How the therapeutic alliance influences treatment outcome

By Mac E. Lancaster, BS, and Ran D. Anbar, MD

Enter therapy can be a daunting step toward improving mental and emotional well-being. The therapist plays a vital role in guiding and facilitating the therapeutic relationship, which has long been considered to play an indispensable role in the outcome of therapy (Bolsinger et al., 2020).

It takes work to discover an appropriate therapy and once found, it takes cooperation and collaboration between the person seeking help and the provider.

Some therapists may believe that the power of therapy lies in their words. However, especially when it comes to hypnotherapy, it is evident that most of the power lies with the patient (Alman, 2001). When a patient is engaged in a process of changing their behavior, they will be more likely to implement strategies themselves, leading to positive change.

Although the patient has the unequivocal responsibility to be open and participate in the therapeutic process, the therapist must facilitate what is called therapeutic alliance. This alliance is threefold: it involves the collaborative relationship, the emotional bond and the ability between the patient and the therapist to come together to work on an agreed upon goal (Stubbe, 2018).

Especially in the case of adolescents, if they feel that the alliance is weakening, it will negatively affect their retention rate and treatment outcomes (Gergov et al., 2021). An effective therapist must be able to articulate, model, inspire, and promote an atmosphere that encourages exploration and change.

Positive therapy outcomes involve not only finding the right therapist, but also demonstrating some signs of progress and growth throughout the therapy journey. Let’s take a look at what it means to get the most out of therapy. We will explore several behaviors associated with an improved patient-therapist relationship and positive therapeutic outcomes.

Effective communication

Communication is not easy for all patients, especially when it comes to emotional expression. Therefore, the therapist must be patient when fostering an environment in which patients feel safe and transparent about their situation. goalsconcerns and progress.

In turn, patients become more comfortable over time and know how to be honest about their thoughts, feelings, and experiences, even when discussing painful topics. If, as a patient, you do not feel safe expressing your feelings during therapy sessions, you can ask yourself the following questions to get to the bottom of what you are feeling:

• “Is this therapist creating the right environment for me?” »
• “Do I really want to start a discussion about this right now?
• “Am I having trouble conversing because this particular topic is too uncomfortable? »

Although communication skills are developed and strengthened during therapy, patients should do their best to ask questions or seek clarification along the way. Indeed, communication is one of the founding elements contributing to the therapeutic alliance (Del Giacco et al., 2020).

Although therapy is a learning process for the patient, therapists also learn to provide a more effective and individualized treatment plan, based on feedback, leading to greater patient satisfaction (Oliveros et al., 2019). .

Communication can improve treatment by encouraging diagnostic accuracy, ensuring that the patient’s needs are met, and reinforcing the patient’s role in deciding how the treatment process will proceed (Popa-Velea and Purcărea, 2014).

In addition to the words exchanged during a session, body language is a sign of commitment to the therapeutic process. For example, when the therapist and patient make eye contact and direct body language forward, the interaction between them takes on a greater sense of presence (Abdulghafor et al., 2022).

Active and practical engagement at home

Consistent and active engagement is one of the most essential principles not only in therapy but also in life. Therapeutic engagement on the part of both provider and patient signifies a genuine desire for change and strengthens the therapeutic alliance. A helpful tip for achieving a beneficial therapeutic outcome is to attend sessions with a notepad to reference future discussion.

To continue the patient’s progress outside of the session, therapists will often provide homework or home exercises to work on the skills taught in therapy. It is the therapist’s responsibility to ensure that they assign home practice with clear instructions and within the patient’s capabilities, keeping in mind their schedule and emotional capacity.

Suppose you, as a patient, consider an assigned practice to be too much work or unrewarding. In this case, it is a good opportunity to practice communicationby informing your therapist so that they can better adapt their practices to your success.

In general, patients in therapy will see better behavioral results over time. However, patients who thoughtfully practice their skills outside of the therapy office are more likely to achieve better treatment outcomes (Mausbach et al., 2010).

Willingness to take responsibility

Patients should approach therapy with a sense of curiosity about themselves, their thoughts, emotions, and behaviors. Self-reflection can lead to understanding how past experiences and behaviors have shaped present circumstances, paving the way for self-awareness and behavior modification for a more desirable outcome.

This is not done alone; a good therapist will help the patient to improve his self-awareness, to acquire trust deal with unpleasant emotions and remain consistent without the patient feeling blamed.

Patients can learn to recognize their an important role in their well-being, feel empowered to take responsibility and hold themselves accountable for their actions and choices, recognizing that they have control over their emotions and behaviors. A great way to practice taking responsibility is to accept the therapist’s feedback with an open mind (Peteet et al., 2023).

Set realistic expectations

Every patient must recognize that therapy is a process and not a quick fix. By setting realistic expectations for progress and showing self-compassion when there are setbacks along the way, patients can feel proud of their efforts in the therapy process. It is crucial that at the start of their therapy, patients are informed of the schedule of upcoming therapy and that their expectations are taken into account (Ekberg et al., 2016).

It takes time to change a thought process, and this happens by learning skills and practicing implementing therapeutic techniques in real-life situations. Such practice allows patients to verify the effectiveness of various techniques and gives the therapeutic alliance the opportunity to modify therapy accordingly.

With practice over time, healthier coping strategies, communication skills, and self-awareness techniques become second nature, leading to positive changes in relationships and overall well-being.

Patience, perseverance and diligence are key qualities in the healing journey.

Take away

Therapy involves a dual relationship, in which the therapist diagnoses and implements an environment tailored to the patient’s needs. The patient attends sessions regularly, communicates effectively with their therapist, and practices their skills on their own.

It is essential that each patient understands their power to change their behavior. The main role of the therapist is to support the patient in their journey of self-discovery, by offering them useful coping tools.

Patients can commit to a positive treatment outcome, knowing that participating in the journey can have a life-changing impact.

Mac Lancaster earned his undergraduate degree in cognitive and behavioral sciences Neuroscience at UC San Diego. Currently, he shadows Ran D. Anbar, MD, observing patients and helping to write articles on hypnosis and advice on publishing in professional literature.

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