Ways to maintain therapeutic alliance in a therapy session

Ways to maintain therapeutic alliance in a therapy session

Ways to maintain therapeutic alliance in a therapy session

The relationship between a therapist and their patients is described by the therapeutic alliance and is thought to be a crucial component of the healing process. It can affect how well a patient responds to treatment. By building a therapeutic alliance, the therapist aims to deliver patient-centred care, in which the therapist serves as a facilitator rather than an authorised person to help the patient reach their goals.

3 Components of a therapeutic alliance

According to Bordin, the following are three important components which contribute to a strong therapeutic alliance:

Collaborative Goal Setting : Setting goals is essential for directing therapy in order to achieve a particular result. A good technique to make sure goals are accomplished is to set SMART (Specific, Measurable, Attainable, Relevant, and Time Limited) objectives.

Goals that are agreed upon by the client and the therapist are more likely to be followed through on. Improvements in results, client satisfaction, and motivation follow from adherence. The therapeutic connection is favourably impacted by all of these elements.

Goals that are merely set for patients without involving them in the process lead to a discontent situation that will harm the therapeutic alliance.

Shared Decision Making : The therapeutic connection is strengthened when decisions are made together. It is a procedure where information is given to the client and they are assisted in making decisions.

Elwyn and colleagues provide a process for shared decision-making that involves a three-step procedure:

  1. Choice Talk
    • Take a step back
    • Offer the choices
    • Give justification for the choices and consider preferences
    • Monitor reaction
    • Defer Closure
  2. Option Talk
    • Estimate Knowledge
    • Give the various options
    • Description of the options and exploring preferences
    • Benefits and Drawbacks
    • Support patient decision-making
    • Summarise
  3. Decision Talk
    • Maintain focus on preferences
    • Elicit the preferences
    • Get closer to a decision
    • Provide review

Effective bond between client and the therapist

The professional tie between the therapist and patient is referred to as the therapeutic relationship. It is essential to a powerful therapeutic connection.

The following elements help to establish a solid therapeutic relationship:

  1. Competency in communication
        • Active listening
        • Empathy
        • Encouragement
        • Being Friendly
        • Confidence
        • Communicating using body languae
  1. Environmental and organisational factors
        • Allowing patients sufficient time for thorough evaluation and treatment
        • Flexibility in scheduling and providing for patients
  1. Practical Skills
        • Patient education that is simple and clear
        • Therapist expertise and training


Patient Centred Care

According to Mead and Bower, there are five components of patient-centred care which have been correlated positively with a strong therapeutic alliance. These are as follows:

  1. Utilising a biopsychosocial perspective: This approach teaches patients how to change their lifestyles for a higher quality of life while giving clinicians a greater grasp of the disease’s contributing factors.
  2. The ‘patient-as-person’: One must be aware that various patients may interpret the same pain experience in different ways. As a therapist, one of the main priorities should be eliciting the specific patient’s worries, expectations, and sensations of disease.
  3. Sharing power and responsibility: The fundamental connection between a patient and a practitioner has always been one of “paternalism,” which some believe is unavoidable given the disparity in competence between the two parties. However, patients can better take charge of their disease by becoming active “participants” rather than passive “clients,” which has been linked to better health outcomes.
  4. The therapeutic alliance: The therapeutic alliance can be strengthened by patient-centred treatment, but it is also possible for there to be a reciprocal relationship. As previously indicated, Bordin identified agreement on goals, agreement on interventions, and a strong link between patient and therapist as the three fundamental components of the therapeutic alliance.
  5. The ‘doctor-as-person’: It stands to reason to emphasise the therapist’s traits since both the therapeutic alliance and patient-centered care recognise the interaction between therapist and patient. The perspective of the therapist is something that cannot be separated from the ongoing relationship between therapist and patient.


It is very important to maintain therapeutic alliance to have a fruitful relationship and gain something out of therapy. It requires mutual understanding between both the parties. In the meantime, it is important to strengthen this alliance with sustained efforts.

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