title: The working alliance: Where have we been, where are we going?
abstract: OBJECTIVE
  This paper reviews the construct of the working alliance, beginning with its historical development and moving into its modern pantheoretical conceptualization.
  
  
  METHODS
  Major research efforts on the topic are reviewed. The review includes both theoretical and empirical literature on the working alliance and related constructs, such as alliance ruptures and repair, and therapeutic negotiation. Existing measures of the working alliance are also reviewed.
  
  
  RESULTS
  The working alliance is critiqued on both theoretical and empirical grounds, including the strengths and limitations of current approaches and assessments. Recent theoretical developments are reviewed, among them work on alliance rupture and repair and the reconceptualization of the alliance as a process of therapeutic negotiation. Emerging applications of advanced statistical techniques to measure the working alliance are also considered.
  
  
  CONCLUSIONS
  The review concludes by supporting recent efforts that have attempted to increase the sophistication of measurement tools and statistical approaches, and encouraging future research in these areas.
authors.affiliation: a Department of Psychology , The New School for Social Research , New York , NY , USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Doran
mesh_terms: D006801:Humans; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes
keywords: alliance negotiation; literature review; multilevel modeling; rupture and repair; working alliance