What is it about the therapeutic alliance that enables trust and engagement with adult survivors of childhood abuse?

This study involved an investigation of qualities of the therapeutic alliance that contribute to trust and engagement when working with adult survivors of childhood abuse, a clinical population renowned for high dropout rates. Thirteen experienced psychologists and 30 of their clients were interviewed, with analyses highlighting factors related to: advanced empathy (cognitive understanding, deep emotional empathy, and instilling responsibility); deep client acceptance (validation, therapeutic presence); therapeutic boundaries (firm and flexible, therapist self-disclosure); issues of power and control (slow pace, goals and direction of therapy); and effective repair work. Clinically meaningful data was revealed that is applicable across psychotherapeutic orientations.