Abstract
This paper explores several peer-reviewed journals on already documented research about the relationship between the client and the therapist. Clients require a strong bonding relationship with the therapist before undergoing the actual treatment. . Clients must consider creating a strong alliance with their therapists/clinicians. This helps them to be sure and develops confidence in them. They should start the treatment without having any fear about the clinician involved. This creates a friendly atmosphere for them in attaining good therapy services. This work outlines the basic elements of the therapeutic alliance as a human service. It also further explains why these elements are very critical in forming strong collaborative client relationships. Therapeutic alliance has been viewed in different ways. Many writers have also provided varying definitions. A rationale as to why this relationship is critical to the outcome of the therapy is included. The purpose of this paper is to broaden the understanding of therapeutic alliance. It also provides reasons why it should be done and its importance. The benefits attained by the clients are also explained.
Introduction
The therapeutic alliance forms the most valuable part of beginning psychotherapy. It is best in giving a prediction of the treatment outcome (Berzins, 2008). It is also considered as the most powerful factor in the process of psychological and emotional healing. This act of service has become a great consideration in the health sector today. Therapists/clinicians prefer to establish a strong working relationship with their clients. This ensures the provision of effective and quality services offered. Therapeutic alliance is defined as the strong and collaborative relationship between the client and the therapist (Meissner, 1996). It is also the trust that is developed between the client and clinician that allows them to interact effectively. The establishment of a good relationship is necessary at the onset of the therapy session. Clients need the therapist warmth and their emotional involvement in the entire treatment process (Muran &Barber, 2010). This work widely explores therapeutic alliance majorly on why it should be established. It explains why the clinician-client relationship is critical to the outcome of the therapy services.
There are basic critical elements that form this collaborative client-clinician relationship. These elements constitute the key factors that strengthen the therapeutic alliance. The elements include; the emotional bond and partnership, goals, tasks and the relationship history of the participants (Meissner, 1996). Goals as an element refers to the end result of the therapy. It involves what the client hopes to acquire from the therapy (Berzins, 2008). Therefore when the working alliance is being established, goals to be achieved must be considered. The client establishes this strong and trustworthy relationship knowing that something must be achieved at the end of the treatment session. The clinician must also know the goals and objectives of the relationship (Muran &Barber, 2010). He/she must strive hard to deliver effective services to the client in order to achieve the set goals and objectives. Some of the goals in a therapeutic relationship includes; the promotion of self-care and independence. Another goal is facilitation of communication of distressing feelings and thoughts of the client (Murans &Barber, 2010). Others are offering assistance to clients with problems to help them in their daily living. Furthermore, they often help clients to examine the alternatives and the self-defeating behaviors, which form the basis of the therapeutic alliance.
The emotional bond and partnership is another component of the alliance that must be considered (Berzins, 2008). A strong bond must exist in order for the clinician and client to develop full trust. This strong bonding establishes a trustworthy relationship. Both the client and the clinician believe in the services being offered under their own given conditions and terms. The therapeutic alliance becomes one that is full of confidence. The therapy services are delivered effectively without any form of fear. This strong bond ensures that the overall goals set will be achieved as desired (Meissner, 1996; Michel, Jobes & APA, 2011). Therapeutic alliance without trust cannot establish achievable goals. In actual sense, it only promotes misunderstanding and disagreements between the clinician and the client. No goals can be attained in an untrustworthy relationship.
Another considered element in therapeutic alliance is tasks. Tasks are what the clinician and the client talks about, discusses deeply and agrees to be done (Muran & Barber, 2010). All that they have agreed to do will guide them in the attainment of the set goals and objectives. The clinician and the client must have a cognitive consensus on the tasks to be done (Muran &Barber, 2010). Both of them must set their terms and conditions. Both must learn to accommodate each other’s opinion. This consensus agreement on the task ensures the existence of a strong and effective working relationship.
The last element of therapeutic alliance is the relationship history of both the participants (Berzins, 2008). This greatly determines whether or not there can be an effective relationship. A bad relationship history results into a weak relationship. The alliance becomes one of less or no trust. The goals set in this kind of alliance can never be achieved. On the other hand, a good relationship history enhances a strong and trustworthy bonding. The clinician and the client are able to interact freely (Meissner, 1996). The working environment is positively enhanced. The set goals and objectives are achieved effectively.
One major issue of concern has been how therapists/clinicians/ nurses are able to win the trust of their clients. This further probes the question of whether strong relationship should be created at the beginning of the therapy or in the middle of the session (Meissner, 1996). Studies conducted shows that the clinician should win the client’s trust and be able to establish the therapeutic alliance before the treatment sessions. There are several ways through which a therapist/clinician can establish this trust. It is through this that they are able to convey to clients that the treatment will be beneficial. Trust in the relationship increases when the clients feel that the clinician will resolve the issues that trouble them (Berzins, 2008). The clinician will be able to keep them safe from anger, hurtful comments and blames. Trust also builds up when the clients feel that the clinician will promote positive feelings of hope and enhance their self-esteem.
Many therapists are able to convey ingredients that make their clients to develop a positive therapeutic relationship. There are 3 ways in which they are able to win their clients (Muran &Barber, 2010). The clinicians give early signal/ evidence that they are helpful. This happens in the first session. The clinicians talk with the clients in a non-blaming manner. The clients are able to experience the situation that affects them. The clinicians employ wonderful talking and listening skills to their clients (Muran $Barber, 2010). Secondly, the clinicians prove to the clients that the session will be emotionally safe. Clients need a clear feedback that indicates that they will be able to grow (Berzins, 2008). The clinicians should not be judgmental to them in the session. They need to hear the feedback in an informative manner but not a critical one. The third way is that the clinicians convey the message in a manner that enhances the clients’ self-esteem. For example, by giving positive comments, appreciation and enjoyment (Meissner, 1996). This builds their self-esteem. The clients are ready to acquire more when they are appreciated and acknowledged. The point of focus is mainly on the clients’ strengths rather than weaknesses. The clinician should also ask good questions. This will enable the clients to realize that the clinician has interest in them (Meissner, 1996). Through all these, a strong and trustworthy bonding is created between the client and clinician. This enhances therapeutic alliance. Those that perceive a trustworthy relationship always undergo the best therapy.
The therapeutic alliance being the foundation of treatment has several characteristics. These characteristics are very effective in establishing a helping relationship. Therapist’s/clinician’s genuineness is the first one. Clinicians must be genuine throughout this relationship (Berzins, 2008). They should not consider themselves as better than their clients. The clinicians must have a deep insight of him/her in order to provide effective treatment. Clinician’s personal hindrances should be excluded from the therapeutic environment. Clinician’s genuineness is also the overall experience and attitude showed to the client (Berzins, 2008). Again the clinician should not prove to be all knowing, rigid, powerful and a controlling person. Another characteristic is a positive regard that is unconditional. The clients should be received unconditionally. There should be warm acceptance of the client’s weaknesses (Muran &Barber, 2010). The clinician should show a unique care to the client. Clients are accepted the way they are by the clinicians. Empathy is another characteristic of the helping relationship. The clinician is to show an empathetic understanding of the client’s problems (Muran & Baerber, 2010). The clinician should put himself to be in the client’s position and experience the same feelings. It involves identification of the client’s needs. Empathy can be expressed both in words and facial expression to the client. The non-verbal actions for example facial expressions contribute most to the therapeutic alliance (Berzins, 2008). Finally humor should be integrated in the relationship. This establishes a strong client-clinician relationship. It transforms the clients and makes them not to view life from a very serious point.
The clinician-client relationship is of great importance and value to the outcome of therapy. I strongly agree and stand for this. This relationship is very significant in helping have positive results at the end of the therapy sessions. The client and clinician connection also leads to a positive evaluation and therapy outcome (Berzins, 2008). Every client would want to undergo a positive experience when seeking for help from the clinicians. Where there is no relationship or positive understanding, the therapy output becomes poor. In some circumstances the client can exit from the therapy sessions. Clients should be profiled and then matched with a particular clinician (Michel, Jobes & APA, 2011). This will probe a more successful therapy outcome. The differences between the client and clinician determine how they relate. They have varied ways of behavior and moral standards. They think and reason differently (Hays, 1994). Their own personalities determine the therapeutic alliance. This is associated with the bond they have, the set goals and objectives and also the tasks to be accomplished (Berzins, 2008). No tasks can be completed where there is poor relationship. The bond between them is also weakened.
A client needs to feel that his or her requirements remain to be the central focus. This relationship provides a secure base for the therapy outcome (Hays, 1994). Through this therapeutic alliance, a mutual interaction is created between the client and the clinician. Through collaboration with the client, the clinician focuses the treatment around the client’s understanding (Muran &Barber, 2010). The mutual alliance between the clinician and the client fosters a joint solution in the therapy outcome. The therapeutic alliance is the effective way of prediction of treatment outcome (Berzins, 2008). It is the most significant part in starting therapy.
The therapeutic alliance has great importance and role to the client (Hays, 1994). By establishing a strong and trustworthy relationship, a favorable therapy atmosphere is created. The client is able to avoid frustrations that might have come in case of no good relationships. The client also feels involved in the treatment (Hays, 1994). He works together with the clinician under their set terms. The clients’ concerns and feelings are put into considerations by the clinician. There is an assurance that the goals set will be achieved (Berzins, 2008). Also he is aware that he is being given the best care and attention by his clinician. The close mutual understanding and agreement makes the client to be hopeful of the treatment. He is sure that there will be a successful outcome at the end. The establishment of the clinician-client relationships enables the client to acquire best services from the clinician (Hays, 1994). This enhances therapy outcome.
The clinician also benefits from this staunch relationship. He or she works under a non-problematic environment. The client understands the methods being used during the treatment. The clinician conducts therapy sessions based on the agreed terms together with the client. Both the client and clinician have a clear mutual understanding of how they carry out their daily operations. This great relationship also boosts the clinician’s career (Meissner, 1996). He or she learns new information from the client. The more he interacts with many clients, the more he becomes professional. These entirely promote the outcome of therapy.
Even though the therapeutic alliance enhances therapy outcome, it also has certain limitations (Hays, 1994). Therapeutic alliance is a special relationship. It is characterized by exceptional trust and also vulnerability. The clients share vital and private information with the clinicians or therapists. They share about thoughts, feelings, behaviors and events that they can never pass to anyone else (Hays, 1994). The clinicians therefore are entitled to hold a special relationship between them and their clients. This makes this kind of relationship to be a rare and a unique one in the society.
A smaller number of the clinicians or therapists take advantage of this vulnerability and trust of their clients. They sexually exploit their clients (Hays, 1994). This is unethical act and is greatly prohibited by civil law in certain countries. This act has consequences both on the clinician and the client. It may ruin the clinician’s career especially if the client reports to authorities (Hays, 1994). It also leaves the client having a feeling of frustration. The client has loss of direction and may become psychologically paralyzed (Berzins, 2008). It also causes cognitive impairment on the affected individuals. Those that are sexually involved with the clinician undergo cognitive dysfunction. This interferes with their concentration, memory and attention. They will often be interrupted by the thoughts, flashbacks and memory fragments. The emotional status is interfered with. It affects the way the person feels (Hays, 1994). The misbehavior between the client and the clinician also brings the problem of isolation and emptiness. The clients feel like they are cut forever from associating with others. This sense of loneliness can be overwhelming to the individual (Hays, 1994). Again those that have been sexually involved may become flooded with sense of irrational guilt. It is an irrational because the clinician has been trained not do the prohibited act but still does it. Other effects attributed to this may be the increased risk to attempt suicide, the impaired ability to trust again, sexual confusion, having suppressed anger and experiencing role reversal and boundary confusion (Hays, 1994). The client may not feel happy when he or she finds out that the clinician has disclosed private information to others.
The therapeutic alliance as way of human service in the health sector is widely employed today. This relationship between the clinicians and the clients is highly recommended in many health institutions. It is the major determinant of the output or therapy outcome. Therapeutic alliance is the main factor in successful treatment outcomes. Clinicians should employ its use as recommended but not for their own selfish interests. A strong clinician-client relationship should be put in place before any client seeks for treatment. This ensures the effectiveness of services offered to the clients in the health institutions.
References
Berzins P., (2008). “Therapeutic Alliance as a Predictor of Psychotherapy Process and Outcome: The Role of Expert versus Novice Raters.” ProQuest.
Hays L. Victoria (1994). The Effects of the Therapeutic Alliance and Social Support on Therapy Outcome and Mental Health of Women. University of Wisconsin.
Meissner W., W. (1996). The Therapeutic Alliance. Yale University Press.
Michel, K., Jobes, D. A., & American Psychological Association (APA). (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association.
Muran, J., C. & Barber., P. J. ( 2010). The Thearapeutic Alliance: An Evidence-Based Guide to Practice. Guilford Press.
