The Therapeutic Alliance in Psychiatry and Beyond

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

“In my early professional years, I was asking this question, How can I treat, or cure, or change this person? Now I would phrase the question this way: How can I provide a relationship which this person may use for his own personal growth?” - Carl R. Rogers¹

This quote from the very well-known therapist Carl Rogers gets at the essence of the therapeutic alliance.¹ Rogers was the founder of humanistic psychology and an advocate of what came to be called the person-centered psychotherapy that could also be applied to other relationships. In general, the therapeutic alliance has 3 main components: caring, collaboration, and common goals.

As a social psychiatrist, I am always on the lookout for connections between social relationships in everyday life, in psychiatry, and in the larger societies. My ongoing assumption is that what makes us each human repeats itself in a kind of parallel process from the individual on up to populations. We humans thrive when the levels of the relationships positively reinforce each other and suffer when they fall apart.

We start with the start of each of us in the child/parent relationship. Don’t the components of the therapeutic alliance fit what we want to eventually come out of this relationship? How well this relationship goes, especially regarding a trusting attachment, greatly influences the future of the child. That secure trust can help to carry relationships through inevitable trouble and conflict.

In psychiatry, ample research over the years confirms the robust contribution of a positive alliance to a positive clinical outcome.²

An early attempt to describe the therapeutic alliance along the lines of persuasion and healing conveyed that such an alliance can occur outside of psychiatry too, in fields and organizations like politics, religion, education, and sports.³ However, it is obvious that such positive alliances are decreasing in our increasingly divisive world. While Facebook and other social media offer the potential for dignified positive alliances, they also offer an easy and anonymous opportunity for disrespect.

Although I would not agree with the recommendation that all individuals need to have psychotherapy, I would say that incorporating the essence of a therapeutic alliance would be useful and possible for most any social relationship. At their best, they are the antithesis of a cultish relationship. Cults are set up to benefit the leader, whereas the therapeutic alliance is set up to benefit both parties.

We in psychiatry have the expertise and experience in therapeutic alliances, and as such can also be a model and source for its application outside of psychiatry.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Stubbe DE. The therapeutic alliance: the fundamental element of psychotherapy. Focus (Am Psychiatr Publ). 2018;16(4):402-403.

2. Bordin ES. The generalizability of the psychotherapist concept of the working alliance. Psychotherapy: Theory, Research, & Practice. 1979;16(3):252-260.

3. Frank J, Frank J. Persuasion and Healing: A Comparative Study of Psychotherapy. John Hopkins University Press; 1993.