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

The knowledge of the professional and the desire to improve and make an effort on the part of the patient 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, acceptance and understanding that makes it easier for those who come to the consultation of a psychologist expose her inner world in the hope that the professional will help him without judge it.

The way in which this link is established is crucial for the patient to improve, and is therefore a very important aspect. investigated in recent years and having great interest in doing everything possible to establish alliances solid therapies. Let's find out more about what it is.

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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. The trust and understanding needed to address the process of change that the patient has begun by resorting to therapy in the first place will build upon this link.

The therapeutic alliance is extremely important, especially in psychotherapy. Although in other relationships between patient and therapist (for example, doctor, physiotherapist, surgeon ...) the therapeutic alliance is a component Very importantly, the value that 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 her psychologist, she does not feel that "feeling" or trust with her psychotherapist, therapy can drag a significant burden 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 outside of the establishment of an interpersonal relationship between the patient and the psychologist. The meeting between the professional and the patient makes these two people become elements meaningful to each other, and not mere strangers or instruments to achieve objectives. The therapeutic alliance is so important that it predicts the success of the therapy.

For a good therapeutic alliance to settle, it is necessary that both the therapist and the patient make an effort in the face of therapy, combining his experience and knowledge. They must be able to adopt different points of view, understand and accept them, in addition to being predisposed to change. The patient must make an effort to change, but it is essential that the psychologist also comes out of the comfort zone of him if necessary and that he understands the person to whom he is doing psychotherapy.

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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, they try to make therapy become a climate of trust, closeness, in the that the patient feels comfortable and feels that he is in a safe environment, where he can open up to expose her fears and needs without fear of being court.

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 of telling them what to do, but help you see for yourself what is best for your life. The aim is to get the patient to open their eyes and understand her potential and ability to induce change in her life.

The therapist is not a friend, but a person who offers support. He accompanies the patient on his long and turbulent exploratory journey, helping him to identify those resources that he has at his disposal but that, due to different psychological barriers such as lack of self-esteem or an excessively externalized locus of control, uses.

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 disturbs those who have come to his aid and analyzing what can help him overcome his problem.

But for this to happen, it is necessary that the patient see your therapist as that person with the ability to pick you up in the moments when you are going to break down and trust him.

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Components of the therapeutic alliance

As we said, the therapeutic alliance is a very important aspect of psychotherapy. Being such a unique and important link between patient and therapist, this link has been studied in numerous investigations. However, it can be said that the serious scientific approach to this link 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 therapy.

Its weight is greater than that of the techniques used by the therapist, the theoretical model from which it starts, or the patient's own expectations of change about 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 extra-therapeutic factors, that is, m variables that are not at the psychologist's hand, that are usually not controllable and that their influence on the process may be higher.

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 by 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 a attitude of absolute respect and acceptance of the experiences, experiences, feelings and opinions of the patient.

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Degree of agreement of the objectives to be reached between patient and therapist

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

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Degree of agreement with the means or tasks to achieve these objectives

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

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How do you get a good therapeutic alliance?

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

Having seen this, it is time to find out how to achieve a good therapeutic alliance. The steps that we will see below can be of great help to psychologists interested in improve the relationship with your patients and increase the success of the treatments applied to them. Some of them may seem very obvious to the professional career of every psychologist but it is possible say that psychologists do not stop being people and sometimes we forget to take these into account Steps.

1. Use active listening

Every psychologist must apply active listening when he is with his patients. It is about listening to him without judging him, being aware of everything he says. It is essential, because if we want it to open completely, it is necessary that you trust us, that you know that, whatever you say, we are not going to stop listening to you.

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

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2. Be nice

Another fundamental aspect in all psychotherapy, but it is worth remembering it: using empathy. We must not only listen to the patient, but we must also put ourselves in their shoes, understand what he feels and show him that we understand him.

This does not mean that we feel compassion or pity for him or her, but rather that we understand how he or she feels. Telling him 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 former as cold unknown with the role of professional, but as a person who really understands him and in whom he can trust.

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3. Adapt to each patient

Another fundamental aspect of all psychotherapy and one that greatly influences the therapeutic alliance. Each person is a world, with a way of perceiving reality, comment on it and interact very varied 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. Explain how the therapy will proceed

A good way to establish the therapeutic alliance is be transparent with the patient as to what will happen with the therapy. It is about reducing the patient's uncertainty regarding how he is doing, in the sense that he knows if progress is being made.

It is important to explain to the patient that, if it occurs, there is a problem or process dysfunctional, but that this may be more common than you think and that it is normal for you to feel frustrated by it. It is pertinent to explain how we are going to work on his problem and mark the objectives that we intend to achieve with him in order to agree on them, making him see that he is a participant in the improvement process.

5. Being honest about the development of therapy

We must be sincere and not convey false hopes of speedy recovery. The psychologist must also be honest with himself and with the patient, accepting that there are things he does not know and offer, if necessary, to seek the information or to refer if you exceed his abilities and knowledge.