What Is The Therapeutic Bond And Why Is It Key?

Carl Rogers (1951-1957) was the first to defend that psychotherapy was effective not so much because of the use of certain techniques, but because of the type of relationship established with the patient. Being empathetic, congruent, warm and accepting positively and unconditionally the patient would be the fundamental characteristics that the therapist should have.

Indeed, the data provided by the research on the different efficacy of psychotherapies has shown that most of the treatments studied do not show great differences in results among themselves.

Therapy is a journey

Many therapists use the metaphor of travel to illustrate the therapeutic process. It is planned, different stages and approaches are considered according to the objectives and the possibility of changing the itinerary is contemplated if it is considered appropriate. Each patient is unique and each therapeutic relationship different from another.

It is about providing psychological security, empathy, pacing, chemistry, respect, love, patience, presence, being attentive to nuances and being sensitive to what is not said. On the journey, the relationship that is created between therapist and patient is different from any other: the therapist genuinely cares about the patient, but is not part of their daily interpersonal relationships.

It is a shared, intense, singular and unrepeatable journey between two subjectivities, in which there are constant cross-linking of schemes and where the multiple personal narratives of both are reflected.

An invisible thread between patient and therapist

The psychoanalyst Jessica Benjamin points out that the negotiation between these two subjectivities, so different, constitutes the nucleus of the mechanism of change in the patient and the very heart of the therapy. Movement that is forged not only from the intellect but fundamentally from the feeling, which will allow the echoes of the experience to last and the changes to be more stable and profound.

The invisible thread that is assembled between the patient and the caregiver is what we would define as a therapeutic bond.

The quality of this depends on whether the trip comes to fruition. Establishing a good bond should be the initial goal of any therapy. It would be about creating a safe place, where the patient can experience himself, the world and his dynamic relationships. A good bond is the basis for starting work. Without it, you can hardly build anything.

Although, as Professor Edward S. Bordin points out, breaks and difficulties in the therapeutic bond are inevitable and one of the most important therapeutic skills is the management of these processes and the ability to repair breaks in the alliance.

What makes the therapist’s journey with the patient possible is his ability to decipher and, in his case, reconstruct the cognitive and emotional maps that he unfolds before him; On the other hand, what makes the patient’s journey with his therapist real, and healing, is the confidence that he can sail alongside him without the anguish of shipwreck, without that fear of capsizing that defines the life of the one asking for help.

The good therapeutic bond is the implicit contract that the therapist and the patient sign to undertake that journey, that firm invisible thread that unites them in their shared will to go far together.

Are therapies more effective if there is this link?

According to the well-known review of professors David Orlinsky and Kenneth I. Howard (1986), the studies done so far suggest that the positive quality of the relational bond between patient and therapist is more clearly related to patient improvement than any of the techniques of particular treatment used by therapists.

Jeremy D. Safran and Christopher Muran (2005) go even further and point out that “after 50 years of research, one of the most systematic findings is that the quality of the therapeutic alliance is the most robust predictor of treatment success”. Psychiatrist Jerome Frank raised the existence of six common factors in all successful therapies:

• It helps that there is a relationship of trust with the professional. The patient must expose his problems, feelings and fantasies feeling sure that everything will be treated with full confidentiality.
• A rational explanation of the patient’s problems and the treatment for their solution. Helping to make sense of and structure, at least in part, states of inner disorder should be one of the main goals of therapy.
• Provide new information about the origin and nature of the problems and the ways to deal with them.
• The hope of the patient to find help in the therapist.
• Having successful experiences in the course of therapy, thereby strengthening the patient’s sense of control and growing sense of self-confidence and ability.
• Facilitate emotional activation. Discover the feelings that are central to understanding the patient’s experience in relation to their problems.

Any therapy is a journey in which both, therapist and patient, have to feel comfortable with each other. If that does not happen, and beyond looking for culprits, it is convenient to cut the thread and start planning a new journey with other colleagues.