Building a strong connection: Meru Health’s exceptional therapeutic alliance

At Meru Health, we believe that the relationship between therapist and patient—known as the therapeutic alliance—is the cornerstone of effective mental health care. The quality of this connection predicts not only how people feel about therapy but also how much they improve.

Over the past three months, we measured the therapeutic alliance using the Session Rating Scale (SRS), a validated tool developed by Scott Miller, Barry Duncan, and colleagues to assess how supported and understood participants feel in therapy. Our results reflect the incredible dedication and skill of Meru Health’s therapists, who bring both compassion and evidence-based care to every participant.

Results from the latest quarter

Across 887 participants in Meru Health’s 12-week program (July–September 2025), the average SRS scores were:

Total Therapeutic Alliance Score: 38.1 / 40

What these numbers mean

The SRS uses a 0–10 scale per dimension (maximum 40 points total). Scores above 36 are considered excellent and reflect a strong therapeutic alliance. Lower scores (below 36) suggest possible disconnects that therapists can address collaboratively with patients.

With an average score of 38.1, Meru Health’s alliance scores are exceptionally strong—indicating that participants consistently feel understood, aligned on goals, and confident in the methods used.

How Meru Health compares to external benchmarks

• Typical community and outpatient benchmarks: In large studies across psychotherapy settings, average SRS totals range from 33 to 37.
  
  

  • For example, Miller & Duncan’s validation work (2003) and subsequent meta-analyses show mean scores between 33.5–36.1 depending on population and setting.
    
    

• Cutoff for “good alliance”: Scores above 36 typically place a therapist in the top quartile of alliance ratings.
  
  

• Meru Health’s 38.1 average places our therapists well above the field average, indicating exceptional relational quality and alignment between patients and therapists.
  
  
  

Why this matters

Decades of psychotherapy research show that the therapeutic alliance is one of the strongest predictors of treatment success, often more important than therapy modality. High alliance scores are linked to:

• Greater engagement and program completion
  
  

• Faster symptom improvement
  
  

• Lower dropout rates
  
  

• More sustained long-term recovery
  
  

Our data shows that compassionate, human connection—enhanced by our digital platform—can thrive even in a virtual care environment.

The Meru Health Approach

Meru Health’s hybrid model combines:

• Licensed, highly trained therapists skilled in empathy and evidence-based care
  
  

• Secure digital tools for between-session support
  
  

• Continuous feedback loops (like SRS) to ensure care stays aligned and responsive
  
  

By routinely measuring the therapeutic alliance, Meru Health creates a feedback-informed treatment model—ensuring every participant’s experience remains centered on trust, understanding, and progress.

Sources:

• Duncan, B. L., Miller, S. D., Sparks, J. A., et al. (2003). The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of Brief Therapy, 3(1), 3–12.

• Flückiger, C., Del Re, A. C., Wampold, B. E., et al. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340.

• CORC (Child Outcomes Research Consortium). SRS Guidance and Norms (2020).