Clients’ Lived Experience of the Mechanisms Underlying the Formation of Success and Failure in the Therapeutic Alliance: A Phenomenological Study
Keywords:
Therapeutic alliance, treatment success, treatment failure, clients' lived experience, interpretive phenomenologyAbstract
Objective: This study aimed to elucidate the mechanisms underlying success and failure in the therapeutic alliance based on clients’ lived experiences.
Methods and Materials: This qualitative study employed an interpretative phenomenological approach. The study population comprised clients with experience of individual psychotherapy in psychological service centers and counseling clinics in Tehran. Using criterion-based purposive sampling supplemented by snowball sampling, 18 clients were recruited, including seven with predominantly successful psychotherapy experiences, six with predominantly unsuccessful or prematurely terminated experiences, and five with mixed experiences. Data were collected through 45–75-minute in-depth semi-structured interviews until thematic saturation was achieved. Data were analyzed using Braun and Clarke’s six-phase reflective and inductive thematic analysis with MAXQDA 2020. Attride-Stirling’s thematic network approach was used to enhance conceptual organization. Trustworthiness was established according to Guba and Lincoln’s criteria, and the Holsti inter-coder agreement coefficient was 0.85.
Findings: The analysis indicated that successful therapeutic alliances emerged from the synergistic interaction of five domains: a secure therapeutic bond and relationship, therapist professional competence and technical transparency, client agency and active participation, functional outcomes and enduring changes, and contextual, environmental, and process-related factors. Conversely, failure was associated with ruptures in the therapeutic bond, deficiencies in professional competence and intervention structure, intrapsychic barriers within the client, cultural and social incongruence, and structural, financial, and environmental constraints. Comparison of successful and unsuccessful trajectories showed that the quality of the emotional bond, perceived psychological safety, and the degree of client agency constituted the principal distinguishing mechanisms.
Conclusion: The therapeutic alliance is a dynamic, multilevel, and feedback-based phenomenon whose success or failure depends less on specific therapeutic techniques than on the interaction among relational quality, therapist competence and flexibility, client participation, and cultural, social, and structural conditions. Continuous monitoring of the alliance and early management of relational ruptures may therefore improve psychotherapy outcomes and reduce premature treatment termination.
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Copyright (c) 2025 Nastaran Sadat Ghasemi (Author); Shahram Vaziri; Farah Lotfi Kashani, Saeed Imani (Author)
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