Past Experiences Influence Therapeutic Alliance

One of the primary goals of successful therapy is the formation of a meaningful and strong therapeutic alliance. This bond between the therapist and client is essential for creating an environment of openness, acceptance, and trust. Therapists are largely responsible for developing this foundation, but clients contribute significantly to the bond as well, even if they are unaware they are doing so. Many clients bring past experiences into therapy. Negative and judgmental encounters with previous therapists can cause clients to be distrusting and fearful in treatment, creating barriers to constructive working alliances. Understanding how clients’ past experiences influence the therapeutic bond, and how therapists can overcome these challenges, was the focus of a recent study conducted by Christian Moltu of the Division of Psychiatry at the District General Hospital of Forde in Norway.

Moltu interviewed a dozen therapists and asked them to describe how they overcame hurdles they experienced with hesitant and resistant clients. The therapists were trained in a range of approaches and yet each described similar methods for interacting with difficult clients. Each therapist stated that he or she achieved a productive working alliance, despite their clients’ reservations, by doing one of three things. The therapists said that successful alliances occurred when clients asked the therapists to help them with the relational challenges they faced. Additionally, therapists noted that bonds were built when they acknowledged the clients’ willingness and courage to overcome existing challenges. Lastly, when clients were unable to move past victimization and suffering, therapists found a way to build a bond with them by recognizing this deficit in their clients and explaining that the goal of therapy was to move from challenging situations to positive outcomes. Moltu added, “We found that participants experienced the client as contributing relationally and that this influences how the therapists respond and are present in the interaction.” By being attentive to the past experiences a client brings to therapy, a therapist can work with the client to overcome these limitations and ultimately develop a strong and cooperative therapeutic relationship.

Moltu, C., Binder, P.-E., Stige, B. (2012). Collaborating with the client: Skilled psychotherapists’ experiences of the client’s agency as a premise for their own contribution in difficult therapies ending well. Journal of Psychotherapy Integration. Advance online publication. doi: 10.1037/a0028010

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  • Layne

    June 27th, 2012 at 4:10 AM

    All of us have preconceived notions about people based on our prior experiences with others like them. The same would be sure to hold true with therapists too. If you have already had a bad experience with one, then your defenses will be automatically be up and you will put up a wall that might be tough to penetrate.

  • Lorna teague

    June 27th, 2012 at 3:07 PM

    I had a really bad experience with a therapist once, and even though I needed to be under a doctor’s care, it took me a very long time to get past all of that and to actively seek help for my depression again.

    Looking back I know now that I just happened upon a bad seed but for a long time that one experience left me with such a bad taste in my mouth that I found it hard to stomach putting it all out there again and be made to feel like I was worthless because of the feelings that I was having.

    Luckily the second time around was much better. I got the help from my family doctor and he helped me get an appointment with a reputable therapist who started helping me form the moment I walked into his office make some changes in my life for the better. I know now though that I could have had that a long time prior had I not had such a terrible first experience in therapy.

  • keith

    June 28th, 2012 at 4:26 AM

    If this is someone with whom we are sharing our deepest and darkest secrets, then I think that this has to be someone we feel comfortable around. We have to feel that this is a person is not only going to help us through our issues but whom we can also trust to help us make the best decisions. If I am not feeling this kind of rapport then how is he or she going to help me make that difference in my life that I am actively seeking?

  • Walker F

    June 30th, 2012 at 6:53 AM

    I think that any time you have a bad experience with something it makes you a little more hesitant to try it again no matter how good of an idea it seems like it could be.

    It’s kind of like when you eat somewhere and then get sick a little later on. Logically you probably know that this was a bug coming on anyway, but the getting sick part is something that you will always associate with the restaurant.

    Same thing with therapy. Even though you know that a bad experience was probably just that you were unlucky with the first therapist and that you can find another one who could be more to your liking, it is hard to get past those thingss that you associated with therapy in the past. You just have to be able to get up your nerve to try it again.

  • Claye

    July 1st, 2012 at 4:15 AM

    I have probably read just about every self help book currently on the market. Name an ailment, I have it. But I refuse to go back into therapy. All tey wanted to do was to dope me up and space me out and I couldn’t take any more of that! So I have moved on to my own personal library and have to say that I feel better about who I am and where I am than I have felt in a long time.

  • molly andrews

    July 2nd, 2012 at 4:25 AM

    For many people, all it takes to break down those barriers that they may have already put up is to simply acknowledge to them that they know that they are frightened, but that the therapist is about helping them discover ways that they can live again without that fear. It may not happen overnight, but I think that a good therapist will not start off saying how easy this will be; but will instead show the patient that this might be hard but worth the work. There will be a lot of people who will respond well to this sort of honesty and will work hard to get to that place that maybe they have finally been given some sort of raod map for.

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