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Revisiting Bordin's Theory on the Therapeutic Alliance: Implications for Family

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Article  in  Contemporary Family Therapy · June 2002

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REVISITING BORDIN’S THEORY
ON THE THERAPEUTIC ALLIANCE:
IMPLICATIONS FOR FAMILY THERAPY
Lee N. Johnson
David W. Wright

ABSTRACT: Because of the belief that relationships are a major con-

tributor to problems as well as the avenue for bringing about change,
the alliance between therapists and clients is important in family ther-
apy. Writings and ideas on the therapeutic alliance from psychoanalytic
theory were used by Edward Bordin to develop a working theory in
1979, and later adapted to the field of family therapy. However, the
adaptation did not account for many variables unique and important
to family therapy. This article describes the therapeutic alliance and
the necessity of creating a theory of therapeutic alliance that accounts
for family therapy concepts. Future ideas for scholarship are presented.
KEY WORDS: therapeutic alliance; family therapy; psychoanalytic theory.

One major common factor that seems to be important in explaining

client change in psychotherapy is the therapeutic relationship (Bordin,
1979; Duncan, 1992; Pinsof, 1994). In the mental health fields, clini-
cians’ conventional wisdom is that the changes clients make are largely
related to the relationship they have with their therapists. The work
of numerous researchers and scholars supports this wisdom (Beutler,
Machado, & Neufeldt; 1994; Coady, 1992; Downing & Rickels, 1978;
Horvath & Greenberg, 1994; Horvath, & Luborsky, 1993; Pinsof, 1994;
Strupp, 1992). However, as with most relationships, defining the thera-
peutic relationship is difficult at best. Despite having similarities, it

Lee N. Johnson, PhD, is Assistant Professor, Department of Child and Family Devel-
opment, University of Georgia, Athens, GA 30602 (e-mail: ljohnson@fcs.uga.edu). David
W. Wright, PhD, is Associate Professor and Chair, Department of Child and Family
Development, University of Georgia, Athens, GA 30602.

Contemporary Family Therapy 24(2), June 2002  2002 Human Sciences Press, Inc. 257
258

CONTEMPORARY FAMILY THERAPY

differs greatly from everyday relationships in that a therapist is respon-

sible to facilitate change and not necessarily to keep clients happy and
comfortable (Callaghan, Naugle, & Follett, 1996). Important factors
affecting the therapeutic relationship include, but are not limited to,
the therapists’ and clients’ personal issues and problems, professional
training, cultural influences (Fine & Turner, 1991), personality traits,
gender, and personal values (Aponte, 1992). This complexity in the
therapeutic relationship makes the development and empirical study
of concrete theoretical concepts difficult. The task becomes even more
difficult in family therapy situations because as the number of people
participating in the therapy process increases so does the number of
relationships. Despite the complexity, some progress has been made
in understanding these relationships; however, further study is neces-
sary to fully understand the therapeutic relationship in family therapy.
This article explores one aspect of the therapeutic relationship,
the therapeutic alliance. The origins of therapeutic alliance will be
described and the paper will give an overview of how those concepts
were adapted to the field of family therapy. As will be shown, because
the direct translation of alliance concepts from individual psychology
to family therapy raises some problems this translation may not have
been totally appropriate. These problems will be discussed. Finally,
direction will be provided to further the study of the therapeutic alliance
in family therapy.

ORIGINS OF THE THERAPY ALLIANCE

Since the origins of mental health professions, great strides have

been made in understanding the therapeutic alliance. As early as 1913,
Freud was exploring the impact of the client-therapist relationship in
the treatment of neurosis (Freud, 1958). Besides Freud, other pioneers
in mental health have written about the importance of the therapeutic
relationship (Greenson, 1967; Menninger, 1958; Zetzel, 1966). Zetzel
(1966), commented that “neither Freud nor the other pioneer analysts
bypassed the doctor-patient relationship as a necessary prerequisite
to successful transference analysis” (p. 89). In many of these early
writings a discussion of the therapeutic relationship focused on trans-
ference, a concept that came to be used in a more general way than
originally conceptualized. Sandler, Dare, and Holder (1973) wrote that
transference is one of the psychodynamic concepts “most commonly
taken from its original context . . . which is now often loosely used in
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LEE N. JOHNSON AND DAVID W. WRIGHT

a variety of senses. It is even used as a synonym for ‘relationship’ in

general” (p. 27). To understand the therapeutic alliance it must be
distinguished from transference.
Transference is made up of client impulses and fantasies, which
are revived in treatment. Whereas an event in the client’s past may
be related to the transference, clients are not thinking of past issues
or events when exhibiting transference. It is an unconscious process
in which the impulses and fantasies are applied to, or projected upon,
the doctor or therapist in the present (Sandler et al., 1973, citing Freud,
1905). Most definitions of the therapeutic alliance, on the other hand,
address a conscious collaboration between the client and therapist. It
is the agreement between them about the “breadth and depth” of ther-
apy and how comfortable and agreeable they are with the course ther-
apy follows (Horvath & Symonds, 1991, p. 139).
Sandler and associates (1973), wrote that in clinical psychoanalysis
there always has been a distinct difference between transference and
the therapeutic relationship and Frieswyk, Colson, and Allen (1984),
while acknowledging that transference has an impact on the relation-
ship, also maintain that transference and the therapeutic relationship
are different.
One bridge to understanding this difference is found in the object
relations text of Scharff and Scharff (1987) wherein the authors de-
scribe contextual transference and focused transference. The former is
related to the client’s perception of the therapist as one who facilitates
and maintains a relationship climate in which change can occur,
whereas the later is akin to the traditional notions of transference in
which the client reenacts with the therapist elements of a past core
relationship. These authors draw a connection between contextual
transference and the therapeutic alliance and note that it is a prerequi-
site for the essential work of analysis. Thus, for patients (clients) to
work effectively with therapists there needs to be established and main-
tained a relationship that precludes their transference reactions (Green-
son, 1967).
Hausner (2000) draws another interesting distinction pertinent to
this discussion by pointing out that for treatment to be successful, the
therapist and the patient must develop a working alliance in addition
to a therapeutic alliance. Although this working alliance is similar and
related to the therapeutic alliance, it is characterized less by transfer-
ence and more by a shared investment in the treatment process. One
might say the patient (client) “buys into” what the therapist is about.
Luborsky (2000) made a similar distinction in forms of alliance between
260

CONTEMPORARY FAMILY THERAPY

therapist and client. He describes Type 1 alliance as referring to the

client’s experience of receiving help, whereas Type 2 alliance refers to
the experience of a client as being in a collaborative effort to reach
therapy goals. Efforts to empirically verify this distinction have not
been successful, although study methods cloud the issue. Gelso and
Carter (1994) approach this topic from a slightly different direction
theorizing that the effective psychotherapy relationship is made up of
three parts: “a working alliance, a transference configuration (including
therapist countertransference), and a real relationship” (p. 296; paren-
theses in original text).
Therefore, it can be seen that from psychoanalytic theory in individ-
ual psychology that the therapeutic relationship involves components
that are different, even if based upon, transference, especially as they
incorporate elements that are “here and now” based. Whereas this discus-
sion of the therapeutic relationship from the early literature provides
some direction, a more refined theory or conceptual framework is
needed to guide therapists in using the relationship as a therapeutic
concept or to operationalize the therapeutic relationship for purposes
of conducting research.

A THEORY ON THE THERAPEUTIC ALLIANCE

In 1979 Bordin published a theory describing a working therapeu-

tic alliance between clients and therapists. The concepts narrowed
the definition of the therapeutic relationship from a reality-oriented
relationship, different from transference, between a client and a thera-
pist to a more narrow set of concepts. Like other scholars, Bordin
proposed “that the working (therapeutic) alliance between the person
who seeks change and the one who offers to be a change agent is
one of the keys, if not the key, to the change process” (1979, p. 252,
parentheses added, italics in original text).
Bordin’s theory is founded in four main ideas. First, all psychother-
apies require an alliance, the difference being in the type of alliance
required by each type of psychotherapy (i.e., individual, family, behav-
ioral, and so on). Second, the effectiveness of the therapy is, in part, a
reflection of the strength of the therapeutic alliance. Third, different
approaches to psychotherapy differ in the demands placed on the thera-
pist and client. Finally, the strength of the alliance is determined by
the compatibility of the demands of a particular therapeutic alliance
and the characteristics of the client and therapist. Whereas these con-
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LEE N. JOHNSON AND DAVID W. WRIGHT

cepts have their origins in psychoanalytic theory, Bordin states that

they are not exclusive to psychoanalytic theory but can be applied and
researched in all forms of psychotherapy. Bordin theorized that the
therapeutic alliance can be described using three constructs: the devel-
opment of bonds, the assignment of tasks, and agreement on goals
(Bordin, 1979).
Bonds represent the part of the therapeutic alliance that encom-
passes the “human relationship between therapist and patient” (Bor-
din, 1979, p. 254). For example the qualities of trust, respect, and caring
between the therapist and the client are included in this construct.
While these qualities seem straight forward they can be influenced by
both the clients’ and therapists’ past life experiences, as well as the
model of therapy used by the therapist.
The tasks construct encompasses the therapists’ skills and clients’
perception of the therapist’s ability to help. Also related to this construct
are the collaboration between the therapist and client in activities
engaged in during therapy, the agreement and collaboration around
the tasks, and the timing or pacing of the activities. Even though the
therapist may possess the skill to help a client, if the therapist has
bad timing and challenges or intervenes too quickly or too late, the
client may perceive the therapist as being unskilled. To illustrate, a
key skill in the tasks domain is for the therapist to “link the assigned
task to the patient’s sense of his difficulties and his wish to change”
(Bordin, 1979, p. 254). The task needs to fit the clients’ lifestyle, world-
view, and expectations for therapy. Asking or expecting an unexpres-
sive male client to start expressing emotions may be too drastic an
intervention. A more appropriate task would be to engage in some
discussion using a metaphor from his life.
The final construct, goals, focuses on the mutual agreement about,
and investment in, achieving set goals. Not only must the client and
therapist agree on set goals, but also the client must perceive that the
therapist is invested in helping them achieve their agreed upon goals
(Bordin, 1979). These goals can vary depending on the presenting prob-
lem and the theoretical stance employed by the therapist. For example
in behavioral therapy goals would focus on a specific part of a client’s
life and their behavior. On the other hand psychodynamic therapies
focus on the client’s stresses, frustrations, and dissatisfactions and how
their actions, thoughts, and feelings contribute to his or her problems.
While Bordin’s tripartite of bonds, tasks, and goals has produced
a wealth of research in the paradigm of individual psychology (Horvath,
& Symonds, 1991), there is one major problem with applying Bordin’s
262

CONTEMPORARY FAMILY THERAPY

conceptualization to family therapy: how to incorporate alliances be-

tween the therapist and additional people in the room? Moreover, in
family therapy not only is it possible to have a therapeutic alliance
with each individual in the room, but it is possible to have alliances
with sub-groups (i.e. parents, children), and with the entire family
(Pinsof, 1988). Bordin’s conceptualization does not account for this
major dimension of family therapy. Therefore, to use Bordin’s theory
about therapeutic alliances in family therapy, it must be revised.

THERAPEUTIC ALLIANCE THEORY

IN FAMILY THERAPY

The development of theory about the therapeutic alliance in family

therapy largely has been the work of William Pinsof (Pinsof, 1988; Pins-
of, 1995; Pinsof & Catherall, 1986). Pinsof has defined the alliance as:

the clinically relevant part of the relationship between the

therapist and patient systems . . . consist[ing] of those aspect
of the relationship between and within the therapist and pa-
tient systems that pertain to their capacity to mutually invest
in and collaborate on the tasks and goals of the therapy (Pinsof,
1995, p. 61).

Like earlier definitions of the alliance, Pinsof ’s definition focuses on

the capacity to mutually invest in and collaborate on therapy. However,
Pinsof uses the term “therapist and patient system” in place of client
and therapist. To modify the definition of the alliance, Pinsof (1995)
use two dimensions: the content dimension and the interpersonal di-
mension.
The content dimension of the alliance is made up of the three
domains of Bordin’s original conceptualization: the bonds, goals, and,
tasks. Pinsof’s definitions of each of these constructs remains similar
to Bordin’s. To address the possibility of the additional people in the
room, Pinsof added the interpersonal dimension. The interpersonal
dimension is divided into individual, subsystem, whole system, and
within-system components. For example using the interpersonal indi-
vidual component, a therapist working with a family of five can have a
personal alliance with one, a few, or all family members. The subsystem
component captures the alliance between the therapist and subgroups
in the family (Pinsof, 1995). So, the therapist might have a good alliance
 263

LEE N. JOHNSON AND DAVID W. WRIGHT

with only the parents, the children, or the females in the family. The
third interpersonal component, the whole system, refers to the alliance
between the therapist and the family as a whole (Pinsof, 1995). The
fourth component is the within-system alliance, which refers to the
amount of agreement about the therapy and the therapy process be-
tween the family, subsystems, and individuals. This component also
includes the agreement within the therapy system (Pinsof, 1995), which
might take into account agency politics, procedures, managed care
policies, and so forth.
The three components of the content dimension and the four compo-
nents of the interpersonal dimension can be graphically depicted in a
3 × 4 model (Pinsof, 1995). When arranged in this fashion the model
allows descriptions of numerous co-existing types and levels of alli-
ances. In the five member family described above, the therapist could
have a good alliance with the mother of the family on the content
dimensions of tasks and goals, yet be lacking a good alliance on the
bonds dimension. At the same time, a good alliance with the child
subsystem may exist on the bonds dimension while there is no positive
alliance on any dimensions with the father.
There is a variety of research supporting this view of therapeutic
alliance. Bennun 1989, found that family members’ perceptions of their
therapist were related to relief of depression and decreased alcohol
dependence. Heatherington and Friedlander (1990) found support for
Pinsof and Catherall’s (1986) Family Therapy Alliance scale. In assess-
ing the therapeutic alliance after the third to sixth session they found
that ratings on the tasks sub-scale were correlated to session depth.
Tasks and bonds ratings were correlated with session smoothness.
Green and Herget (1991) found a link between factors that are a part
of the therapeutic alliance (warmth and structuring) and therapeutic
outcome operationalized as goal attainment. In 1998, Johnson found
that changes clients reported in reduced symptom distress and im-
proved interpersonal relations were explained by the family alliance.
Additional research has explored alliance-related therapist behaviors
and how those behaviors relate to therapeutic changes (Diamond, & Lid-
dle, 1999; Morris, Alexander, & Turner, 1991; Patterson, & Forgatch,
1985; Robbins, Alexander, Newell, & Turner, 1996; Waldron, Turner,
Barton, Alexander, & Cline, 1997). These studies add to the knowledge
that the alliance is important in family therapy and that certain thera-
pist behaviors that may be important in alliance development.
That knowledge notwithstanding, the field of family therapy is
still without a theory or conceptual framework on the therapeutic alli-
264

CONTEMPORARY FAMILY THERAPY

ance that accounts for additional aspects of family therapy other than
the increased number of people participating in therapy. To a large
extent this is because of limited development of the conceptualization
of the alliance in family therapy since the addition of the interpersonal
dimensions to Bordin’s original theory. It is somewhat ironic how few
scholars and researchers have worked to develop our understanding
of the therapeutic relationship in family therapy, a field that focuses
on relationships. This paper will now present some ideas that may help
change that situation.

PROBLEMS WITH BORDIN’S CONCEPTUALIZATION

IN FAMILY THERAPY

Pinsof ’s addition of the interpersonal relations dimension to alli-

ance theory served the valuable purpose of addressing the existence of
additional family members in the room. But it does not account for
several important variables that affect therapy when the number of
people in the therapy room is increased. Additionally, Bordin’s theory
may not be as amenable to family therapy as once thought. It may not
adequately take into account the differences between family therapy
and individual therapy. In particular, the descriptions of each of the
three domains are not rich enough to capture exactly how an alliance
forms in a group that includes an individual family member, various
sub-systems within the family, or the whole family.
Unless there is a model of the alliance that accurately describes
the difference in alliances across family members and within family
groups, and a method to measure those varying alliances much valuable
information is not being used. The measurement limitations can be
easily seen by looking at the Family Therapy Alliance Scale (Pinsof
& Catherall, 1986). To assess for alliances within sub-systems or fami-
lies the authors simply ask questions such as “all other members of
my family feel accepted by the therapist” or “the therapist does not
understand my family’s goals for therapy.” Questions such as these
require family members to decide if a sub-system or whole family alli-
ance exists and report the magnitude of that alliance. Although self-
reports of the alliance on how an individual feels with his or her thera-
pist may be the most accurate ratings (Horvath & Symonds, 1991),
having family members’ reports of their perceptions of other family
members’ alliances may result in inaccuracies. The inaccuracy may
 265

LEE N. JOHNSON AND DAVID W. WRIGHT

include not reporting an alliance when one does exist, reporting a non-
existent alliance, or reporting an inaccurate alliance. This approach
also assumes that all family members hold the same definition for
bonds, goals, and tasks, and that everyone’s definition remains consis-
tent across relationships within the family and in relationship with
the therapist. There are similar problems in the theory of the alliance.
These problems can be found in all three domains; however, they are
especially problematic for the bonds domain.
Currently the bonds domain focuses on how clients perceive trust,
respect, and caring, concepts that vary in meaning depending on the
context and people involved. Whereas they seem straightforward, for
many reasons they are not. For example, they can be influenced by the
therapists’ and clients’ perceptions of events that have occurred in their
families of origin. These perceptions can make the relational qualities
of trust, respect, and caring difficult to develop between some clients
and therapists. Furthermore, bonds can be difficult to develop due to
reasons unperceivable to clients and therapists. For example, a thera-
pist who grew up in a controlling family may not be able to develop
bonds with a family that, in therapy, exhibits controlling behaviors
toward the therapist. Additionally, a family member’s definition of
trust or caring can be different when applied to a relationship with a
fellow family member compared to a relationship with the therapist.
Other influential variables may be clients’ degree of comfort with a
trusting and caring alliance, the desire to be in a trusting and caring
relationship, the amount of humor used in session, and the actual
expression of trust and caring. The theoretical description of therapeu-
tic bonds does not take into account these issues.
In comparison to the bonds domain, the tasks and goals domains
focus on behaviors that are more inherently observable by everyone
involved in the family therapy. But, despite being more observable,
these two domains have similar problems. For example, a mother can
see her husband’s discomfort with tasks assigned during therapy and
hear him complain about how the therapist does not know what his
family needs, but it is much more difficult for a family member to truly
understand how another family member is feeling about the therapy,
or what others’ perceptions of the therapist’s competence and invest-
ment in helping the family. Similar to the problems found within the
bonds domain, simply having family members rate their perceptions
of sub-system and family alliances can yield an inadequate description
of what is truly occurring within the tasks and goals domains of the
alliance.
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CONTEMPORARY FAMILY THERAPY

CONCLUSION AND RECOMMENDATIONS

The therapeutic alliance is an important part of all mental health

fields. This is also true for family therapy where therapists place em-
phasis on relationships being a determining factor in client problems
and the avenue of intervention for client changes. While the current
theory is lacking in some areas, it has a great deal of value. The notion
that a therapist can have an alliance with an individual, a sub-system
within the family, and with the whole family seems to adequately fit
the systemic paradigm associated with family therapy. Building on the
foundations set in place by Bordin (1979) and Pinsof (1986, 1995) will
be beneficial to the field of family therapy. It also will be beneficial to
the field if there is a model of the therapy alliance that is based on the
processes that are unique to family therapy. As Gottman (1998) has
stated, one of the problems with many marital therapy models is that
those models are constructed by “extending methods of psychotherapy
to the design of marital interventions” (p. 5). A similar statement can
be made in the area of the therapeutic alliance and family therapy.
Many of the therapeutic alliance concepts are constructed by extending
the methods of psychotherapy to a family therapy setting. Future schol-
arship in four areas will be helpful to incorporate unique family therapy
aspects into the therapy alliance.
First, as previously discussed, the theory of the therapeutic alliance
used in family therapy lacks descriptions that are easily operational-
ized. Qualitative studies exploring how the therapeutic alliance forms
in each of the three domains will allow researchers to more accurately
assess the strength and impact of the alliance. As discussed earlier,
this research needs to focus on alliance formation within sub-systems
and the family as a whole. Another outcome of this research is that
instructors and supervisors will then have the information necessary
to be able to provide more in depth training on the therapeutic alliance
and alliance concepts unique to family therapy.
Second, qualitative research exploring the bonds domain of the
therapeutic alliance will greatly increase the theory’s ability to explain
behavior and increase the applicability of future use of this domain of
the alliance. Despite conventional wisdom that the bonds domain is
the most important, in fact, this domain is the aspect of the alliance
most lacking in theoretical descriptions. Not only is there a need to
describe how the bonds alliance is formed, but also there is a need
to define what bonds actually consist of.
Third, process research needs to be employed in the development
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LEE N. JOHNSON AND DAVID W. WRIGHT

of therapy alliance concepts and models. This research needs to focus

on observing families in therapy where a positive alliance develops
and on discovering how that alliance develops. This research will be
enhanced by also observing families in therapy where a therapeutic
alliance does not develop to determine barriers to a positive therapy
alliance. Additional ways to observe and measure the alliance are also
necessary. This research, would aid in advancing the theory and appli-
cation of the therapy alliance in family therapy.
Fourth, scholarship and research that investigates the relationship
of the therapy alliance with related variables is necessary. For example,
an individual’s attachment is important in determining how they relate
to and perceive others. Investigating alliance and its connection to
attachment can provide valuable information for family therapy. Addi-
tionally, ethnicity and gender are other aspects that are important in
the understanding of people, relationships, and families. How ethnicity
and gender influence the development of the therapeutic alliance is a
necessary question that needs to be answered in understanding the
alliance in family therapy.
Scholarship and theory development on the therapeutic alliance
are needed in family therapy. Great strides have been made in formulat-
ing a theory of the therapeutic alliance in family therapy. However,
efforts toward a more descriptive theory that takes into account more
of the unique factors associated with family therapy are needed. These
would greatly increase the utility of the alliance in future family ther-
apy training and research.

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