The image of the therapist taking notes and bestowing their interpretation on the patient is a classic stereotype of therapy. It evokes the idea that the psychologist is the expert, but this is not the case.
Psychologists recognize that it is an interplay between two people and what they are doing that brings about change. For example, did you ever change doctors because you weren’t sure about their bedside manner, even though their medical knowledge might have been sound?
The Therapeutic Alliance
Psychologists think about both the suitability of a therapy for someone and how they can help the person in front of them. Hence, what psychologists term the therapeutic alliance is important. Several definitions of therapeutic alliance exist 1. Most researchers agree the alliance consists of three components 2: (a) an affective bond between the client and therapist, (b) mutually agreed-upon goals between the client and therapist, and (c) collaboration between the client and therapist on assigned tasks. In a meta analysis Baier and colleagues (2020) 3 reported that 26 out of 37 studies in their review suggested client symptom reduction in therapy was associated with the therapeutic alliance.
Psychologists want the best outcomes for their clients. Feedback helps us work towards this. Feedback in therapy can look like a questionnaire or your psychologist asking you a question. This is helpful to monitor symptoms and treatment progress, as well as the therapeutic alliance.
Best outcomes for clients come from the right therapy and a good therapeutic alliance which means client feedback is very valuable. Lambert and colleagues (2010) 4 found that client feedback improved the clients’ outcome better compared to clients who did not provide feedback. This study also reported that for those clients who showed improvements in therapy and provided feedback to psychologists reduced the number of treatment sessions without reducing positive outcomes.
Feedback questionnaires that we use at the Centre for Clinical Psychology include the Agnew Relationship Measure-5 (ARM5) and our client feedback questionnaire. We welcome all feedback and take it very seriously. Just telling your psychologist you are not sure about something is of value and we will take it seriously.
A simple analogy to take away from this blog is that a psychologist can steer the ship, but it takes the psychologist AND client to chart the course. Talk to your psychologist about the course!
Baier, A.L., Kline, A.C., & Feeny, N.C. (2020) Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clinical Psychology Review, 82. https://doi.org/10.1016/j.cpr.2020.101921
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885
Lambert, M.J., Whipple, J.L., Smart, D.W., Vermeersch, D.A., Nielsen, S.L. & Hawkins,E.J., (2001). The effects of providing therapists with feedback on patient progress during psychotherapy: Are outcomes enhanced?, Psychotherapy Research, 11(1), 49-68. https://doi.org/10.1080/713663852
Sijercic, I., Liebman, R. E., Stirman, S. W., & Monson, C. M. (2021). The Effect of Therapeutic Alliance on Dropout in Cognitive Processing Therapy for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 34(4), 819–828. https://doi.org/10.1002/jts.22676