Will talking about trauma damage the therapeutic relationship?

Will talking about trauma damage the therapeutic relationship?

By |2019-06-23T21:06:05+00:00June 23rd, 2019|

Common sense (of the clinical variety) tells us that a strong therapeutic alliance predicts better outcomes. The research indicates this is true in PTSD treatment (Keller, et. al.2010). Some therapist worry that discussing trauma undermines therapeutic alliance and leads to poor engagement in treatment.

Chen, et al (2019) compared therapeutic alliance in CPT, a therapy where the trauma is discussed, to non-trauma-focused supportive psychotherapy.

They found that direct discussion of traumatic experiences did not worsen therapeutic alliance. Participant in the study reported similar levels of alliance in CPT and non-trauma-focused supportive psychotherapy.

As is often the case with research there are some caveats. In this particular study, interpretation of the findings was limited by the fact that alliance was measured after treatment had been delivered.


Chen, J. A., Fortney, J. C., Bergman, H. E., Browne, K. C., Grubbs, K. M., Hudson, T. J., & Raue, P. J. (2019). Therapeutic alliance across trauma-focused and non-trauma-focused psychotherapies among veterans with PTSD. Psychological Services. Advance online publication. PTSDpubs ID: 51848

Keller, S. M., Zoellner, L. A., & Feeny, N. C. (2010). Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence, childhood sexual abuse history, and social support. Journal of Consulting and Clinical Psychology, 78, 974-979. PILOTS ID:35447

About the Author:

Clinicians PTSD blog is written by Dr Jon Finch a Clinical Psychologist, a clinician treating PTSD and traumatised individuals for over 10 years. It is mainly for clinicians treating people who have PTSD and other trauma related conditions. It is focused on evidence-based therapy, trauma focused therapy and Cognitive Processing Therapy.