Access and satisfaction reveal only part of the care experience. Therapeutic alliance can help employers assess whether members and providers are building the working relationships associated with better outcomes.
When it comes to mental health care, connection can shape outcomes.
As HR and benefits leaders navigate a growing landscape of workplace mental health solutions, one thing has become clear: Access alone doesn’t guarantee quality.
Seeing a provider is only the beginning. The experience of care— including whether employees feel seen, heard, and supported—can influence whether they remain engaged and improve over time.
That’s where therapeutic alliance comes in.
Therapeutic alliance is the working relationship between a person and their mental health provider. It reflects whether they trust the provider, feel understood, agree on the goals of care, and believe they are working together toward those goals.
Across decades of research, therapeutic alliance has consistently been associated with better clinical outcomes across different types of treatment. When the alliance is strong, people may be more likely to remain in care, participate actively, and make progress.
Despite its importance, therapeutic alliance isn’t routinely measured by mental health vendors—and few can demonstrate how it relates to member outcomes.
Here's why:
Metrics such as access, utilization, and satisfaction are relatively easy to track. Measuring alliance requires clinically grounded tools, consistent data collection, and thoughtful analysis—capabilities not every vendor has developed.
Strong therapeutic relationships require more than providing sessions. They begin with recruiting highly qualified providers across clinical specialties and cultural backgrounds, including professionals who reflect the populations they serve.
From there, vendors need thoughtful provider-member matching, consistent training, and clear accountability for care quality across every interaction. Building that infrastructure takes time and intention, as well as scale.
For years, conversations about mental health benefits centered largely on access: how many people received care and how quickly they could get it. As employers look more closely at outcomes and value, the quality of the care experience deserves greater attention—and therapeutic alliance offers an important signal.
Strong therapeutic alliances aren’t limited to therapy. Modern Health research found similarly high alliance ratings among members using coaching, therapy, or both. Meaningful working relationships can develop across different forms of support.
For employers, that finding supports a more tailored approach to care. Employees can receive support suited to their needs without automatically defaulting to higher-intensity, higher-cost services.
“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.”
If you want a clearer view of the quality behind your mental health benefit, consider asking these questions:
If not, ask why. Alliance is a clinically established predictor of outcomes and an important indicator of care quality.
Ask whether the vendor uses established measures, such as items adapted from the Working Alliance Inventory, and how consistently those measures are administered across the member population.
Ask which measures the vendor tracks and shares across clinical outcomes, member experience, and engagement. Without alliance and outcomes data, it can be difficult to assess the real-world quality and effectiveness of care.
Ask about provider selection, training, clinical supervision, and the support available to help providers foster trust, collaboration, and rapport.
Provider networks can vary widely in their structure and level of oversight. Ask how the vendor selects, manages, and evaluates providers, and who is responsible for maintaining consistent standards.
If your organization operates internationally, ask how the vendor supports quality across geographies, languages, cultural contexts, and types of care.
Ask for evidence—ideally peer-reviewed research—showing whether members form strong alliances and how those ratings relate to improvement over time.
As you evaluate vendors, keep an eye out for potential warning signs:
Modern Health was the first workplace mental health platform to publish global, peer-reviewed research examining the relationship between therapeutic alliance and members’ well-being.
The study found:
This provides real-world evidence that members can build strong working relationships with providers through virtual therapy and coaching—and that stronger alliance is associated with better follow-up well-being.
These findings reflect Modern Health’s investment in a high-quality global provider network designed to deliver personalized support, not simply sessions. We measure alliance because employers deserve greater visibility into the quality of the care they offer.
If a current or prospective vendor can’t explain whether or how it measures therapeutic alliance, it’s worth asking why.
Making care available is an essential first step. Its value ultimately depends on what happens once someone begins: whether the support fits their needs, whether they trust their provider, and whether the experience helps them move forward.
That’s the quality of care employees deserve—and the level of insight employers should expect from a mental health partner.
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