What is the therapeutic link 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. Be empathetic, congruent, warm and accept the patient positively and unconditionally These would be the fundamental characteristics that the therapist should have.

Indeed, the data provided by the research on the different efficacy of psychotherapies have shown that most of the treatments studied do not show large differences in results between them. In this article, the psychologist Anna Rodríguez Ximenos explains it to us.

By Anna Rodriguez Ximenos

therapy is a journey

Many therapists use the metaphor of the journey 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 considered 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 unlike any other: the therapist is genuinely interested in the patient, but is not part of the patient’s everyday interpersonal relationships.

Is about a shared, intense, unique and unrepeatable journey between two subjectivities, in which constant crossovers of schemes occur 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 core of the mechanism of change in the patient and the very heart of therapy. Movement that is forged not only from the intellect but fundamentally from the feeling, which will allow the echoes of the experience to endure and the changes to be more stable and profound.

The invisible thread that is built between the patient and the person who cares for them is what we would define as a therapeutic bond.

The success of the trip depends on the quality of this. 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 link is the basis to start working. Without it, you can hardly build anything.

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

What makes the therapist’s journey with the patient possible is his ability to decipher and, where appropriate, reconstruct the cognitive and emotional maps that it displays before him; For his part, what makes the patient’s journey with his therapist real, and curative, is the confidence that he can navigate alongside him without the anguish of shipwreck, without that fear of capsizing that defines the life of those who are asking for help.

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

Are therapies more effective if this link exists?

According to the well-known review by 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 it is more clearly related to patient improvement than any of the particular treatment techniques used by therapists.

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

It helps to have 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 its solution. Helping to make sense 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 the nature of the problems and ways to deal with them.The patient’s hope to find help in the therapist.Have successful experiences in the course of therapy, and thus strengthen the patient’s sense of control and growing feeling of self-confidence and that he is someone capable.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 They have to feel comfortable with each other. If that does not happen, and beyond looking for the guilty, it is convenient to cut the thread and start planning a new journey with other colleagues.