The Therapeutic Alliance in Refugee Mental Health and Psychosocial Support: A Narrative Review

The therapeutic alliance-a collaborative relationship between mental health/psychosocial support (MHPSS) providers and clients-has consistently demonstrated positive impacts on mental health outcomes. This narrative review focuses on the therapeutic alliance within the context of refugee clients, who face unique challenges stemming from forced displacement, trauma, and systemic barriers. Utilizing a systematic search and thematic synthesis, 20 studies published between 2014 and 2024 were analyzed to address four key questions: the state of knowledge, the role of interpreters, strategies for improvement, and gaps in research. Findings highlight significant challenges in building alliances with refugee clients due to cultural and linguistic differences, power dynamics, and trauma-related distrust. The presence of interpreters transforms the traditional dyadic alliance into a triadic relationship, introducing both benefits and complexities. Interpreters act as co-constructors of the alliance, requiring strong collaboration and role negotiation with providers. Recommendations for strengthening the alliance include flexible therapeutic boundaries, advocacy integration, continuity of care, and tailored training for providers and interpreters. Despite the growing body of research, gaps remain in understanding non-verbal communication, virtual care dynamics, and the perspectives of clients discontinuing therapy. This review emphasizes the need for a paradigm shift recognizing clients, providers, and interpreters as equal partners in therapeutic processes, alongside further exploration of emerging contexts such as telehealth and refugee-led MHPSS initiatives.