Defining the Therapeutic Alliance
Sometimes called the "therapeutic alliance," and other times, the "therapeutic relationship," this term describes how the child and therapist, be it face to face or via teletherapy, engage and connect. There are those who say very simply that this intangible but genuine connection is the "bond" that develops in the therapy room.
In today’s world of therapy and counseling, most see the therapeutic alliance as an essential tool for effective therapy. Aside from the necessity of developing therapeutic skills and techniques, for a clinician to be truly successful, s/he must devote ample time and focus on developing a healthy relationship with the client as well.
In the early days of psychotherapy, there wasn’t much emphasis placed on the importance of this relationship. It wasn’t until Carl Rogers, the founder of humanistic or ‘person-centered’ therapy, came along in the 1950s, that clinicians began to see the critical connection between successful therapy and this alliance.
The Importance of the Therapeutic Alliance
Today there is a significant body of research demonstrating the benefits of the therapeutic alliance developed between therapist whether onsite or delivered via teletherapy and client.
A comprehensive 2011 overview taking into account many of the previous studies on the subject made the following assertion that “the quality of the client-therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures.”
When you think about it, this makes perfect sense. At the core of any relationship between friends, family, or colleagues is trust. And so it follows that any benefits accrued through such a relationship are built upon that trust. What transpires in the therapy room between therapist and client is no different.
Ironically, many of those who seek help from a therapist doesn’t feel at ease around other people, and that includes their family and friends. Generally, their past is riddled with events and relationships that taught them quite the opposite, to be suspect of others even when they profess to love. This is often why they are in therapy altogether!
This is why the alliance or relationship between therapist and client isn’t only valuable but is essential. The child who has been placed in therapy by a parent, caretaker or administrator can’t expect to get very far without this cornerstone of trust and genuine belief that the therapist is there to help.
For some children, the most crucial aspect of the therapy, at least at the beginning, is that the child finally can experience what it means to relate healthily to another person. Perhaps for the first time in his/her life, the child can remove the mask, stop playing the games, and feel safe interacting with an adult from whom there is no fear.
Key Ingredients of a Healthy Therapeutic Alliance
Carl Rogers, known as “the father of the therapeutic alliance,” laid out the three primary aspects of a healthy therapeutic relationship.
Empathy- Is the therapist supportive and understanding?
Congruence- Is the therapist genuine and not pretending to be a ‘guru’?
Unconditional Positive Regard- Does the therapist see your human value?
Ways to Nurture the Therapeutic Alliance
Keeping the client feeling emotionally safe
Children may be little, but they can often sniff very early on in the session if the therapist, whether face to face or vial teletherapy, is judgemental. While the child will want feedback from the clinician, that’s providing the feedback is given in a manner that is informative and not critical.
It is often not so easy to distinguish between criticism and feedback, but the child, while perhaps unable to articulate the distinction, knows the difference. Both feedback and criticism involve evaluation; however, the difference lay in that criticism contains fault finding and judgment, whereas feedback is merely passing on corrective information.
It is imperative that in conjunction with sharing feedback that is constructive, the therapist maintains an abiding interest in building the child’s self-esteem. Sharing appreciation of the child, positive comments when appropriate, and expressing enjoyment of the session will often go a long way to enhancing the child’s self-esteem.
The Power of Relationship
Therapists often claim that they rarely recall either from their reading research studies, or their own clinical experience where clients reported that it was some particular intervention or technique that was most helpful to them. Instead, clinicians say that clients told them that feeling understood and heard was the most valuable part of the therapy.
Let’s not kid ourselves. The therapeutic relationship doesn’t replace effective therapy. But without the rock-solid foundation of the relationship between therapist and client, most therapists agree that anything else accomplished in the session won’t have much if any long term value.
There is no set formula that will facilitate creating the emotional bond between therapist and client. The chemistry will be different in every situation. It might be a strong emphasis on offering supportive and positive feedback, sharing humor, empathetic listening, or impressing upon the child the therapist’s genuine compassion and concern.
Acceptance, Validation, and Empowerment
Another crucial aspect of the clinical session is assisting the child to open up so he/she can be heard and understood. This won’t happen unless the child feels safe and unconditionally accepted. Once the child opens up, it is essential to validate what the child said to promote a sense of comfort with regards to expressing feelings.
Allowing the child the freedom to stray from the straight and narrow path of the session and veer off on tangents can have a potent subconscious impact on the child. The child feels more than just the object of the dialogue. Instead, by taking the initiative the child feels empowered. This can be very beneficial to the therapeutic relationship.
Taken together, these various contributors can do much to cement the bond between therapist, be it face to face or via teletherapy, and client. The bottom line? Perhaps the most significant factor in an active, healthy, effective therapeutic alliance is for the therapist to help the child. Genuine help more than anything else will build that precious trust and all but guarantee an upward spiral of success in the therapy.