Methods in my practice
Collaboration and alliance
If you do not feel safe, heard and understood, it is hard to trust the person who is supposed to help you. And without trust it is hard to be open and vulnerable, which is necessary to work on yourself and develop. That is why it is very important to me that you feel comfortable when you are with me. That is not just a nicety. Research shows it is crucial to whether therapy works.
What the research shows
Collaboration and the therapeutic alliance have been studied intensively in psychotherapy research, and there is broad agreement that they play a central role in whether therapy succeeds. In 1989 Horvath and Greenberg introduced the Working Alliance Inventory, an instrument for assessing the quality of the alliance between client and therapist, and their work became the basis for many later studies of the link between alliance and outcome.
In 2000 Martin, Garske and Davis analysed 79 studies with more than 6,000 clients. The result was that the therapeutic alliance is an important predictor of a good outcome, whatever form of therapy is used. A strong alliance is not just "nice to have". It is a crucial part of getting better. That fits completely with my own experience from almost 19 years as a practising psychologist.
Research on the therapeutic alliance
Horvath, A. O., & Greenberg, L. S. (1989). “Development and validation of the Working Alliance Inventory.” Journal of Counseling Psychology, 36(2), 223–233.
Martin, D. J., Garske, J. P., & Davis, M. K. (2000). “Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review.” Journal of Consulting and Clinical Psychology, 68(3), 438–450.
Why it matters so much in cognitive therapy
Collaboration and alliance are central in many forms of psychotherapy, but they are especially crucial in cognitive behavioural therapy, because it is an active and collaborative form of therapy. You are the one who does the work, and I walk alongside you.
Your commitment
You have to find and challenge your unhelpful patterns of thinking and behaving yourself, do homework and use what you learn outside the sessions. A strong alliance makes it easier to stay motivated.
Open dialogue
When you feel safe, you can talk openly about what is sensitive and difficult. That is necessary to spot the distorted thoughts and work with them.
Your feedback
Tell me what works and what does not. Then I can adjust so it fits you better.
When there is resistance
Everyone experiences resistance to therapy at some point. A strong alliance makes it possible to notice it and work with it, so we can move forward.
Independence
The goal is not only that the symptoms ease, but that you gain the skills to handle future challenges yourself. A good alliance strengthens your belief in your own abilities.
You keep going
A strong alliance reduces the risk that you stop before you reach your goal.
We agree on the direction, and we talk about what is not working
At the start we talk about what you want help with and what you hope to change. I explain how I suggest we work, and you should have the chance to ask questions and help choose the next steps. I contribute professional knowledge. You know your life and your experiences. We need both.
It is common to have doubts along the way or to feel that the work is going slowly. We need to be able to talk about that. Say so if you do not feel understood, or if an exercise is too hard, and we will look at whether the goals, the pace or the way we work should change. Ultimately, collaboration and alliance are not just good practice. They are crucial to the success of therapy, and they require a deep, mutually respectful relationship between you and me.