Therapeutic Alliance: Success in Psychotherapy

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Therapeutic alliance

Introduction

Therapeutic alliance is a word describing a more inclusive term for therapy. This is because it puts emphasis on the importance of collaboration or partnership between therapists and patients in provision of treatment and medication. This means that the treatment process also takes into account preferences of the patient. Furthermore, the process involves a combined effort to establish goals of the treatment and their achievement benchmarks. The alliance focuses on the ability of a therapist or a care giver to perform without giving unwarranted advises in addition to behaving judgmentally. Nevertheless, therapeutic alliance approach to medical attention and care provision has both good and bad sides (Piper & Ogrodniczuk, 2011). 

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Arguments in Favor of Therapeutic Alliance 

Increased Ability to Predict the Outcome of the Medication

Therapeutic alliance is one field that has received considerable attention of researchers. This was informed by rigorous research on physiotherapy and drug treatment. All studies pointed to the undeniable fact that therapeutic alliance was a good indicator of the effectiveness and outcome of a treatment program. Results are directly proportional to the quality of therapeutic alliance. This means that the better the therapy and the relationship between a therapist and a client is, the better the results are. These results build on each other to help achieve better outcome at the end when treatment is over (Halperin et al., 2010). 

Therapeutic alliance also helps register positive changes of the patient because the treatment helps cure long term illnesses. This is often achieved by determining and fighting different health conditions that might seem not alarming to the patient. Success of therapeutic alliance in predicting the outcome of treatment is evident in almost all fields ranging from cognitive behavioral treatment to medication treatment. In addition, this approach has helped predict the outcomes in other fields such as placebo medical treatment and interpersonal psychotherapy for depression (Swift et al, 2012). 

Increase in Patient’s Commitment to Treatment Sessions

Therapeutic alliance works with the precepts of collective bargaining for an improved and more effective treatment process. This means that the therapist has to open up to the client as a way of building a rapport and finally a relationship with the client. A therapist is, generally, expected to map out what the client can expect during the treatment session. This approach generally helps disseminate the fears or uncertainties that the patient or client might harbor concerning therapeutic alliance. Furthermore, the knowledge that the client can use to make a decision regarding almost all issues and conditions during the therapy session gives them the urge to enroll and attend the sessions regularly (Verhulst et al, 2013). 

Commitment to intervention sessions and continued participation helps the patient build trust in the therapist and disclose information that may be instrumental for effective treatment. This trust helps build behavioral responses of the patient towards treatment sessions. In the absence of therapeutic alliance, the client has the liberty to either commit himself to the sessions or totally abscond sessions. However, therapeutic alliance helps build a sense of responsibility for the treatment given the presence and willingness of the therapist to offer multidimensional advice and expertise (Hill & Knox, 2009). 

Improvement of Treatment Outcome

The presence of a good working relationship between the client and therapist helps establish an effective outline for undergoing medication. This automatically helps improve the process of medication since every single issue is tackled. Consequently, it improves the outcome of the treatment. This is because the outcome of the treatment depends on issues such as quality of treatment and the time taken during the treatment. Positive relationships between the client and the therapist often lead to the prolonged treatment sessions (Beck et al., 2011).

Therapeutic alliance has also notably helped to increase retention when allied in substance abuse treatment. Drug and substance abusers always have a high dropout rate when enrolled for treatment. However, application of therapeutic alliance helps retain them because of the nature of the approach to factor in their views and decisions. This also impacts the outcomes of treatment, which indicates an improvement in the outcomes as opposed to cases where therapeutic alliance is not used (Messer & Wolitzky, 2011). 

Arguments Against Therapeutic Alliance 

Places More Expectations on the Therapist

Therapeutic alliance places more emphasis and expectations on the therapist. The therapist, for example, has a duty to try to convince the patient to enroll in the multidimensional therapy. This is complicated with the requirement of neutrality on the part of the therapist to allow the client adopt his or her preferred intervention approach. This creates an imbalance on the side of the therapist. This is much harder to balance especially when the therapist is convinced that the patient will respond better to medication when enrolled for the services. Furthermore, it does not factor in personality traits of a therapist since not every therapist has a cool collected and calm personality (Abrishami & Warren, 2013). 

The therapist is the only person with the responsibility to make the relationship work. This might cause their stress level to increase in the case where they have uncooperative clients to work with. In addition, it is clear that in some therapies, clients are not only uncooperative but also hostile. However, the therapist is always expected to act professionally and assume a leadership position in bringing this to a successful and reasonable conclusion. This makes it quite a challenge for the therapist or a care giver since in many occasions they are expected to deliver quality services despite all challenges (Piper & Ogrodniczuk, 2011). 

Constant Risk of Blurring of Boundaries

Therapeutic alliance always puts therapist-client relationship boundaries at risk. This is because it has over the years resulted in blurring of boundaries in the therapist-client relationship. In as much as all therapists undergo training to help them establish boundaries when taking a client through therapy, it is blurred in quite a number of cases. This leads to a non-therapeutic relationship, which may affect the outcome of therapy sessions. Unfortunately, the causes of blurring the relationship are often unavoidable. The therapist for example has little control over their relationship with the client slipping into a social context in some circumstances (Halperin et al, 2010).

Some of other causes of blurring the relationship include the tendency of a therapist to over help the client or patient. This involves situations when a therapist goes beyond the expectations of patients in helping them to recover. Other therapists might display a controlling aspect during the therapy. This means that the therapist might adopt authoritative or assertive nature due to a belief that it is for the sake of safety of the patient. Others include prioritization of therapists’ demands and ignorance of the welfare and needs of the patient. The therapist might also choose a passive type of a relationship (Piper & Ogrodniczuk, 2011).

Transference and Counter-Transference

These two phenomena refer to behaviors of patients and therapists in relation to each other throughout therapeutic sessions. Transference is an unconscious process that patients undergo to displace their current behavioral patterns and emotional reactions with the behaviors they used to have during their childhood in relation to certain significant figures in that period. Therefore, patients will react to the therapy with that subconsciously predetermined behavior (Abrishami, & Warren, 2013). This means that the therapist will become the object of transference in the eyes of the patient. The most common symptoms of transference include the desire for affection and high level of dependency. This might include continued requests for favors from the therapist. Other clients harbor harshness and hostility on the therapist (Muran & Barber, 2011).

Counter-transference, on the other hand, refers to the tendency of the therapist to relate or displace the conditions of the current client to that of previous clients and disclose some of the confidential details about them. This tendency to relate to clients has both positive (if the past client left a good impression on the therapist) and negative effects. However, this approach is always unprofessional because it prompts the therapist to create a formed opinion about the client. In the case where the past clients have harbored harshness and hostility, the therapist will automatically have negative reactions to the current client. This consequently affects the quality of therapy, therefore, the outcome becomes negative (Bachelor, 2011). 

Conclusion

Therapeutic alliance is the best approach to treatment in the modern society with evolving multidimensional nature of conditions. This is because it involves and values the input of the client during the treatment session. Research supports the fact that the approach has always helped provide an insight into the outcome of the treatment. This therefore means that the use of the approach can increase the accuracy of prediction of medication outcome. This prediction can find its use in planning for an effective medical outline. Therefore, therapeutic alliance proves to be the best approach to improve medical outcomes.

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