“The relationship between patient and clinician is central to the provision of mental health care. Where psychological therapies are concerned, decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is actually the nature of the therapeutic alliance.” – Russell Razzaque , Emmanuel Okoro, Lisa Wood
Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance.
The therapeutic alliance is conceptualized as consisting of three components, tasks, goals, and bond. Tasks are what the therapist and client agree need to be accomplished to reach the client’s goals. Goals are the outcomes that the client hopes to result from the therapy. The bond between the therapist and client develops from trust and confidence in the therapist that the process will satisfy the client’s goals. It should be clear that this alliance is a cornerstone of the process of psychotherapy. If the client’s goals and expectation are not aligned with those of the therapist, if the client does not agree with or is unwilling to undertake the tasks involved, or if the client doesn’t trust the therapist, then the therapy is doomed to failure.
The personality and characteristics of the therapist are a essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves. It would seem that mindfulness would be essential. Communications involve not only talking but listening, a mindfulness skill. Being able to look at things as they are without judgement, another mindfulness skill, would appear to be essential to this relationship. The mindfulness component of being in the present moment would also seem essential to focusing on what are the client’s immediate experience and reactions. So, it would be reasonable to suspect that the mindfulness of the therapist would be related to the therapeutic alliance and to the outcome of the therapy.
In today’s Research News article “Mindfulness in Clinician Therapeutic Relationships”
Razzaque, Okoro, and Wood explore the relationship between mindfulness and the therapeutic alliance in experienced therapists. They found a strong positive relationship between mindfulness and the ability to form effective therapeutic alliances. All of the components of mindfulness were found to be related to therapeutic alliance, but openness to experience and non-judgmental acceptance were found to be the most important components.
The fact that openness to experience was the most important mindfulness characteristic predicting therapeutic alliance should be of no surprise. It allows the focus of the therapist’s attention to be open to whatever the client brings to the therapeutic session. This results in the clients feeling listened to. In addition, the clients themselves can learn to be open by modelling the openness displayed by the therapist. The fact that non-judgmental acceptance was an important mindfulness characteristic should also be of no surprise. This results in the therapist being more accepting of the clients’ difficulties without judging them. This allows the clients to also come to accept themselves and their problems and work toward solving them rather than ruminating about them.
Hence the results of the study support the notion that the mindfulness of the therapist is essential to the therapeutic alliance and the ultimate success of the therapy. It should be mentioned that this study was correlational and cause and effect cannot be determined. It will be important to perform research in the future where mindfulness training is provide to therapists and to determine if this then improves the therapeutic alliance and the outcomes of therapy.
So, be mindful to be a better therapist.
“In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?” – Carl R. Rogers
CMCS – Center for Mindfulness and Contemplative Studies