Therapeutic alliance: what it is, how it influences therapy and how it is created

Let's see what the therapeutic alliance is and how it is established between the psychologist and the patient.

The professional's knowledge and the patient's willingness to improve and make an effort are aspects that influence the success of psychotherapy. However, in therapy this is not everything, since the relationship between the psychologist and the patient acquires a very great weight when it comes to inducing improvement in the patient.

The therapeutic alliance is the interpersonal bond that exists between the patient and the therapist, a relationship based on trust, confidence and trust.It is a relationship based on trust, acceptance and understanding that allows those who come to a psychologist's office to expose their inner world in the hope that the professional will help them without judging them.

The way in which this bond is established is crucial for the patient's improvement, which is why this aspect has been the subject of much research in recent years and why there is great interest in doing everything possible to establish solid therapeutic alliances. Let's find out more about it.

What is the therapeutic alliance?

The therapeutic alliance is the meeting point between the patient and the therapist, a unique bond that is established within the therapy.. It is on this bond that the trust and understanding necessary to address the process of change that the patient has begun by seeking therapy in the first place will be based.

The therapeutic alliance is extremely important, especially in psychotherapy. Although in other patient-therapist relationships (e.g., physician, physiotherapist, surgeon...) the therapeutic alliance is a very important component, the value it acquires in the relationship between patient and psychologist is crucial, so much so that it determines the success of the psychotherapy. If the patient does not have a good relationship with his psychologist, does not feel that "feeling" or trust with his psychotherapist, the therapy can drag an important ballast that will hinder the recovery and improvement of the patient.

Psychologists do not work with disorders, but with people who suffer from a problem or pathology that requires specialized intervention. Treatment or therapy cannot be conceived apart from the establishment of an interpersonal relationship between the patient and the psychologist. between the patient and the psychologist. The encounter between the professional and the patient makes these two people meaningful to each other, and not mere strangers or instruments to achieve goals. The therapeutic alliance is so important that it predicts the success of the therapy.

For a good therapeutic alliance to be established, it is necessary for both the therapist and the patient to have a good therapeutic alliance, it is necessary that both the therapist and the patient make an effort to face the therapyby pooling their experience and knowledge. They must be able to adopt different points of view, understand and accept them, and be predisposed to change. The patient must make an effort to change, but it is essential that the psychologist also goes out of his comfort zone if necessary and understands the person to whom he is doing psychotherapy.

A meeting point between two people in psychotherapy

The therapeutic alliance begins to be established from the moment the patient establishes contact with the therapist.. From the moment these two people meet, we try to ensure that the therapy becomes a climate of trust, of closeness, in which the patient feels comfortable and feels that he/she is in a safe environment, where he/she can open up to expose his/her fears and needs without fear of being judged.

It is essential to understand that in therapy the psychologist does not judge, but accepts. Psychotherapists are not people in charge of solving the patient's problems or telling him/her what to do, but help him/her to see on his/her own what is best for his/her life. The aim is to get the patient to open his eyes and understand what is his potential and capacity to induce change in his life.

The therapist is not a friend, but a supportive person.. He accompanies the patient in his long and turbulent exploratory journey, helping him to identify those resources that are within his reach but that, due to different psychological barriers such as lack of self-esteem or a too externalized locus of control, he does not use.

The therapeutic alliance is the meeting point between two minds, two universes. Two very different people coincide in time and space in a therapeutic context, a place where it does not matter who or why. The psychologist is in charge of offering help to the patient, discovering what it is that distresses the person who has come to his help and analyzing what it is that can help him to overcome his problem.

But in order for this to happen, it is necessary that the patient sees his therapist as that person with the capacity to pick him up in the moments when he is going to collapse and trusts him..

Components of the therapeutic alliance

As we said, the therapeutic alliance is a very important aspect of psychotherapy. Being a unique and so important bond between patient and therapist, this bond has been studied in numerous investigations. However, it must be said that the serious scientific approach to this bond is relatively recent, with Lambert being one of the first to investigate it in 1992. According to him and his research this therapeutic alliance is a variable capable of predicting up to 30% of the success of the therapy..

Its weight is greater than that of the techniques used by the therapist, the theoretical model used as a starting point or the patient's own expectations of change in psychotherapy. In fact, in Lambert's own studies, the therapeutic alliance is the most determining factor in the success of therapy, being only surpassed by extratherapeutic factors, i.e., variables that are not at the psychologist's hand, that are not usually controllable and that may have a greater influence on the process.

Three basic components that make up the therapeutic alliance can be identified.

The relationship established with the patient

As might be expected, a fundamental component of the therapeutic alliance is the relationship established with the patient. This is established through what the American psychologist Carl Rogers describes as the unconditional acceptance of the patient..

It can also be understood as unconditional positive acceptance, in which the psychotherapist has an attitude of absolute respect and acceptance of the patient's experiences, experiences, feelings and opinions.

Degree of agreement on the goals to be achieved between patient and therapist.

A fundamental task in psychotherapy is that the therapist helps the patient to define the goals to be achieved during the psychotherapy.. In addition to it, it is tried to reach with him an agreement to obtain them.

Degree of agreement with the means or tasks to achieve such objectives.

Before starting with the therapeutic process, it is essential that the psychologist explains to the patient what techniques he/she is going to use and what he/she intends to achieve with them.. In case the patient has any doubts, the beginning of the therapy is the perfect moment to answer them since, once these doubts are clarified, the patient's involvement in the therapy will be greater.

How is a good therapeutic alliance achieved?

At this point we can understand the importance of the therapeutic alliance. As we have mentioned, it is a factor that increases the chances of success of the therapy, because it makes the patient feel more comfortable sharing his inner world and sees the psychologist as the person able to help him to get his life back on track and gain psychological and emotional well-being.

In view of this, it is time to know how to achieve a good therapeutic alliance. The following steps can be of great help to psychologists interested in improving the relationship with their patients and increase the success of the treatments they apply to them. Some of them may seem very obvious for the professional career of every psychologist, but it must be said that psychologists are still people and sometimes we forget to take these steps into account.

1. Use active listening

All psychologists should apply active listening when they are with their patients.. It is about listening to them without judging them, being aware of everything they say. This is essential, because if we want him to open up completely, he must trust us and know that, no matter what he says, we will not stop listening to him.

Moreover, it is often the case that patients need to listen to themselves, to give voice to their thoughts and to understand them. Therefore, as psychologists, we should not be afraid to quote the patient literally, as this will help him to see that we are listening to him and will help him to analyze his own words.

2. Be empathic

Another fundamental aspect in all psychotherapy, but it is not superfluous to remember it: to use empathy. Not only must we listen to the patient, but we must also put ourselves in his or her shoes, understand what he or she feels and what he or she wants.understand what he/she feels and show him/her that we understand him/her.

This does not mean that we feel compassion or pity for him or her, but that we understand how he or she feels. Telling him or her how we would feel, not what we would do, in the same situation can help because it builds trust. When the psychologist shows empathy towards the patient, the latter does not see the psychologist as a cold stranger with the role of a professional, but as a person who really understands him or her and whom he or she can trust.

3. Adapt to each patient

This is another fundamental aspect of all psychotherapy and has a significant influence on the therapeutic alliance. Each person is a world, with a way of perceiving reality, of thinking about it and of relating to it that varies from individual to individual.and relate to it varies greatly from individual to individual. Their way of explaining things is also different, using their own language. As psychologists we must adapt to them, a gesture that helps the patient to feel understood.

4. Explaining how the therapy will develop

A good way of establishing the therapeutic alliance is to to be transparent with the patient as to what is going to happen with the therapy.. This is to reduce the patient's uncertainty about how it is going, in the sense of knowing if progress is being made.

It is important to explain to the patient that, if there is a problem or dysfunctional process, it may be more common than he/she thinks and that it is normal for him/her to feel frustrated about it. It is pertinent to explain how we are going to work on the problem and set the objectives we intend to achieve with the patient in order to reach a consensus, making him/her see that he/she is a participant in the improvement process.

5. Be sincere about the development of the therapy

We must be sincere and not transmit false hopes of rapid recovery.. The psychologist must also be sincere with himself and with the patient, accepting that there are things that he does not know and offering, if necessary, to look for information or to derive in case it exceeds his abilities and knowledge.