Therapists who are most adept at accurately understanding their patients have the best chance of establishing and preserving positive alliances with their patients.

In this sense, a good case formulation goes a long way toward helping the therapist and patient maximize their collaborative effort.

When conflicts arise between a therapist and a patient, and/or when unexpressed but problematic ill feelings exist in the therapeutic relationship, the therapist can explore aspects of the case conceptualization to make sense of the interpersonal tensions in session. Oftentimes, this strategy will not only shed light on the reasons for the problems in the therapeutic relationship, but will advance an overall understanding of the patient's life issues. As a result, important material is revealed, the patient feels better understood, and the therapeutic alliance is strengthened.

The following are some general guides for using the case conceptulation in the service of improving the therapeutic relationship:

1. Strive to understand the pain and fear behind the patient's hostility and resistance.
2. Explore the meaning and function of the patient's seemingly oppositional or self defeating actions.
3. Assess the patient's beliefs about therapy.
4. Assess your own beliefs about the patient.
5. Collaboratively utilize unpleasant feelings in the therapeutic relationship as grist for the mill.