What is a Therapeutic Alliance and How Does it Improve Patient Outcomes

The global COVID-19 pandemic has made all health care providers, including nurses, more aware of the complex interplay between psychological, physical and social factors that influence a patient’s mental health, recovery time and overall well-being.

Nursing programs such as the BSN degree at John Carroll University, a private Jesuit university located near Cleveland, Ohio, have begun to incorporate additional coursework, training, and conversation about the overlap between mental and physical health. The goal is to help nurses serve a broader range of patients, raise overall awareness of emotional, cognitive, and physical factors, while easing the pressures placed on nurses and other medical staff.

One concept that new nurses can familiarize themselves with is called therapeutic alliance. Nurses may see the alliance as a way to magnify their impact by applying both professional and interpersonal skills; while the patient desires to be involved in their care, and to be more broadly seen and understood. 

Therapeutic alliance becomes a piece of a larger shift of approaching mental health, recovery time and overall well-being more holistically going forward.

Therapeutic Alliance Basics

Researchers first began to study the connection between patient outcomes and provider/patient relationships in the 1980s, recognizing that the traditional notion of a unidirectional, authoritative exchange from a clinician to the patient failed to capture the full picture. At its most basic, the shift involves moving from a ‘doing to’ the patient mindset to one of engaging meaningfully with patients and families. 

No Two Interactions Alike

Early in their clinical rotations, younger nurses begin to recognize that every patient interaction has a few traits in common, and many more that make it truly one of a kind. Building a therapeutic alliance involves a convergence between the nurses life and work experience, and the patient’s outlook on their condition. Each new pairing starts the alliance building process over again.

Beyond Acute Mental Health Settings

The idea of therapeutic alliance and patient participation in their treatment is most often applied in acute mental health settings and conditions. One frequently studied example is the alliance between psychiatric nurses and patient populations with eating disorders where there is a high-risk of relapse. But therapeutic alliance offers insights and applies across healthcare situations. Surgeries, drugs and other interventions cannot fully account for the improvement of patient outcomes. One study for instance showed that nonverbal communication between physical therapists and their patients predicts health outcomes in geriatric settings.

Research continues to reveal the nuanced ways that nurses and patients establish ground rules and trust, essential for a good working relationship (the “alliance”) and progress toward improved health. Foundational concepts such as control and self-determination come into play, and while skills such as emotional intelligence and empathy always play a role, the patient-provider negotiation remains dynamic and highly subjective. As younger nurses move further into their careers, they can observe the therapeutic alliance at work among their fellow nurses and the patients in their care. Research findings show that successful therapeutic alliances do not magically develop through negotiation of equal partners. Rather, the therapeutic alliance is often dependent on nurses’ capacity to maintain their position of clinical authority, while also building a human bond and  demonstrating their trustworthiness to patients. When patients trust nurses, they might shift their behavior and attitude about their ability to invest time and energy in a new concept of well-being.