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The therapeutic relationship: alliance, empathy, transference, resistance, boundaries and ending
What contributes most to treatment effectiveness is the therapist himself and a strong therapeutic alliance; the therapist owns the setting and boundaries, responds with empathy without losing distance (without identification), recognises transference and countertransference and brings them to supervision, accepts resistance as part of the process, and ends therapy in a shared conversation.
Why it matters in the exam
Questions on this topic give a therapist's sentence and ask what he did: mirroring back the gap between the patient's wish to improve and his lack of practice is reflection; agreeing that "in your place I wouldn't practise either" is identification, not empathy; acknowledging the missed practice warmly and inviting a joint try is empathy. Empathy is stepping into the other's shoes without losing our own identity, and it turns into identification once that inner distance is lost.
Also asked: transference is when feelings and patterns from the patient's earlier relationships land on the therapist (a young man whose father left him reacts with fury when the clinician says she will stop treating him); countertransference is the therapist's emotional reaction, and it belongs in supervision. Resistance comes from fear of change alongside the wish for it, and it should be accepted and taken into account. The setting and boundaries are set and kept by the therapist — lengthening a session to "make up" for a cancellation breaks the setting. At the end of therapy there is a conversation about achievements and about the ending, and both sides react to the parting; awareness of the ending does not harm success.
Key points
- The therapist and the therapeutic alliance are the central factors in success.
- Empathy without losing distance; identification is losing the distance.
- Transference — the patient's; countertransference — the therapist's; to supervision.
- Resistance: fear of change; accept it and take it into account.
- Setting and boundaries are the therapist's; ending in a shared conversation.
Summary table
| Concept | What it is | Example or exam point |
|---|---|---|
| Therapeutic alliance | Trust-based cooperation between therapist and patient (with a child — also with the parents) | Goals are set together; parents need not be in therapy themselves |
| Empathy versus identification | Empathy — understanding from inside without losing ourselves; identification — loss of distance | Siding with the avoidance — identification; examine it in supervision |
| Reflection | Showing the patient the contradiction in what he said, without judgement | "On the one hand... and on the other..." |
| Transference and countertransference | Transference — feelings from earlier relationships moved onto the therapist; counter — the therapist's reaction | Telling a child "you are hurting me" — countertransference |
| Resistance | Fear of change set against the wish for it | Accept, respect and build it into planning |
| Setting, boundaries and contract | Fixed time, place, length and rules that the therapist sets and keeps | A contract clear to both sides; boundaries give security |
| First session and ending | Getting to know each other and starting the alliance; ending in a shared talk about achievements | Both sides react to the ending; it is not what alone decides how therapy is remembered |
A free exam question
After two sessions Sarit stopped therapy with the communication clinician and told her friend: 'I stopped because the therapist is a cold, inconsiderate, uncaring person'. What most likely happened?
- A. It is related to cognitive difficulties
- B. It is related to countertransference
- C. It is related to denial
- D. It is related to transference
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Sources
- Shipley & Roseberry-McKibbin, Interviewing and Counseling in Communicative Disorders, 3rd edition (2006) — The clinician-client relationship
- Luterman, Counseling Persons with Communication Disorders and Their Families, 6th edition (2017) — Counseling principles and termination
- Rogers, Client-Centered Therapy, 1951 — Empathy and the therapeutic relationship
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.