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The Therapeutic Alliance | Why It Is So Important For Mental Health Treatment

The Therapeutic Alliance | Why It Is So Important For Mental Health Treatment

The majority of people who face challenges with mental health never seek help. Those that do finally garner the courage to find support only go to 1-2 therapy sessions and then quit. Why is that? There are various reasons why people never seek treatment for their mental health concerns or stop going to treatment. Thankfully, virtual therapy is a promising option that overcomes many challenges that keep people from getting the help they need. 

One of the most important components of mental health treatment is the therapeutic alliance, a relationship that is often ignored by treatment providers. Understanding the challenges that many face when it comes to seeking mental health treatment and ensuring that people have a strong bond with their providers can improve outcomes and help a person get where they are going. 

Why Are So Many Treatment Providers Missing The Mark?

Reasons why people never seek treatment for their mental health concerns can vary, including:

  • Lack of time
  • Accessibility to transportation
  • Provider availability 
  • Worries about what others will think
  • The stigma surrounding therapy for mental health

Virtual therapy provides solutions for many common problems that individuals face when considering getting help. It is not only efficient but convenient as well. Through virtual therapy, people have much more access to providers, which overcomes challenges found within many areas of the country designated as Mental Health Professional Shortage Areas

Additionally, with virtual therapy, individuals can seek help from anywhere, like the comfort of their own bedroom, without having to worry about being seen at a particular physical location. However, the reasons why people give up after only 1-2 therapy sessions can be much more complicated and, for many, are often related to a lack of connection with their therapist. The relationship between a therapist and their client, known as the therapeutic alliance, is a critical component of the delivery of mental health treatment. And yet, this relationship is often ignored by treatment providers. 

What Is The Therapeutic Alliance?

The concept of the therapeutic, or working alliance, has roots in Freud’s (1912) description of transference and countertransference as key parts of the change process in psychoanalysis. Additionally, Rogers’ (1965) humanistic psychotherapy emphasizes the patient’s experience of therapist empathy. However, the therapeutic alliance is a phenomenon that goes beyond specific treatment modalities. Most current conceptualizations of the therapeutic alliance are based on the work of Bordin (1979) and include:

  • An agreement on goals
  • An assignment of tasks
  • The development of bonds between the client and therapist

Interestingly, recent research has indicated that the therapeutic alliance is more predictive of treatment outcomes than clinical competency, reflective ability, years of experience, or specific treatment modality. The therapeutic alliance has 7 times the impact on treatment outcomes over the treatment modality utilized with a client (Delgadillo et al., 2020). Upon reflection, this is not too surprising. After all, there is plenty of evidence demonstrating that the perception of social support improves effort, endurance, and well-being while reducing the experience of pain. Thus, a client who bonds with a care provider will immediately feel better and will work harder and longer on their issues with the guidance of their care provider. 

Given that most clients drop out of therapy before their third session, the early establishment of the therapeutic alliance is critical to successful treatment. Indeed, the therapeutic alliance is most predictive of treatment outcomes when measured early in the treatment process (Horvath & Symonds, 1991).

Positive Outcomes With Clients

Not all therapists are equal when establishing a therapeutic alliance and producing positive outcomes with clients. In a seminal study of therapist effects, Orlinsky & Howard (1980) found that the clients of 5 out of 23 therapists studied demonstrated poor outcomes, with over 10% of these clients being worse at the termination of therapy. In contrast, 6 of the 23 therapists had clients with outstanding outcomes. Further research has shown that the psychotherapeutic process is often influenced by the personal characteristics of the therapist and the positive feelings that arise in the client (Strupp, 2001). This goes to show that the personal attributes of the care provider matter. 

So much so that the client dropout rates for the least effective therapists are 4 times higher than the most effective therapists (Saxon et al., 2017), and the client recovery rates are less than half those attained by the most effective therapists (Okiishi et al.. 2003). In fact, the most effective therapists may be up to ten times more efficient than even average therapists. It is safe to say that the therapeutic alliance is an extremely significant, if not critical, component of positive treatment outcomes. 

Therapeutic Alliance: How Is Mindfuli Different?

When we conceptualized Mindfuli in the Summer of 2021, we realized there were a lot of virtual therapy companies providing great technology, but very few focused on delivering great care. Therefore, we set out to develop a virtual therapy platform that uses technology to leverage the best clinical science. The therapeutic alliance is at the heart and soul of the care provided through Mindfuli. Our care providers must pass an extensive assessment to ensure they possess key personal characteristics necessary to form empathic, supportive, and collaborative relationships with our clients. 

This proprietary screening algorithm helps us identify the most effective therapists before they even begin to provide treatment to our clients. In addition, we repeatedly measure the therapeutic alliance between our clients and care providers to ensure a strong working relationship; after all, supportive relationships result in more enduring gains compared to poor-quality matches (Rhodes & DuBois, 2008). Because of all of the work that Mindfuli does upfront to ensure high-quality client and care provider pairings, our average therapeutic alliance score, as self-reported by our clients, is an astounding 4.8/5!

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