How the Therapeutic Alliance Influences Treatment Outcome

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

Source: Yurii Maslak/Shutterstock

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

It takes some work to discover an appropriate therapeutic match and once it is found, it takes cooperation and collaboration between both the individual looking for help and the provider.

Some therapists may believe the power of therapy is held in their words. However, especially involving hypnotherapy, it is apparent that most of the power is in the patient (Alman, 2001). When a patient is engaged in the process of modifying behavior, they will be more inclined to implement strategies on their own, leading to positive change.

While the patient has an unequivocal responsibility to be open and take part in the therapeutic process, the therapist must facilitate what is known as the therapeutic alliance. This alliance is three-fold, involving the collaborative relationship, affective bond, and ability between the patient and therapist to come together to work on an agreed goal (Stubbe, 2018).

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

Positive therapeutic outcomes involve not only finding the right therapist but also demonstrating certain signs of progress and growth throughout the therapeutic journey. Let's illuminate what it means to make the most of therapy. We will explore several behaviors associated with an enhanced relationship between patient and therapist and positive therapeutic outcomes.

Effective Communication

Communication does not come easily for every patient, especially regarding emotional expression. Therefore, the therapist must use patience when fostering an environment wherein patients feel secure being transparent about their goals, concerns, and progress.

In return, patients grow more comfortable over time in being honest about their thoughts, feelings, and experiences, even when discussing painful topics. If you, as a patient, don't feel safe expressing your feelings during therapeutic sessions, you can ask yourself the following questions to get to the root of what you're feeling:

• "Is this therapist creating the right environment for me?"
• "Do I even care to engage in a discussion about this right now?"
• "Am I struggling to converse 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. This is because communication is one of the foundational elements contributing to the therapeutic alliance (Del Giacco et al., 2020).

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

Communication can improve treatment by encouraging diagnostic accuracy, ensuring the patient's needs are being met, and uplifting the patient's role in deciding how the treatment process should go (Popa-Velea & Purcărea, 2014).

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

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Active Engagement and Home Practice

Consistent, active engagement is one of the most vital tenets in not only therapy but in life. Commitment to therapy from both the provider and patient signifies a genuine desire for change and strengthens the therapeutic alliance. One helpful tip for a beneficial therapeutic outcome is to come into sessions with a notepad to reference the discussion in the future.

To continue patient progress outside the session, therapists will often provide home practice assignments or exercises to work on the skills taught in therapy. It is the therapist's job to ensure they are assigning home practice with clear instructions and within the patient's capabilities, keeping in mind their schedule and emotional capacity.

Suppose you, as a patient, deem an assigned practice to be too much work or not rewarding. In that case, this is a good opportunity to practice communication, letting your therapist know so they can better tailor practices toward your success.

In general, patients in therapy will see improved behavioral outcomes over time. However, patients who thoughtfully practice their skills outside the therapy office are likelier to have an improved treatment outcome (Mausbach et al., 2010).

Willingness to Take Accountability

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 modifying behavior for a more desirable outcome.

This is not done alone; a good therapist will assist the patient in improving self-awareness, gaining confidence in dealing with unpleasant emotions, and staying consistent without making the patient feel blamed.

Patients can learn to acknowledge their role in their well-being, feel empowered to take responsibility, and hold themselves accountable for their actions and choices, recognizing that they are in control of their emotions and behaviors. A great way to practice taking accountability is by accepting feedback from the therapist with an open mind (Peteet et al., 2023).

Setting Realistic Expectations

Any patient needs to recognize that therapy is a process, not a quick fix. By setting realistic expectations for progress and having self-compassion when there are setbacks along the way, patients can feel proud of their efforts in the therapeutic process. It is crucial that early in their therapy, patients are informed about the timeline of the therapy to come and have their expectations addressed (Ekberg et al., 2016).

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

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

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

Takeaway

Therapy involves a two-fold relationship, where the therapist diagnoses and implements an environment tailored to the patient's needs. The patient attends sessions consistently, communicates effectively with their therapist, and practices skills on their own.

It is paramount that each patient understands their power in modifying their behavior. The therapist's main role is to support the patient in their journey of self-discovery, offering useful coping tools.

Patients can commit themselves to a positive therapeutic outcome with the understanding that participating in the journey can offer a life-changing impact.

Mac Lancaster obtained his undergraduate degree in Cognitive and Behavioral Neuroscience at UC San Diego. Currently, he shadows Ran D. Anbar, M.D., observing patients and helping to write articles about hypnosis and counseling for publication in professional literature.