Perhaps contrary to what many people might think, there's one thing that contributes more to someone making significant and meaningful change in therapy, and it isn't the type of therapy or the credentials of the therapist. It's something called the therapeutic alliance.
Research says this can contribute to up to 30% of someone's success in therapy.
So today, I'm going to go over what this is so you can have a better understanding of this thing that has such a huge impact on reaching your goals in therapy.
The Three Components of the Alliance
The therapeutic alliance is composed of three components:
1. The bond between you and your therapist
This is very important because a big part of therapy is just how it feels to be in the room together. Therapy is hard work and it isn't always comfortable, so you really need to have that foundation of trust there. Good therapy also has a lot of adjustments that are based on feedback, so you have to feel comfortable enough to be honest with your therapist to make these meaningful adjustments.
2. Goal alliance
This is the collaborative understanding between you and your therapist on the goals of therapy. This might seem simple but someone coming into therapy might say they want to reduce their anxiety but that can look 100 different ways. A good therapist will help you really define your goals and what they look like and check in to make sure you’re working on things YOU actually want to work on.
3. Agreement to the methods and tasks of therapy
You and your therapist also need to be on the same page about the tasks of therapy. Basically, the things we think need to happen to get you to your goals, this includes both what YOU and your therapist need to happen. A good therapist will make sure you know, "why the heck are we practicing breathing when I came in to quit smoking?!" and not only make sure you know, but also make sure you agree that the things we're doing in therapy could be of benefit to you. Basically, you understand and agree to the journey you're on to your goals.
Excellent therapy strikes a Goldilocks balance of providing warmth, caring, and understanding with the perfect mix of deliberate and hard work towards your goals. The Goldilocks balance is how these three things come together in therapy!
Why is This Information Important?
Well, a lot of people might leave therapy early if they feel misunderstood by their therapist, or if the sessions lack the clear roadmap and practical approach they expected.
If you find yourself uncertain about therapy or you don't feel engaged in the first few appointments, it is likely because one or multiple of these compounds aren't strong enough.
What Can You Do About It?
If you're new to therapy, starting with a new therapist, or even if you've been working with your therapist for a long time, think to yourself:
- Do I think my therapist knows and fully understands why I am here in therapy?
- Does my therapist know how I want them to help me with my goals?
- Do I know why we are doing what we are doing in therapy? And do I see how the things we are doing can be beneficial to my goals?
- Do I genuinely understand and believe in the path we're taking in therapy?
- Do I feel genuinely liked and respected by my therapist?
If one of these answers feels iffy or off, I would bring this up to your therapist. A good therapist will be able to course-correct.
What if it's just the "click"?
If you're in the super early stages of therapy and the hesitance is mostly the vibe or click …Do I feel like me and my therapist just have too different energies, personalities, or communication styles? It's likely just a mismatch, and you could ask your therapist for a referral to another therapist they think would be a better match.
If you are seeing a therapist at a clinic like Cultivate Mental Health, you can always reach out to the admin team to say, "I don't think it's a match." There is absolutely nothing wrong with this!
Often, you can also give consent to your therapist to have them give the therapist you are being transferred to a debrief on things too, so you don't have to rephrase EVERYTHING over again.
If you think it's not the click, then you can bring this up to your therapist. Highly effective therapists will regularly seek feedback from you and would genuinely love to make adjustments to strengthen the things we talked about in this article.
Contrary to what you might think, therapists actually aren't that good at just guessing how therapy is landing with a client! This is why a trusting relationship with your therapist is so needed. Do I feel comfortable giving my therapist feedback? Are they asking me for feedback? The feedback leads to continuous small adjustments that feed forward into better care for you, and it is overall an important part of the therapy process.
Therapeutic Alliance Measurements
The reality is, even though a good therapist is always happy to receive feedback, it can be super scary as a client to GIVE feedback.
Some of the therapists here at Cultivate Mental Health use tools to actively invite conversations to make treatment feedback-informed, and therefore more tailored and adapted to you!
We use super short pre- and post-session surveys (called the Outcome Rating Scale and the Session Rating Scale) to figure out in real-time what's going right and what's going wrong. It's important to be honest on these surveys so we can continue to feed the feedback forward into making needed adjustments to your treatment plan.
This is extremely valuable information to our work and we appreciate the honesty. Feel free to ask your therapist about these measures or email hello@cultivatemh.ca if you’d like to be set up with a therapist who uses these in their work.
References
- Wampold, B. E., & Imel, Z. E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge. (Supports the claim that the therapeutic relationship and alliance contribute to approximately 30% of the variance in therapy outcomes).
- Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. (The foundational framework establishing the three components of alliance: bonds, goals, and tasks).
- Lambert, M. J. (2013). Introduction and Historical Overview. In M. J. Lambert (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (6th ed.). John Wiley & Sons. (Contextualizes the common factors in therapy, emphasizing relationship factors over specific technical modalities).
- Miller, S. D., Duncan, B. L., Brown, J., Sorrell, R., & Chalk, M. B. (2006). Using formal client feedback to improve retention and outcome. Journal of Brief Therapy, 5(1), 5-22. (Examines the clinical utility and value of using the Outcome Rating Scale and Session Rating Scale for feedback-informed treatment).
