The Therapeutic Alliance



Behavioral changes occur in psychodynamic psychotherapy through two processes, which are a perception of the cognitive and affective processes emanating from the childhood (defense mechanisms), along with understanding the conflict relations that have emerged in the patient with the most important objects in childhood, along with their resurrection in the relationship with a therapist (transfer). The diagnosis of understanding such feelings and perceptions is the focus of treatment. The decor of a treatment should be organized in such a way that maximizes resources to facilitate an entry of these phenomena on the surface. This should be done in a way of enabling them to analyze, without mixing with the reality of the relationship to the patients clinician and not waving from them as something trivial. The first necessary condition for success in psychoanalytically oriented psychotherapy is the patients need to take part in this practice, along with his confidence in the relationship with the therapist. Such a therapeutic alliance is based on the realities of treatment. It is a common practice for achieving the mutual purpose, along with the consistency and reliability of the therapist.

Keywords: clinician, client, clinician-client relationship, therapeutic alliance, psychotherapy, therapist, therapeutic process, communication, conditions.

The Therapeutic Alliance

The issues of relationships between a doctor and a patient in psychotherapy are part of a broader problem of relationship between a doctor and a patient in general, as a section of medical ethics (the study of the role of moral and ethical principles in a doctors practice and other health care providers) and medical ethics (part of medical ethics, which study law behavior of medical personnel). In numerous studies, including monographs, the dependence of the basic principles and content of the problem of relationship between a doctor and a patient can be emphasized from the public consciousness, moral and ethical society. A special significance of relationship between a doctor and a patient gain in the area of psychotherapy, where they act in a way of the most important factors of treatment, on which its success depends in general.

Due to the nature of psychotherapy, a psychotherapist in one way or another brings uniqueness of his/ her personality, personal system of values, the preferred theoretical orientation and psychotherapeutic techniques to relationships with the patient. Different accents in assessing the significance of personal qualities of the therapist or psychotherapeutic techniques for effective treatment are characterized for different directions of psychotherapy. This difference is found when comparing the psychodynamic, behavioral, client-centered, rational-emotional therapy (ODonohue & Fisher, 2009).

There are some conditions that contribute to a successful therapeutic process, which are generally sufficient, regardless of the particular characteristics of the patient. First, therapist is congruent in relationships to the patient. Congruence or authenticity of the psychotherapist means the necessity in the right symbolization by the psychotherapist of his/ her own experience. Unconscious events and phenomena presented in consciousness (all that is potentially accessible to consciousness) and related to a certain point, but not to some set of experience are under the experience. Second, a therapist is experiencing an unconditional positive assessment to a patient. Usually, the definition of a positive assessment includes such concepts as warmth, location, respect, affection, acceptance, and others. Indeed, to evaluate positively another person means to evaluate despite the feeling that might appear because of his/ her actions. Actions can be assessed in different ways, but the adoption of the recognition of an individual does not depend on them. A therapist appreciates the patients personality in general. He/ she equally feels and shows unconditional positive evaluation as those experiences, because of which the patient is afraid or ashamed, along with those, which he/ she is satisfied with. Third, a therapist treats a patient empathically. To have empathy means to perceive the subjective world, covering a full range of sensations, perceptions, memories and other available consciousness at the moment, as if perceiving himself/ herself was this other person (ODonohue & Fisher, 2009).

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Communication plays an important role in the life of people. Without communication, it is impossible, for example, the development of culture, art, standard of living. The reason is that only with the help of communication, experience of the past generations is conveyed to new generations. Today the topical issue is a clinician-client relationship.

It is possible to discuss the relevance of an effective and ineffective interaction of the patient with medical personnel of such definition as communicative competence, which means the ability to begin and maintain the needed contacts with another individuals. This process refers to a mutual understanding between the partners of a dialogue, a better understanding of the issue and the theme of communication. It is also necessary to notice that communicative competencies are a professionally important doctors and nurses characteristic (Dawson, 2012). However, even if a patient must look for a help from a doctor in clinical conditions, communicative competence is also important for a patient. A successful contact with a doctor will contribute to a patients fast recovery and applied treatment has the best effect, which has less side effects and complications.

One of the foundations of therapeutic activity is the health workers ability to understand the sick person. A skill to listen to the patient plays an important role in the process of medical activity that seems necessary for the formation of a contact between him/ her and a health state of a worker, in particular, a doctor. The ability to listen to the sick person not only helps to identify or diagnose a disease, to which it may be subjected, but the process of listening itself has a beneficial interaction to the psychological contact of a doctor and a patient. It is also necessary to consider the features of the disease when contacting to the patient, because there are patients of the various facial profile in common therapeutic departments of the clinical medicine. These are, for example, patients with diseases of the gastrointestinal tract, cardiovascular system, kidneys, respiratory system, and other diseases. Their painful conditions very often require long-term treatment that has an impact on the process of clinician-patient relationships. A prolonged separation from family and usual professional activities, along with the concern for their health causes a complex of different psychogenic reactions from patients. However, not only these factors affect the psychological atmosphere and the patients condition. As a result of psychogeny, the duration of the basic physical illness may be complicated, which in its turn impairs the mental condition of patients. It is also important to note that different types of complaints, arising ethical problems indicate the absence of the necessary psychological knowledge and the practice of the appropriate communication with patients from the side of the clinicians. Differences in clinicians and patients opinion may be caused by their social roles, along with the other factors (Dawson, 2012).

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