A therapeutic alliance refers to the interaction between physicians, their patients, and the working environment. It is regarded as an essential aspect of the treatment procedure and influences psychological treatment and general therapy care results. By creating a working alliance, medical practitioners aim to present consumer-oriented care. The physician is viewed as a facilitator for the recipient to realize their objectives than an administrative figure (Asnaani & Hofmann, 2017). Therefore, by creating a strong working alliance and encouraging patient involvement, physicians can also tackle psychosocial features of discomfort that are usually ignored in old unidirectional client-therapist relationships. This paper aims to expound on the therapeutic association as a vital aspect of the health process that influences all the medical fields.
Components Therapeutic Alliance
The therapeutic alliance entails vital components that participants should follow to achieve a strong working relationship. First, objective setting acts as an essential role in directing rehabilitation to realize a precise result. Therefore, establishing SMART (Specific, Measurable, Attainable, Relevant, and Time conscious) goals helps ensure the objectives are effective (Asnaani & Hofmann, 2017). It develops patient satisfaction and motivation, significantly influencing the working environment alliance (Asnaani & Hofmann, 2017). Consequently, an inclusive goal creation will help realize a successful treatment relationship beneficial to both the consumer and the general medical profession.
Second, shared decisions also help strengthen the therapeutic relationship since it involves providing the consumer with information and encouraging them through the decision-making process. Therapists and health stakeholders can begin a successful resolution with a patient-centered strategy by inquiring about the client’s concerns regarding the treatment and the results they expect from the procedure (Gehart, 2018). Hence, they should be directly on the working alliance’s significance and focus on the consumers’ getting their wants satisfied. Third, physicians should certify that patients appreciate their engagement and presence in the decision-making process (Gehart, 2018). Therefore, the medical practitioners should establish a framework to allow communication outside the arrangements if they have fears.
Additionally, developing a therapeutic relationship by creating a bond between therapists and patients is vital for the process’s success. The healthcare stakeholders can realize the connection by discussing consumer satisfaction with the therapeutic relationship, treatment, and regular communication practices using dialogues about various concerns (Gehart, 2018). Furthermore, directly addressing the probability of clients’ skeptical feelings on diagnosis, treatments, and medication will further establish a successful therapeutic alliance.
The consumer and health system relationship is also a single power despite the therapists having more control over the client. However, the power imbalance rises from the medical stakeholders having more power and influence in the health system, access to privileged information, specialized data, and the ability to advocate for the consumer (Patterson et al., 2018). Fourth, respect identifies every person’s overall value, uniqueness, and dignity despite the patient’s attributes, socio-economic status, and nature of their health problem (Patterson et al., 2018). Therefore, to achieve a successful working alliance, both parties should be respectful and ensure their interactions are not biased. Finally, trust is vital in the patient and health industry collaboration since the consumer is in a vulnerable position. At the beginning of the exchange, trust is delicate, so it is essential to keep the clients’ premises (Patterson et al., 2018). Therefore, it is important to focus on building trust with the patient by conducting ethical practices during treatment.
Challenges in Establishing a Strong Therapeutic Alliance
Relationship raptures vary in intensity from comparatively negligible, where both client and nurse may be indefinably aware of a substantial rift in alliance, communication, and understanding, to more serious ones. First, the common involuntary admission where many patients receiving treatment in an acute psychiatric setting are admitted against their will has also influenced the rift (Richards, 2017). Consequently, there has been an establishment of a negative relationship between involuntary admission and the quality of care found in such facilities. However, if psychiatric emergencies are handled effectively, there is a stable therapeutic relationship, thus enabling less coercive approaches such as talking down.
Second, autonomy is a vital aspect of the consumer’s dignity and the willingness to indulge in the working alliance. Regardless of the nature of a patient’s admission, researchers assume that therapeutic facilities have a feature restricting a patient’s independence.
However, practices such as restricted access for visitors, limited permissions to leave the ward, and closed doors have prevented meaningful choices, thus reducing sovereignty among patients (Richards, 2017). Therefore, there is a significant hindrance to establishing a successful therapeutic alliance, which stakeholders should address deliberately and prudently.
Third, the involuntary admission and coercion of medication on consumers have resulted in negative results in achieving a Therapeutic relationship. For instance, the forcing of treatment and other health services such as chemical or physical restraints and seclusion without consent on patients have been termed coercion forms (Richards, 2017). However, a positive therapeutic alliance has been illustrated as an indicator of medication adherence in schizophrenic clients. Therefore, healthcare stakeholders are advised to employ coercion when presenting the right medical treatment to patients despite its interpersonal impacts.
Fourth, acute in-patient care is usually short, and nurses should make decisions early after the first interaction between the consumer and the physicians. For instance, if a severely psychotic client is permitted unwillingly, accompanied by state administrators, the first interaction between the medical environment, practitioner, and the client may occur in their presence and in the context of coercive measures (Richards, 2017). Consequently, there will be difficulty building and maintaining a good working alliance since the temporal limitations will reduce the trust level between the patient and the nurse.
Finally, the handling of severe psychiatric clients is performed by interdisciplinary specialists. Professionals outside the standard therapists face challenges in developing and managing a therapeutic alliance in nursing. Consequently, there has been a spill-over effect where both the specialist and consumer engage in conflict in the multi-professional team (Richards, 2017). Therefore, creating effective strategies to overcome these hindering conditions and focus on satisfying individual clients’ needs will help facilitate a successful therapeutic alliance.
Methods of Repairing Ruptures in Therapeutic Alliance
Despite all the challenges impacting the therapeutic alliance’s success, various interventions have been suggested to repair the working interaction’s rupture. First, the treatment procedure occurs at the beginning of therapy. Although the approach is normally outlined for the patient, the medical procedure’s objectives are sometimes overlooked by the stakeholders and practitioners (Gaztambide, 2019). Furthermore, once the therapeutic rationale has been examined, it is necessary to adjust the objectives and approaches (Gaztambide, 2019). If there were disagreements regarding treatment, the healthcare system shareholders, such as the state government, should change the practices and make the intervention more significant to patients.
Second, correcting a breach should be simple to identify the changes in a patient’s demeanor during the treatment process by tackling confusion and maladaptive procedures that the client may experience. Exploring underlying interpersonal themes to the empathetic failures, such as difficulty working with nurses of specific genders, administrative figures, and the general medical team, will reduce the effects of the breach (Gaztambide, 2019). The issues can further present insight into the patient’s setbacks that the health industry can implement to achieve a successful therapy.
Third, it can be advantageous to focus on the raptures by developing a connection between what is experienced during a treatment process and how it is viewed in the patient’s life. Once the forms are recognized, they can be further exercised in safe treatment surroundings, thus addressing the breach. Fourth, the approach implemented in therapy may be ineffective and unknown to the consumer. Stakeholders sometimes develop new strategies without knowing the underlying factors and employ them to present the client with new interpersonal experiences (Gaztambide, 2019). Fifth, a nurse should focus on managing their emotions to avoid getting anxious whenever a patient opens up about their illness. The practitioner can achieve this by planning, meditation, and conducting validation exercises ahead of their session with the client.
Sixth, the provider should ask more diverse questions to get their clients to open up about their feelings. The physician should focus on asking questions similar to those of an interviewer, not an interrogator. The move will get the client to feel comfortable and speak freely without feeling judged, thus creating trust with the medical officer. Finally, in non-responsiveness to therapy, the healthcare system, through its practitioners, should adopt new practices such as building trust between them and the patient to enable them to utilize the treatment strategy being used and breach the gap created through mistrust (Gaztambide, 2019). Therefore, the raptures in a therapeutic alliance can be corrected through extensive assessment and understanding of the client’s needs and practicing ethics during treatment and within the medical environment.
In my opinion, the current healthcare system has not achieved its objective in treatment processes such as personal and psychiatric therapy since most patients are still struggling to achieve autonomy. While conducting my research in a psychiatric hospital, I witnessed medical officers restricting patients’ environment and interaction with visitors. Furthermore, there were clients with worse psychological conditions who were not allowed to be visited. Such action restrictions significantly affected the patients as I would see some of them being aggressive as they saw their relations leave the institution. According to my observation, independence is vital to achieving a successful working relationship. Therefore, medical experts should do further research to manage the growing relationship rupture between patients and medical practitioners.
In conclusion, the purpose of this study was to achieve a preliminary understanding of how medical practitioners view the importance of the therapeutic alliance and the impact of ruptures and treatment outcomes. Therefore, the working partnership is a vital component of therapy and plays a significant role in patient recovery. The therapeutic alliance is a critical health care issue that stakeholders should further examine through various studies to determine its benefits and disadvantages fully.
Asnaani, A., & Hofmann, S. G. (2017). Collaboration in multicultural therapy: Establishing a strong therapeutic alliance across cultural lines. Journal of Clinical Psychology, 68(2), 187–197.
Gaztambide, D. J. (2019). Addressing cultural impasses with rupture resolution strategies: A proposal and recommendations. Professional Psychology: Research and Practice, 43(3), 183.
Gehart, D. R. (2018). Mastering competencies in family therapy: A practical approach to theory and clinical case documentation. Cengage Learning.
Patterson, J., Williams, L., Edwards, T. M., Chamow, L., & Grauf-Grounds, C. (2018). Essential skills in family therapy: From the first interview to termination. Guilford Publications.
Richards, C. (2017). Alliance ruptures: Etiology and resolution. Counselling Psychology Review, 26(3), 56-62.