Feedback Enhances Therapeutic Alliance

“The alliance, typically defined as the client and therapist agreement on the goals and tasks of therapy and the development of a therapeutic bond, is consistently found to be a robust predictor of therapy success,” said Christoph Flückiger, Department of Clinical Psychology and Psychotherapy, at the University of Bern, Switzerland and lead author of a new study examining the effects of feedback on therapeutic outcome. “Especially in a remediation phase of therapy during which therapy is focused on actively changing clients’ problems/disorders, challenges to the alliance are common. Therapists often focus on deeper issues that are painful and/or threatening to the client; and maintenance of a collaborative therapeutic relationship and prevention of a lasting breakdown is crucial for therapeutic work.”

Experts believe that the feedback intervention theory (FIT), which is founded on the client’s ability to provide constructive and meaningful feedback to a therapist, is beneficial to goal attainment during treatment. In order to test this theory, Fluckiger and his colleagues interviewed 94 clients from an outpatient clinic in Switzerland. The clients had been enrolled in 24 sessions of therapy and were encouraged to give feedback of treatment experience to a neutral third party several times during the therapy. “The results indicated that the introduction of a brief meta-communication intervention at an institutional level (valuing client’s perspective) reinforced clients’ global alliance with their therapists over the course of therapy,” said the team. They added that although this approach is still rather unconventional, it is quite effective and should be considered by clinicians. “The implementation of this short adjunctive instruction was not time-consuming or expensive in comparison to other interventions that involves training therapist,” they said. “The results indicate that interventions, even brief or subtle, can produce lasting benefits in the alliance when targeted at specific psychological processes. Systematic meta-communication from the institutional level appeared to reinforce clients’ therapeutic alliance with their therapists in individual treatment.”

Flückiger, C., Del Re, A., Wampold, B. E., Znoj, H., Caspar, F., & Jörg, U. (2011, May 23). Valuing Clients’ Perspective and the Effects on the Therapeutic Alliance: A Randomized Controlled Study of an Adjunctive Instruction. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0023648

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Genevieve


    October 1st, 2011 at 5:37 PM

    If it looks like it is something that is going to benefit the patient, then by all means, if it does no harm then it should at least be tried.

  • Leslei


    October 2nd, 2011 at 6:24 AM

    How could there ever be a successful clent/therapist relationship without eventually getting to the point that they can both offer some feedback to one another? I mean, the answer here is that they are talking to one another and learning from one another, and hopefully both of them are getting something out of the process.

  • Ivan Chan

    Ivan Chan

    October 2nd, 2011 at 5:29 PM

    Check out the International Center for Clinical Excellence. It’s a group of therapists who have been researching and practicing Feedback Informed Treatment for quite some time now.

  • LF


    October 2nd, 2011 at 10:05 PM

    Therapy is something that will not work unless there is good communication and understanding between the therapist and the patient. Therefore in addition to the actual treatment, they will also need to ensure that there is sufficient understanding and coherence between the therapist and the patient.

  • Emery


    October 3rd, 2011 at 3:30 AM

    The levels of comfort and trust that the client has plays an immense role in the success of therapy.I have been to three different therapists and I clearly know the difference between the first two and the third one!

  • John Brownlee

    John Brownlee

    October 3rd, 2011 at 1:03 PM

    To be successful in any field you need feedback on your performance. Heck, even burger joints and motels understand that. That’s why they have those little cards you can fill in scoring how their service was that go to their head offices. I admit that’s a very simplistic example. You get my drift though. It’s a proven path to success.

  • Ann Becker-Schutte, Ph.D.

    Ann Becker-Schutte, Ph.D.

    October 3rd, 2011 at 2:45 PM

    I love the idea of a safe, neutral avenue for direct client feedback. While I agree that the ideal result would be that clients can provide that feedback directly to therapists, it’s important to remember that therapy clients are at different levels of comfort with confrontation & communication. I think that a neutral avenue can create safety for a client who might otherwise remain silent.

  • Anthea C.

    Anthea C.

    October 4th, 2011 at 6:38 PM

    @John Brownlee: I do get your drift there, yes. And why shouldn’t therapists be open to the same concept? If feedback helped me do my job better, I’d be grabbing it with both hands. I get an appraisal every year that does just that and I only work in a little office job. I think the problem would be dented egos.

  • Julie Holt, MA

    Julie Holt, MA

    October 27th, 2011 at 1:22 PM

    I believe that a therapist should actively solicit feedback from the client. If the client is not automatically providing feedback to the therapist, it is likely they are not providing it to others in their life about how those people are impacting them. It’s a huge growth step to honestly and actively speak openly to your therapist about what your experience of therapy with them is like. And it’s great training ground for doing it in the rest of your life!

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