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 strive on the part of the patient are aspects that influence the success of psychotherapy. However, in therapy this is not all, as the relationship between psychologist and patient acquires a lot of weight to induce 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 anyone who sees a psychologist to expose their inner world in the hope that the professional will help them without judging them.

The way in which this link is established is crucial for the improvement of the patient, which is why it is a very sought-after aspect in recent years and there is a lot of interest in doing everything possible to establish strong therapeutic alliances. . Let’s find out more about what it is.

    What is a therapeutic alliance?

    The therapeutic alliance is the meeting point between the patient and the therapist, a unique bond that is established within the therapy. On the basis of this bond will be the confidence and understanding necessary to approach the process of change that the patient began when seeking therapy in the first place.

    The therapeutic alliance is very important, especially in psychotherapy. While in other patient-therapist relationships (eg: doctor, physiotherapist, surgeon, etc.) the therapeutic alliance is a very important component, the value it acquires in the patient-psychologist relationship is crucial, so much so that it conditions the “success of psychotherapy”. . If the patient does not have a good relationship with their psychologist, does not feel this feeling, or does not trust their psychotherapist, the therapy can lead to a significant burden which will make it difficult for the patient to recover and improve.

    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 designed 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 important to each other, and not mere strangers or instruments to achieve goals. The therapeutic alliance is so important that it predicts the success of therapy.

    For a good therapeutic alliance to be established, the therapist and the patient must make an effort in front of the therapy, combining their experience and knowledge. They must be able to adopt, understand and accept different points of view, as well as be ready to change. The patient must make an effort to change, but it is essential that the psychologist also step out of his comfort zone if necessary and understand the person for whom he is giving psychotherapy.

      A meeting point between two people in psychotherapy

      The therapeutic alliance begins to be established from the moment the patient makes contact with the therapist.. From the moment of the meeting between these two people, we try to make the therapy a climate of trust, of closeness, in which the patient feels at ease and feels in a safe environment, where he can be. open up to expose fears and needs without fear of being judged.

      It is crucial to understand that in therapy the psychologist does not judge, but accepts. Psychotherapists are not people who take care of the patient’s problems or tell him what to do, but help him see for himself what is best for his life. The goal is to get the patient to open his eyes and understand his potential and his ability to induce changes in his life.

      The therapist is not a friend, but a support person. He accompanies the patient in his long and eventful exploratory journey, helping him to identify the resources at his disposal but that due to various psychological barriers such as lack of self-esteem or an overly externalized locus of control, he cannot do 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 doesn’t matter who or why. The psychologist is responsible for offering help to the patient, finding out what is distressing that went to help him and analyzing what can be used to overcome his problem.

      But for this to happen, the patient must see your therapist as that person who can pick you up in times when you fall apart and trust him.

        Components of the therapeutic alliance

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

        Its weight is greater than that of the techniques used by the therapist, the theoretical model on which it is based or the patient’s own expectations of change are closer to psychotherapy. In fact, in Lambert’s own studies, the therapeutic alliance is the most decisive factor in the success of therapy, being overtaken only by extra-therapeutic factors, i.e. variables which are not. in the hands of the psychologist, which are usually not controllable and their influence in the process may be greater.

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

        The relationship that is established with the patient

        As you might expect, a key part of the therapeutic alliance is the relationship that is established with the patient. This is established by that 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 experiences, experiences, feelings and opinions of the patient.

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

          A key task of psychotherapy is that the therapist helps the patient to define the goals to be achieved throughout the psychotherapy. In addition, an agreement is found to reach them.

            Diploma according to the means or the tasks to achieve these objectives

            Before starting the therapeutic process, it is essential that the psychologist explains to the patient what techniques he will use and what he intends to achieve with them.. If the patient has doubts, the start of therapy is the ideal time to address them because, once these doubts are clarified, the patient’s involvement in the therapy will be greater.

              How to achieve a good therapeutic alliance?

              Arriving here, we understand the importance of the therapeutic alliance. As we have mentioned, this is a factor that increases the chances of success of therapy, as it allows the patient to feel more comfortable in sharing their inner world and seeing the psychologist as the person trained to. help him reorient his life and acquire psychological and emotional well-being. -to be.

              Faced with this, it is time to know how to achieve a good therapeutic alliance. The steps below can be of great help to psychologists interested in improve the relationship with patients and increase the success of treatments that apply them. Some may seem very obvious in the professional career of any psychologist, but it must be said that psychologists do not stop being people and sometimes we forget to take these steps into account.

              1. Use active listening

              Every Psychologist Should Apply Active Listening When With Patients. It’s about listening to it without judging it, to be aware of everything he says. This is fundamental, because if you want him to be completely open, you have to trust him, know that, whatever he says, we will not stop listening to him.

              In addition, patients often need to listen to themselves, express their thoughts and understand them. Therefore, as psychologists, we should not be afraid to literally quote the patient, as this will help them see that we are listening to them and help them analyze your own words.

                2. Be empathetic

                Another fundamental aspect of any psychotherapy, but one that should be remembered: the use of empathy. Not only must we listen to the patient, but we must also put ourselves in the shoes, understand how he feels and show him what we understand.

                This does not mean that we feel compassion or pity for him, but that we understand how he feels. Telling him how we would feel, and not what we would do, may help him in his own situation as it builds self-confidence. When the psychologist empathizes with the patient, the latter does not see the former as an unfamiliar cold to the role of a professional, but as a person who truly understands him and whom he can trust.

                  3. Adapt to each patient

                  Another fundamental aspect of any psychotherapy which has a notorious influence on the therapeutic alliance. Each person is a world, with a way of perceiving reality, comment on and relate it in a very varied way from one individual to another. Their way of explaining things is also different, using their own language. As psychologists, we have to adapt to it, a gesture that helps the patient to feel understood.

                  4. Explain how therapy will evolve

                  A good way to establish a therapeutic alliance is be transparent with the patient about what will happen with the therapy. It’s about reducing the patient’s uncertainty about how they are doing, in the sense that they know if progress is being made.

                  It is important to explain to the patient that in the event that this happens, there is a problem or dysfunctional process, but it may be more common than he thinks and it is normal for him. be frustrated. It is relevant to explain how we are going to work on your problem and to set with him the objectives that we intend to achieve in order to reach a consensus, showing that he is an actor in the improvement process.

                  5. Being sincere brings the development closer to the therapy.

                  We must be honest and not leave false hopes for a quick recovery. The psychologist must also be honest with himself and the patient, accept that there are things that he does not know and offer, if necessary, to seek information or to refer in case he exceeds his skills and his knowledge.

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