Patients’ and Therapists’ Grounded Theory of the Development of Therapeutic Alliance in Individual Psychotherapy in a High-Secure Hospital

Limited research has explored patients’ and therapists’ perspectives on developing therapeutic alliance in forensic services. The present study aimed to contribute to the understanding of this process by building a grounded theory of therapeutic alliance development in individual psychotherapy in a high-secure hospital based on the perspectives of patients and therapists. Fourteen participants (seven patients and seven therapists) engaged in individual interviews exploring the therapeutic alliance process. Their accounts were transcribed and analyzed using a grounded theory methodology. The findings indicated three interrelated theoretical categories, namely “being separate in the same space,” “coming alongside,” and “joining together.” “Joining together” was the core category, which highlighted the importance of aligned therapeutic interactions that meet the patient’s as well as the therapist’s needs. Applying this understanding of therapeutic alliance development may improve the quality of alliances built within forensic inpatient psychotherapy, which might have some bearing on the therapeutic outcomes achieved.