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J. Christopher Muran and Jacques P. Barber (Eds): The Therapeutic Alliance:

An Evidence-Based Guide to Practice

Article  in  Clinical Social Work Journal · June 2011

DOI: 10.1007/s10615-011-0374-x

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Clin Soc Work J
DOI 10.1007/s10615-011-0374-x
BOOK REVIEW
J. Christopher Muran and Jacques P. Barber (Eds): The
Therapeutic Alliance: An Evidence-Based Guide to Practice
The Guilford Press, New York, 2010, 368 pp, $45.00
Christine Lynn Norton
! Springer Science+Business Media, LLC 2011
Clinical social work has long history of valuing the thera-
peutic alliance in direct practice with clients. Clinical
social work includes psychotherapy approaches that high-
light the ‘‘interaction between a social worker and a client
(either individual, couple, family, or group) in which a
therapeutic relationship is established to help resolve
symptoms of mental disorder, psychosocial stress, rela-
tionship problems, and difficulties in coping in the social
environment’’ (NASW 2005, p. 10). In The therapeutic
alliance, Muran and Barber bring together theory, research
and practice considerations regarding the therapist-patient
alliance, all of which is highly applicable to clinical social
work. Examining the history and function of the thera-
peutic alliance as a primary variable in the change process
is the focus of their book. The book contains three main
parts: (I) critical studies of the therapeutic alliance; (II)
practice and the therapeutic alliance; and (III) training pro-
grams on the therapeutic alliance. The research and practice
wisdom in this book are based on both Dr. Muran’s and
Dr. Barber’s psychotherapy research on developing inter-
vention strategies and training models relating to the thera-
peutic alliance.
Clinical social workers know firsthand that the power of
the therapeutic relationship is related to treatment outcome,
but we have struggled to know exactly how this occurs.
This text begins to answer that question. Part I of Muran
and Barber’s book critically examines the most current
research on the therapeutic alliance in order to provide
empirical support for the therapeutic process and move past
anecdotal evidence and practice wisdom on the importance
C. L. Norton (&)
School of Social Work, Texas State University-San Marcos,
601 University Dr., San Marcos, TX 78666, USA
e-mail: cn19@txstate.edu
of the therapeutic relationship. Through a meta-analysis of
the literature, Muran and Barber (and their contributing
authors) examine the therapeutic alliance as predictor,
moderator, and mediator of outcomes. Likewise, they
explore the therapeutic alliance as a therapy outcome in
and of itself. Overall, Muran and Barber’s analysis of the
research shows that the alliance is an important factor in
promoting the client’s involvement and continuation in
treatment; however, ‘‘the specific ways in which having a
good alliance is positively associated with good outcome
remain elusive’’ (2010, p. 40). Their findings demonstrate
the complexity and challenges of research in this area, as
there are so many moderating variables to consider, even
when examining the therapeutic alliance over time. These
variables may include the type of psychotherapy approach
being used, other significant relationships and events in the
client’s life, and prior and/or subsequent changes in
symptoms that may or may not be related to the therapeutic
relationship.
Most notable and useful for clinical social workers is the
qualitative research presented on negative experiences in
psychotherapy, as well as alliance ruptures and resolution.
This research provides important data that can guide ther-
apists in working effectively with clients around negative
events that occur in the therapeutic relationship. This
research also looks at various types of ruptures in the
alliance that fall into broad categories of either withdrawal
or confrontation. According to Muran and Barber, both
negative events and ruptures in the therapeutic alliance
‘‘are common clinical phenomena that can pose significant
challenges to therapists but can also provide opportunities
for therapeutic change’’ (p. 88). This perspective on the
pitfalls and the opportunities posed by these experiences
reminds therapists of the importance of dealing with rup-
tures in the therapeutic relationship.
123

Part II of The therapeutic alliance transitions from a
review of the research to practice considerations for the
therapeutic alliance based on various clinical theories. This
section encompasses perspectives from Psychodynamic
therapy, Interpersonal therapy, Cognitive-behavioral ther-
apy, Functional analytic psychotherapy, and Humanistic
psychotherapy, as well as couple, family and group thera-
pies. All of Part II’s chapters provide an overview of
therapeutic alliance research within the nuances of each
approach. But the most useful aspect of each chapter for
clinical social workers is the focus on direct practice
interventions and skills involving the therapeutic relation-
ship, with an emphasis on factors that moderate this alli-
ance. Several chapters provide helpful case studies and
practice examples along with the research.
Notably, this broad overview of theory and practice
focuses on the therapeutic relationship in somewhat of a
vacuum. What is lacking is an inclusion of an overarching
developmental goal or rational for establishing a mean-
ingful therapeutic relationship (other than to enhance
treatment outcomes). While the therapeutic alliance is an
important variable in the treatment process, the establish-
ment of this bond between therapist and client also creates
opportunities for the development of transferable relation-
ship-building skills in the client’s life. As the therapist and
client process negative events, resolve ruptures, and renew
trust, the client can be working through relational issues in
her life outside of the therapeutic setting. This can lead to
more durable, resilient relationships in the client’s life and
help the client maintain the gains made in the context of the
therapeutic relationship. Relational–cultural theory refers
to this as relational resilience, which is the ability to create
and maintain mutually empathic and empowering rela-
tionships over time and is a critical life skill that transcends
treatment outcomes (Jordan 2005).
For this reason, it is here that the authors may have
decided to include relational–cultural theory (RCT) in
order to understand the therapeutic alliance from a more
feminist and less traditional perspective. At the core of
RCT is
… the belief that all psychological growth occurs in
relationships, and that movement out of relationship
(chronic disconnection) into isolation constitutes the
source of much psychological suffering. Moving
away from a ‘‘separate self’’ model of development,
RCT also suggests that resilience resides not in the
individual but in the capacity for connection (Jordan
2005, p. 79).
If the authors had chosen to include RCT in this book, it
may have expanded the view of the therapeutic alliance
to include the process of enhancing our clients’ overall
capacity for connection, as well as furthering clients’
123
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Clin Soc Work J
specific treatment goals. This idea also fits with the most
current neuroscience research on the power of caring
human relationships on healthy neural integration and
functioning (Cozolino 2006), as well as the powerful
influence of psychotherapy on the brain (Cozolino 2010),
both of which are notably missing from this book.
Given the importance and complexities of the thera-
peutic alliance, Muran and Barber strongly advocate for the
need for training programs that help therapists learn skills
for negotiating negative events with clients and learn how
to use these events for positive growth and change in the
client system. Part III of The therapeutic alliance presents
effective strategies for helping therapists build important
relationship-building skills. This section draws on the
authors’ research on several clinical training programs that
focus specifically on the therapeutic alliance. In this
reviewer’s opinion, these important recommendations for
practice and training are the most useful part of this book
for clinical social workers and students of clinical social
work because they create a deeper understanding of the
intersection between the therapeutic alliance, clinical the-
ories and practice skills and techniques.
The appeal of this book is that it brings together much of
the research, theory and practice considerations relating to
the therapeutic alliance in a way that is highly readable and
accessible to clinical social workers and other mental health
practitioners. Though other books have been published on
this subject (Meissner 1996; Safran and Muran 2003), this
book is set apart by its critical review and application of
research on the therapeutic relationship up to this point.
Muran and Barber achieve their goal of translating ‘‘the latest
scientific knowledge into practical guidelines that clinicians
of any orientation can use to optimize the alliance’’ (p. 1).
References
Cozolino, L. (2006). The neuroscience of human relationships. New
York: W. W. Norton & Company.
Cozolino, L. (2010). The neuroscience of psychotherapy: Building
and rebuilding the human brain (2nd ed.). New York:
W. W. Norton & Company.
Jordan, J. V. (2005). Relational resilience in girls. In S. Goldstein &
R. B. Brooks (Eds.), Handbook of resilience in children
(pp. 79–90). New York, NY: Springer.
Meissner, W. (1996). The therapeutic alliance. New Haven, CT: Yale
University Press.
Muran, J. C., & Barber, J. P. (2010). The therapeutic alliance: An
evidence-based guide to practice. New York: The Guilford
Press.
National Association of Social Workers. (2005). NASW standards for
clinical social work in social work practice. Washington, DC:
NASW.
Safran, J. D., & Muran, J. C. (2003). Negotiating the therapeutic
alliance: A relational treatment guide. New York, NY: The
Guilford Press.