therapist therapy, therapeutic alliance

A strong therapeutic alliance leads to growth in therapy.

Trust in a therapeutic relationship builds when clients feel that their therapist:

(1) will be helpful, guiding them through to resolution of the issues that trouble them

(2) will keep clients safe from blame, anger or hurtful comments, and

(3) will nourish positive feelings of hope and self-esteem.  

Establishing this sense of safety and hopefulness can be especially challenging in couples treatment.  That's because many couple therapists:

(1) are not particularly helpful (alas) because they themselves do not know and therefore cannot coach the skills for successful marriage,

(2) allow clients to interact angrily and hurtfully during the sessions and

(3) look backwards too much of the time, instilling hopelessness instead of proactively helping the couple to build a better relationship.

Fortunately, many therapists, including couple therapists, do convey the ingredients that enable their clients, individuals and couples, to establish a positive therapeutic relationship with them. Here's how they do it.

The therapist gives early evidence of being helpful.

Clients generally regard their therapist as helpful if, right from the first session, the therapist offers them a way to see their situation in a new, non-blaming manner.  For couples this explanation often includes the idea that the couple faced challenges that were very difficult with skills for talking together collaboratively that were insufficient for addressing these challenges

Couples also begin to trust that treatment will be helpful if, from the outset, the therapist shows them a sample of what they will do in treatment that will lead to an improved relationship. Toward this goal, I generally aim to teach at least one or two talking or listening skills in the first session.

I describe some of these skills in my PT postings, for example, small words that can wreck relationships, win-win conflict resolution, and, for individuals, about agitating versus thinking

The therapist shows ability to keep the sessions emotionally safe.

In individual therapy clients sniff out from early on whether their therapist is likely to be judgmental. Clients generally do want to receive enough feedback that they will be able to grow.  At the same time they want the feedback to be given in a manner that feels informative rather than critical.  My posting about the difference between feedback and criticism discusses what makes one feel safe and the other hurtful.

In couples therapy sessions clients need the therapist to keep a tight hold on the reins by shepherding mutually respectful talking and eliciting responsive listening.  The therapist needs to train combative spouses each to look for what they themselves can change rather than to seek to change each other. Zero tolerance for blaming or arguing in the session is essential.  When clients get out-of-bounds, the therapist needs immediately to blow the whistle and stop the action.

Along with ample constructive feedback and coaching, the therapist conveys perspectives that enhance clients' self-esteem.

When a therapist shares positive comments, appreciation, enjoyment, etc. to clients, clients’ self-esteem grows. Genuine appreciation, admiration, acknowledgement of clients' growth and focusing on their strengths also helps clients to relax so that they can learn more.  Appreciation often teaches clients as much or more than feedback about their areas of difficulty.

Asking good questions enables clients to gain insights and at the same time conveys to clients that their therapist is interested in them.  Offering a summary that pulls together a sympathetic narrative of how they got to where they are is another gift that can strengthen the client-therapist bond. 

Coaching new skills plus guiding clients from conflict to resolution of troubling issues further strengthens the therapeutic alliance by enabling clients to feel a sense of progress as indicated by their doing and feeling better.. 

Altogether, these contributors to a strong therapeutic alliance set the groundwork for a therapy that is effective.  The bottom line?  Therapeutic alliance is strengthened by therapy that gets the job done.  When a therapist genuiney furthers clients' healing and growth, clients are most likely to feel securely bonded, trusting and appreciative toward their therapist.

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Denver clinical psychologist Susan Heitler, Ph.D. writes about the theory and practice of psychotherapy in her book From Conflict to Resolution.  Her Power of Two book, workbook and fun relationship education online program teach couples the skills for relationship success.

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