Therapeutic alliance is one of the strongest predictors of mental health outcomes—yet few vendors measure it. Learn how to evaluate this critical indicator of care quality and what to ask when assessing your mental health benefit.
When it comes to mental health care, connection is foundational to outcomes.
As HR and benefits leaders navigate a growing landscape of workplace mental health solutions, one thing is becoming clear: access alone doesn’t guarantee quality.
Just because someone sees a provider doesn’t mean that care will lead to meaningful improvement. What matters is how that care is delivered—and whether employees feel truly seen, heard, and supported.
That’s where therapeutic alliance comes in.
Across decades of research, therapeutic alliance has been shown to be one of the strongest predictors of clinical outcomes—more than the type of therapy used or the provider's credentials.
If the alliance is strong, people are more likely to stay in care, engage in the process, and get better faster.
Despite this, most mental health vendors don’t measure it—and few can prove it impacts outcomes.
“As a psychiatrist, I’ve seen firsthand how the strength of the relationship between a person and their provider can make or break someone’s mental health journey,” said Dr. Neha Chaudhary, Chief Medical Officer at Modern Health.
“Therapeutic alliance is one of the most important predictors of whether care truly works—and yet it’s still missing from most evaluations.”
Despite its clinical importance, therapeutic alliance is rarely included in RFPs or vendor scorecards—and there are a few key reasons why.
Metrics like access, utilization, and satisfaction are relatively easy to track. Alliance, by contrast, requires validated clinical tools, longitudinal data collection, and rigorous analysis—capabilities that many vendors lack.
Building strong therapeutic relationships requires more than providing sessions. It starts with recruiting top-tier providers across clinical specialties and cultural backgrounds—professionals who are not only highly qualified but also reflect the diverse populations they serve.
From there, it requires thoughtful provider-member matching, consistent training, and a commitment to care quality across every interaction. That kind of infrastructure takes time and intention—not just scale.
For years, the mental health benefit conversation centered on quantity: how many people got care and how quickly. But now, as employers face rising costs, utilization plateaus, and demand for proof of outcomes, there’s a shift toward evaluating value—and therapeutic alliance is emerging as a key signal.
Importantly, strong therapeutic alliances aren’t limited to therapy. Modern Health’s research found equally high alliance scores across both therapy and coaching, demonstrating that meaningful connections can happen across different levels of support.
This opens the door for more tailored care pathways, ensuring that individuals receive the type of support that fits their needs without defaulting to higher-intensity, higher-cost care.
“We’re seeing a shift in what employers are asking for,” said Alison Borland, Chief People and Strategy Officer at Modern Health. “It’s no longer just about access. Organizations want to know if care is actually helping people—and that starts with whether those people feel connected to their provider. That connection is what drives outcomes, engagement, and ultimately, ROI.”
Leading advisors are now encouraging clients to ask vendors directly about therapeutic alliance. In a recent article, WTW called this a “game-changer” and urged employers to evaluate vendors not just on cost or access but on the quality of their clinical relationships.
If you want to raise the bar for your mental health benefit, these are the questions worth asking:
If not, ask why. Alliance is a clinically validated predictor of outcomes and an essential signal of care quality.
Look for validated instruments like the Working Alliance Inventory, administered regularly across your member population.
A vendor’s value isn’t just in cost savings—it’s in transparency. Ask what metrics they track and share across clinical outcomes, member satisfaction, and engagement. If vendors aren’t measuring or sharing alliance data, it’s difficult to assess real-world effectiveness.
Care quality starts with connection. Ask about training, supervision, and how providers are coached to foster trust and rapport.
Some vendors rely on fragmented networks with inconsistent oversight. Ask whether the provider network is proprietary and directly managed.
If you operate internationally, ask how care quality is maintained across geographies, languages, and cultural contexts.
Any vendor can claim impact. Ask for evidence—ideally peer-reviewed research—that shows alliance is tied to real improvement.
As you dig into these questions, keep an eye out for common red flags:
At Modern Health, we believe connection within care is critical. That’s why we were the first mental health platform to publish global peer-reviewed research linking therapeutic alliance to well-being improvements among our members.
Here’s what we found:
These findings are more than statistics—they reflect our intentional investment in a high-quality, proprietary global provider network trained to deliver personalized care and connection, not just sessions. And we measure alliance regularly using validated clinical tools—because we believe employers deserve visibility into the quality of the care they’re offering.
If your current or prospective vendor can’t speak confidently about therapeutic alliance, it’s time to ask why.
Outcomes don’t just happen because care is available. They happen when care is personal, connected, and grounded in trust. That’s the care your people deserve—and the care that drives long-term value for your organization.
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