Understanding efficacy in psychotherapy: an ethnomethodological perspective on the therapeutic alliance.

In recent years there has been considerable interest in the discovery of a universal paradigm to explain how psychotherapy works. One potential paradigm, known as the therapeutic alliance, is highly correlated with positive patient change. However, the phenomenology and clinical significance of the alliance remains ambiguous. Using a sociological subdiscipline known as ethnomethodology, the author advances a novel perspective on the therapeutic alliance that promises to resolve this ambiguity.