Not every therapist is good for your recovery. A good therapeutic fit and strong rapport is key to progress. Learn what to look for and key considerations when vetting prospective therapists:
“Therapeutic alliance” is just a fancy way of saying “how well you and your therapist get along with, and relate to, each other.” Or, as one doctor put it, “the trust between you and your therapist that allows you to work together effectively.”
Not only a trust element, but an element of mutual understanding and respect, is involved. If your typical therapy session is conducted in an atmosphere of mutual dislike, or if you can’t communicate effectively, the results of your “treatment” will be more negative than positive. At best, you won’t get really helpful advice. At worst, you may find the sessions so stressful that all you want is to reach once again for the old chemical method of relief.
THE VALUE OF AN EFFECTIVE THERAPEUTIC ALLIANCE
If, on the other hand, you feel that your therapist understands and empathizes with you, and, moreover, is someone you know and personally like, that bodes well for your treatment outcome because:
- You feel that at least one person understands you—and that knowledge reduces self-pity and the temptation to comfort yourself in unhealthy ways.
- You aren’t afraid to say exactly how you feel, be honest about your struggles or open up about what’s really bothering you—so you give your therapist more and better material to work with.
- You trust your therapist to always have your best interests at heart and be there for you, so it’s less tempting to quit therapy when progress feels elusive.
The strength of your therapeutic alliance may well make the difference between successful recovery and repeated relapse. So if you’re just starting addiction recovery or otherwise looking for a new therapist, make extra effort to ensure that therapist is a good fit for you.
That may not always be possible. Your insurance company (or the courts) may simply assign you to a particular therapist or give you a limited list to choose from. In which case, all you can do is make up your mind to expect the best, and ask your support group or an insurance/court representative for advice if you experience problems.
When the final decision is yours, however, here are some ideas on how to find a good fit in a therapist. While searching, keep in mind these components of a strong therapeutic alliance:
- Agreement on the goals for your treatment and the steps required to achieve those goals
- Openness and genuineness
- Clear communication
- Healthy emotional bonds (caring, trust, mutual “liking”—but not dependence, guilt or fear of “disappointing them”)
THE INITIAL INTERVIEW
When choosing among multiple therapists, make a “preliminary interview” appointment with each before committing to anyone. During each interview, pay attention to these points:
- Do you feel the therapist is listening to you with empathy? Does he or she look you in the eye? Nod or otherwise react favorably to your words? Offer “what I hear you saying” comments to increase clarification? Ask questions to further pin down your problems and concerns?
- Does the therapist encourage you to talk—and do they refrain from interrupting you, except to clarify a point?
- Do they show willingness to work with you in developing a treatment plan and schedule that fits your financial, job and living situations?
- Do they show in expression, gesture or words that they understand you are hurting emotionally? Do they express sincere belief in your ability to recover and build a bright future?
- Do they mention having worked with problems similar to yours, and personality types that match yours?
- Do you leave the interview with a sense of hope?
Therapists to cross off your “for consideration” list:
- The one who seems overly confident of “fixing” the situation quickly. This indicates someone who will hand down instructions rather than encourage you to think for yourself, and who will blame you if things go poorly.
- The one who talks down to you or otherwise appears condescending. Therapists with this attitude are annoyingly confident in their own expertise, and see their clients as low-intelligence types to be “straightened out” for the benefit of the therapist’s professional ego.
- The one who’s committed to a treatment approach you don’t feel suits your personality, and who tries to convince you it will work for anybody, without addressing the reasons behind your doubts.
- The one who has a communication style that pushes your buttons, or who reminds you (for whatever reason) of someone with whom you had a bad experience. Even if this is an excellent therapist in all other respects, you won’t get all you could from counseling if you’re plagued by semi-conscious resentment. (One exception here: if you can be immediately open with the therapist about the source of your discomfort, and get an understanding and empathetic response, you may have a chance of building a good alliance and healing a prejudice. But take the risk only if all your instincts tell you this is the right move—never just to prove you can “handle it.”)
- The one who just gives you bad vibes. Whether or not you can articulate a definite reason, better to look elsewhere than find out the hard way that your “bad feelings” were right. (Of course, if every therapist you talk to gives you “bad vibes,” it’s time to consider that your real problem may be a habit of nit-picking, or a fear of therapy in general.)
YOUR SHARE OF THE RESPONSIBILITY
Finally, remember that every alliance is two-sided. In itself, the severity of an addiction has little effect on how easy it is to form a strong therapeutic alliance: but if you use “I’ve had such a rough time” or “I’m weaker than others” as an excuse for demanding your therapist solve all your problems with no help from you, it won’t do much good for your alliance—or your recovery.
To contribute your fair share to the therapeutic alliance, you’ll need:
- Reasonable expectations—which means not only resisting temptation to demand the impossible, but having faith in the therapist’s ability and good intentions, while simultaneously appreciating their human side. Especially if you had a bad experience with an earlier therapist, make up your mind you will take neither an “all or nothing” nor an “I can’t expect much” attitude.
- Honesty and openness. Don’t let pain or pride keep you from explaining what’s bothering you, admitting your mistakes or going into detail about an unpleasant experience.
- If you must change an appointment, have a better reason than being tired after a stressful day—and reschedule it rather than just cancelling. If your payment plan is tied to a bank account, keep adequate funds in the bank.
- Good manners. Don’t snap at the office staff—or at your therapist. Just because they’re used to dealing with others’ tough feelings doesn’t mean they have no feelings of their own.
And, believe in yourself, your therapist and the alliance!
Addictions.com. “Therapeutic Alliances and Addiction Treatment Choices.” Accessed September 23, 2017.
Arnow, Bruce A., and Dana Steidtmann. “Harnessing the Potential of the Therapeutic Alliance.” World Psychiatry, October 2014, Vol. 13, No. 3, pp. 238–240. Accessed September 23, 2017.
Bridges to Recovery. “How a Strong Therapeutic Alliance Improves Treatment Outcomes for Borderline Personality Disorder.” March 3, 2017. Accessed September 23, 2017.
Cabaniss, Deborah L. “The Therapeutic Alliance: The Essential Ingredient for Psychotherapy.” HuffingtonPost.com, July 31, 2012. Accessed September 23, 2017.
Cronin, Elisabeth, Bethany L. Brand, and Jonathan F. Mattanah. “The Impact of the Therapeutic Alliance on Treatment Outcome in Patients with Dissociative Disorders.” European Journal of Psychotraumatology, 2014. Updated March 6, 2014. Accessed September 23, 2017.
Urbanoski, Karen A., John F. Kelly, Bettina B. Hoeppner, and Valerie Slaymaker. “The Role of Therapeutic Alliance in Substance Use Disorder Treatment for Young Adults.” Journal of Substance Abuse Treatment, October 2012, Vol. 43, No. 3, pp. 344–351. Accessed September 23, 2017.