Can You Build A Therapeutic Alliance With A Chatbot?

In my early professional years, I was asking the question, How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?

Carl R. Rogers

The therapeutic alliance is the relationship that is formed between a therapist and a client to work together towards making the client feel better. Stubbe notes that three parts are generally assumed to form the therapeutic alliance:

• collaborative nature of relationship

• affective bond between patient and therapist

• joint agreement on treatment goals and tasks

The quote by Carl Rogers illustrates how many therapists undergo a transformation as they become more effective in their practice. In my experience, young therapists often focus on techniques and interventions, which is understandable; during those early years of insecurity, it can be difficult to see the healing potential that lies beyond concrete exercises.

As you gain experience, you come to realize that any meaningful change can only occur when you and the client establish a strong therapeutic relationship. This requires skills that go beyond mere techniques. Trust is essential. You need to like each other enough to collaborate effectively. As the therapist, you must be perceived as competent, even when you have your own doubts. If something goes wrong, you need to be able to repair the relationship.

All of these components require advanced skills and a talent for working with people. The idea of a therapeutic alliance is intriguing when we consider how it connects with digital psychotherapy. Is it possible to establish a therapeutic alliance through videotherapy? Research indicates that yes, you can, and it is comparable in intensity to the alliance formed in face-to-face therapy.

How Do You Measure The Therapeutic Alliance?

A review from 2014 by Simpson et al. listed eight scales and questionnaires to measure the therapeutic alliance, while qualitative interviews serve as another method for evaluation. The review included 23 studies, of which 14 utilized the Working Alliance Inventory (WAI) for measurement. This scale examines three components of the therapeutic alliance: tasks, goals, and bonds. A shorter version, the Working Alliance Inventory Short Revised (WAI-SR), is also used in studies. An example can be seen here.

The concept of a therapeutic alliance gained more attention due to the first randomized controlled trial of a therapy chatbot by Dartmouth College. The research showed positive effects in a study involving 106 people who experienced depression, anxiety, or eating disorders and who could interact with the Therabot at any time.

„Critically, people reported a degree of “therapeutic alliance” in line with what patients report for in-person providers, the study found. Therapeutic alliance relates to the level of trust and collaboration between a patient and their caregiver and is considered essential to successful therapy.“ (Source: Dartmouth College).

What You Lose When You Photograph A Symphony

The most straightforward approach is to give participants five minutes to answer twelve questions. That’s it. More importantly, you receive twelve statements about your relationship, goals, and therapy tasks, and you are asked to rate them on a 5-point scale that ranges from „seldom" to „fairly often" to „always." You then receive an average score on the three subscales: bond, task, and goals.

However, there is a clear mismatch between the complexity of the phenomenon and the simplicity of the tool used to measure it. The therapeutic alliance evolves over hours between two human beings working through psychological distress. They explore together which direction is right and question themselves when they hit dead ends. The questionnaire is a five-minute evaluation in a rigid matrix.

Measuring the working alliance with a quick questionnaire is like trying to capture a symphony with a single photograph. The music unfolds over time, with movement, subtle changes, and emotional crescendos—but the snapshot freezes just one moment, stripped of motion, texture, and meaning. If you reflect on it, it seems impossible to capture what a therapeutic alliance is about in 12 statements and a five-point Likert scale.

While this scale has been used in many research studies, it does not take much time, and hey, do you have a better way to measure the therapeutic alliance? I don’t. However, I strongly urge the research community not to view this tool and its results as evidence that the therapeutic alliance between a client and a chatbot is comparable to that of face-to-face therapy.

Do not try to photograph a symphony.

These are my thoughts but I am eager to hear yours in the comments!