What Educational Strategies Exist for Developing Therapeutic Alliance Skills in Healthcare Students: A Scoping Review

Therapeutic alliance (TA) is a key determinant of treatment outcomes across health professions. Educating health students on this concept has gained increasing attention; however, no prior scoping review has mapped the educational interventions used to develop TA competencies. This review aims to provide a comprehensive overview of the educational interventions designed to develop TA competencies among health profession students.

We searched PubMed and Web of Science databases up to February 2025. Eligible studies included any design focusing on health profession students and reporting educational interventions aimed at developing TA-related competencies.

In total, 13,192 records were screened, and 327 included. Publications increased substantially over the past decade, particularly in nursing and medical education. Thirteen categories of educational interventions were identified, with interactive workshops, reflective practices and feedback or mentoring being the most common. Most studies adopted multimodal approaches, especially targeting empathy and communication. In contrast, other relational dimensions, including trust, respect, congruence, caring and emotional intelligence, were addressed much less frequently. Only 12 studies explicitly named 'therapeutic alliance' as the primary training objective. Considerable methodological heterogeneity in intervention design, duration and outcomes limited comparability across studies.

Despite growing interest in teaching TA, notable asymmetries exist in the targeted competencies and the populations studied. Future research should prioritise underexplored competencies, employ more robust study designs and contribute to the development of shared frameworks for teaching TA. These findings highlight a critical opportunity to strengthen TA education and better prepare students for the relational dimensions of clinical practice.