The Therapeutic Alliance

September, 2022. Much has been written about the importance of the therapeutic alliance in psychotherapy. Studies have demonstrated that when a strong therapeutic alliance develops between patient and therapist, the forecast for a good outcome is favorable.1 But what is it, really? Here’s one fairly typical definition: “Although scholars may differ in how the alliance is conceptualized, most theoretical definitions of the alliance have three themes in common: the collaborative nature of the relationship, the affective bond between patient and therapist, and the patient’s and therapist’s ability to agree on treatment goals and tasks.”2 This recognition of the value of the very “real” human, collaborative, 2-way relationship in psychotherapy has always made sense to me. And it is a long way from the portrayal of the psychoanalyst as a neutral “blank screen” about whom the patient knows as little as possible. (In training, I had a psychoanalytic supervisor who recommended that the analyst wear plain, neutral-colored clothing in order to blend better into the background!) In today’s world of psychotherapy and psychoanalysis, however, the establishment of a genuine relationship, involving trust, mutual respect, compassion, and courage, is perhaps the single most important feature of successful work, whether it is psychodynamic psychotherapy, psychoanalysis, DBT, CBT, MBT, or other forms of evidence-based therapy.

As implied above, the therapeutic alliance is generally thought of as a 2-person phenomenon. In this issue of the Journal, however, Shepard and colleagues focus on the nature of the therapeutic alliance between the patient and the treatment team in an intensive, hospital-based, 6 to 8 week treatment program for “emerging adults” with disabling anxiety and emotion dysregulation. In their study, they found that patients “who maintained a strong therapeutic relationship with their clinical team had the most significant decreases in anxiety-related scores.”

Yet another important facet of the therapeutic alliance can be referred to as the pharmacotherapeutic alliance, elegantly described by King and Shapiro, also in this issue of the Journal. In today’s fast-paced clinical world, prescribing psychiatrists are too often carrying out 15 to 20 minute “med checks,” with very little capacity to get to know the patient. Describing the “science of the art of prescribing,” King and Shapiro argue that “it is imperative for clinicians to dispel superficial separations between mind versus body, objective versus subjective domains, and pharmacological versus psychological treatment modalities, all of which impede therapeutic efficacy to the detriment of the suffering individuals whom psychiatrists strive to serve.” And since they say it better than I can, here’s another quote: “Psychodynamic psychopharmacology stresses the importance of becoming well informed about the person being treated, not just the syndrome the person presents with, by addressing the ubiquitous mind-body split—the patient’s experience of mental illness and its treatment; pharmacotherapeutic alliance; secondary gain factors in treatment resistance; and the physician’s countertransference reactions that may affect his or her clinical attitude.” I couldn’t agree more!

1. Baier AL, Kline AC, Feeny NC. Therapeutic alliance as a mediator of change: a systematic review and evaluation of research. Clin Psychol Rev. 2020;82:101921. 2. Stubbe DE. The therapeutic alliance: the fundamental element of psychotherapy. Focus (Am Psychiatr Publ). 2018;16:402–403.

留言 (0)

沒有登入
gif