Becoming and being therapists through the therapeutic alliance: exploring early-career psychologists’ experiences of the therapeutic alliance in CBT practice

Becoming and being therapists through the therapeutic alliance: exploring early-career psychologists’ experiences of the therapeutic alliance in CBT practice

Studies consistently show that the therapeutic alliance—the bond between therapist and client and the agreed-upon goals and tasks—strongly predicts therapeutic outcomes. However, the therapist’s perspective on the alliance remains underexplored, particularly among early-career psychologists who are developing their professional identity. This study examined the therapeutic alliance experiences of psychologists with less than five years of practice, focusing on those using cognitive behavioural therapy (CBT) to enhance generalisability. It aimed to identify and describe their experiences, assess potential negative impacts on alliance formation, explore psychologist qualities influencing the alliance, and examine how their perceptions shape their work and identity. A mixed-methods sequential explanatory design was used. Study 1, a quantitative phase, surveyed 53 participants using the Working Alliance Inventory (WAI), Counselling Self-Estimate Inventory (COSE), Therapist Work Involvement Scale (TWIS), and Work as Meaning Inventory (WAMI). Study 2, the qualitative phase, included 16 one-to-one interviews, followed by two focus groups: one with six early-career psychologists from the same organisation and another with six senior clinicians. Data were analysed using reflexive thematic analysis, integrating findings from both studies. Study 1 found a strong relationship between global WAI scores and the goals and tasks subscales, but a moderate relationship with the bond subscale. Some COSE and TWIS subscales followed this pattern. However, contrary to expectations, WAMI scores did not correlate with WAI scores. Study 2 identified five themes: (1) The alliance’s importance, (2) Three forms of “being there” in therapy, influenced by context, (3) The transformative impact of the alliance, (4) Experiential or phenomenological knowing in the alliance, and (5) Being a psychologist versus merely doing psychology. The study concluded that early-career psychologists experience the alliance as both instrumental (skills-based) and personal (interpersonal/intrapersonal), supporting a dual-factor view of the alliance. Limitations and recommendations for supervision and training to enhance alliance-building skills are discussed.