What is a Theraputic Alliance and Why Does It Matter?

A therapeutic alliance is the positive social connection fostered between client and facilitator, leading to improved outcomes and participation. It’s a professional relationship based on collaboration, empathy and respect. Ideally, you are in a therapeutic alliance with every person involved in supporting your health and wellness, including your physiotherapist, massage therapist, and coach. In a therapeutic alliance, this person recognises that you have the answers and supports you in reaching your potential.  

How do you know your therapeutic relationship is an ‘alliance’?

It’s collaborative- This means both parties have a say in what happens, how it happens and have a stake in the outcome. The expectation is that both you and your facilitator are active autonomous participants despite having different roles and responsibilities.

Both parties practice empathy- Empathy is the ability to understand another’s perspective and convey that understanding back to the person. In practice, it may be acknowledging that your facilitator may make mistakes despite having your best interests at heart.

There is mutual respect- Despite different perspectives, you and your facilitator listen to each other with open and curious minds, willing to learn from each other.

Therapeutic relationship Red Flags:‍

These are signs that your therapeutic relationship isn’t an alliance based on collaboration, empathy and respect.

• They interrupt you.
• They dismiss your ideas.
• They invalidate your lived experience.
• They don’t try to understand things from your perspective.
• They blame you for not improving.
• They try to use fear or shame to motivate you.
• They make sessions about themselves.
• They lecture or moralise to you.
• They talk down to you.
• They don’t value your time.
• They won’t change ‘their’ plan regardless of constructive feedback from you.
• They tell you there’s something wrong with you that needs to be fixed; They have the solution to your problems; only they can help you; you need them.

We are all human. We all have bad days and make mistakes. If your facilitator recognises their error, apologises and asks for further clarification, this could be a sign of a good therapeutic relationship worth preserving. You don’t always have to agree with them, or they with you, for the relationship to be helpful and healthy, but you should always feel respected and empowered.

It’s time to move on from any relationship if you feel:

• Unsafe 
• Dismissed
• Disrespected
• Misunderstood
• Powerless
• Unimportant

What to do if you disagree?‍

The great thing about a respectful collaboration is that you can agree to disagree and still achieve a better outcome than working on your own. However, if you do disagree, it is crucial to communicate clearly to preserve the therapeutic alliance.‍

Be clear about your concerns: If you don’t agree or don’t think something will work, let your facilitator know. This allows them to modify, address your concerns and learn more about you. ‍

Recognise their desire to help: Often, those who work in health and wellness are empathetic people who really want to help. Sometimes they may not recognise their enthusiasm to ‘fix’ you is disempowering and unhelpful. They are also human and will make mistakes even if they are trying their best for you.‍

Offer to explain from your perspective: Speaking about your experience is a great way to bridge the gap between enthusiastic good intentions to practical, helpful support. It can be beneficial to explain what has worked for you in the past and what you find useful at the moment. It doesn’t matter how experienced and knowledgeable your facilitator is; they will never know as much about you and your concerns as you do. Give them a chance to learn from you.

You and your facilitator have chosen to enter into a therapeutic relationship, so you both have the right to end the relationship if the alliance breaks down. Whilst there is an onus on the facilitator to remain professional, it is always helpful to communicate respectfully.

Learn more:

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Finding the right physio as a Pole Dancer

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