and Clinical Psychology, 80(5). DOI: 10.1037/a0029158
  • Sharf, J., Primivera, L.H., & Diener, M.J. (2010). Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Journal of Psychotherapy, 47(4). DOI: 10.1037/a0021175