therapeutic alliance

A web-based engagement tool and much much more for therapists.

I have this therapist friend Christy, who is smart, compassionate and highly capable. Everything one could want in a therapist. What impresses me, however, is her incredible talent for finding connections between things that, to most people, appear to be only loosely connected. For example, she and her husband have been learning to dance the tango. She later observed how striking the similarity was between the tango and psychotherapy. The tango involves two individuals who come together with their own set of strengths and weaknesses. Although one partner leads and the other follows, the dance is actually a complex partnership where what particular action each takes depends upon the other's action. Their entire success rests on their ability to “listen” to the other and work cooperatively.

Psychotherapy is much the same. Two individuals, the client and the therapist, come together. The client brings to therapy their problem, psychological distress, their extra-therapeutic strengths and weaknesses, and their expectations and goals. Initially, the client may only have a vague idea of what their problem is and their goal may be even less clear. The therapist brings to this partnership knowledge, experience and insight. The therapist enters the situation ignorant of pretty much everything there is to know about the client, including their level of psychological distress.

Although there can be tremendous variation in how psychotherapy proceeds, it is at the initial therapeutic session that the therapist begins to understand what the client needs. It is also at this initial therapeutic session that the client begins to clarify what their problem is. Together the client and the therapist identify their goal and begin taking steps moving towards it.

There are, of course, multiple factors influencing progress made in therapy, but one critical factor is the therapist's talent for listening to their client. Obviously, any therapist, who begins working with a client believing they know what is best for that client, even before talking to them, is bound to run into difficulties in achieving therapeutic success. Equally problematic is a therapist who doesn't listen to what the client thinks or what the client wants. Any therapist in pursuit of personal excellence will recognize that their relationship with the client is not one of parent-child, but one that is more of a partnership, like…the tango.

Another critical factor in predicting therapeutic success is whether the client is engaged. If the client isn't engaged, the client won't do their part and, if that happens, reaching the goal is unlikely, no matter how good the therapist is. This is much the same situation as found in the tango. The leader may be a fantastic dancer but if their partner isn't engaged in the dance, the partner will fail to follow and the dance won't be successful. Just because the leader's partner follows, it doesn't mean that the follower is passive. Their active contribution is vital to the successful completion of the dance.

There are some who suggest that MyOutcomes, the automated, web-based application of Partners for Change Outcome Management System (PCOMS), is simply an engagement tool. If that notion was entirely accurate, MyOutcomes would still be a powerful tool, playing an essential role in helping the psychotherapist guide their client to their therapeutic goal. The truth, however, is that MyOutcomes is an engagement tool and it is much, much more.

One of the tools offered by MyOutcomes is the Session Rating Scale (SRS). The SRS is a measure of the therapeutic alliance. The strength of the therapeutic alliance is considered to be a major predictor of successful outcomes. There are some therapists who view their client's rating on the SRS as being an indictment of them personally. If the rating score is low, they may feel they need to hang their head in shame. If the rating score is high, the therapist might feel that it is time to uncork the champagne. Neither of these approaches fit with what the SRS actually measures. What the SRS measures is the level of client's engagement in the therapeutic process. If the SRS rating is low, that can provide the therapist a much needed heads up that they need to try something different in order to engage their client. If the SRS rating is high, it doesn't mean that the therapist is great and they can rest on their laurels. Rather, it indicates that the therapist may be on the right track.

The other tool offered by MyOutcomes is the Outcome Rating Scale (ORS). Administered at the beginning of each session, the ORS measures the level of psychological distress experienced by the client since the last session. As the ratings given by the client are instantly plotted on a graph, one can compare the levels of distress experienced by the client since the initial therapeutic session. This measure provides the evidence of how therapy is proceeding. It is because the ORS provides this measurable evidence of therapeutic progress that MyOutcomes has been included in SAMHSA's National Registry of Evidence-Based Programs.

If you are a psychotherapist in pursuit of excellence and you are concerned about how engaged your clients are, you will not find any tool that comes close to matching MyOutcomes' power. Be warned, however, because the power of MyOutcomes' transcends simple engagement. It is for this reason that MyOutcomes is a leader in the field of feedback-informed therapy.