The therapeutic alliance: what to expect from psychotherapy
When choosing a psychologist, I believe it is important to pay attention to the connection we feel with the professional and how comfortable we are discussing personal matters. Feeling at ease, listened to and able to trust the person we are working with is an important part of beginning psychotherapy.
What is the therapeutic alliance?
The therapeutic relationship, also known as the therapeutic or working alliance, was conceptualised by Bordin in 1979 as a collaborative relationship between therapist and client, based on three components: agreement on therapeutic goals, agreement on the tasks involved in treatment, and the emotional quality of the relationship.
During psychotherapy, personal difficulties are explored across different dimensions: cognitive (what I think), behavioural (what I do), emotional (what I feel) and physical (what I notice in my body).
Psychotherapy can be understood as a process that starts with the psychological or physical manifestations of human distress and aims to promote changes in behaviour, adaptation to one's environment, physical and psychological health, the integrity of one's psychological identity, and biopsychosocial well-being.
This work can be adapted to different ages and formats, including individual, group, couples and family psychotherapy.
Why the therapeutic alliance matters
Researchers have examined common factors involved in psychotherapy and their relationship with treatment outcomes.
Orlinsky, Grawe and Parks (1994) highlighted the relevance of the therapeutic alliance to psychotherapy outcomes. A positive relationship between client and therapist can support collaborative work and help reduce the distress that often leads someone to seek psychotherapy.
As a young psychologist, I have often found that a professional's age can be a concern for some clients. Nevertheless, I believe it is particularly important to consider the relationship established with the psychologist, the trust they inspire, and whether it feels possible to build a collaborative therapeutic space.
How is the psychotherapy process structured?
From my perspective, the psychotherapy process involves three key stages.
1. Finding a therapist and attending the first session
Before beginning psychotherapy, several external factors may influence the decision, such as the location of the practice, the weather, social commitments, or balancing work and family responsibilities.
Internal factors also play a role, including personal motivation, the reasons for seeking help, and the influence of family and social relationships.
One of the most decisive internal factors is overcoming certain personal obstacles beforehand. This preparation often influences whether someone begins psychotherapy or decides to postpone it. Difficulties in recognising the need for help and seeking a psychologist may be related to gender, cultural factors or previous experiences.
During the first session, clients are free to explain what has brought them to therapy. This can be a relieving experience: while the psychologist provides support and a space to explore their concerns, clients may begin to release accumulated tension and ease some of the difficult emotions associated with their situation.
The psychologist gathers information about the client's concerns and relevant circumstances, including symptoms, coping strategies, family relationships, employment, adjustment to life circumstances, motivation, attitudes and sociocultural factors.
The psychologist then shares their initial understanding with the client. This also provides an opportunity for the client to consider the psychologist's approach, training and the connection they feel with them. Finally, any questions that arise can be addressed.
2. Planning and developing the treatment
From this point, treatment is planned and appropriate techniques are applied according to the goals and therapeutic approach agreed upon.
As the process progresses, evaluations are carried out to monitor progress and consider the changes taking place.
3. Evaluating the therapeutic process
Treatment evaluation is carried out collaboratively with the client.
It takes into account both the concerns raised during the first session and the aspects that have emerged throughout the process.
Based on this evaluation, therapist and client may agree to conclude treatment or establish new therapeutic goals, where appropriate.
Why the first sessions are important
In conclusion, several factors can be decisive when beginning psychotherapy. I want to place particular emphasis on the period before choosing a psychologist and on the first sessions, when the therapeutic relationship begins to develop.
I understand psychotherapy as a process of exploration and transformation that can benefit people at different stages of life, provided that the appropriate conditions are in place and there is a clear agreement on goals and tasks.
If you are considering starting a personal therapeutic process, you now know some of the essential aspects involved in taking that first step. At Pelegrina Psicologia, I am available to answer any questions you may have about the process and the first sessions.
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