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The therapeutic alliance, or working alliance, has been shown to be reliably predictive of therapy outcome. The therapy relationship is, conceivably, the most significant variable in the treatment process. This appears to be so regardless of theoretical orientation or treatment method. As an area research studies have focused on defining the construct, methods of measurement, issues of validity and reliability and development of proper research designs. While much work is still needed in all of these areas, consensus does exits that there is a high correlation between the quality of the therapy relationship and a successful conclusion to treatment.

As would be expected, identifying the complex elements of the therapy relationship has been the subject of much examination in the literature. For the purposes of this chapter the components have been limited to the influence of: therapist/client variables, attachment styles, cultural variables, theoretical orientations,