Therapeutic Alliance and Taking Charge of Mental Illness

October 8, 2019 Miranda Card

The therapeutic alliance between you and your therapist is an important one whether you discuss mental illness or physical illness. I started therapy to better manage the mental symptoms of chronic illness, an autoimmune disease called Behcet's. After all, there's plenty for me to work through. Because I develop abdominal pain when I eat, I have developed a complicated, even disordered relationship with food. I have anxiety when I leave my apartment, fearful that I'll have a flare and will be trapped in a less than ideal setting. When I take steroids, there comes an unfortunate depression side effect. The list goes on.

But somehow, my therapist and I have been talking about my boyfriend for the past month's worth of session instead of these symptoms. When I saw my therapist this week, I decided to discuss the therapeutic alliance and how it determines our relationship. 

The Therapeutic Alliance and How It Pertains to Mental Illness

The therapeutic alliance refers to the relationship between a healthcare professional and his or her patient. It includes relationship variables like the degree of mutual respect and feeling understood, as well as the degree to which the patient and therapist agree on the goals and the strategies used to get there. While it's the therapist's responsibility to check in and ensure that you're on the same page, it can be helpful to be an active participant in this process and useful to speak up when it feels like there's a disconnect. 

"I appreciate that the work we're doing around my relationship is important," I told my therapist, "but I need to clarify how the work we're doing around this issue pertains to my goal of better managing my illness."

He told me that, yes, we were still on the same page regarding my goals. However, it was his view that I sometimes use my illness to frame my relationship (i.e. he is a good boyfriend because he showed up to my surgery) and that he felt this was worth exploring. I agreed and felt better about our partnership as a result. 

It's Normal to Question Your Therapeutic Alliance 

Much the same as any relationship, it's normal for there to be moments of disconnect between therapist and patient. I know this well because there are moments that I doubt the abilities of my other doctors and begin to question our partnership. Just because I felt misunderstood and disconnected in that moment does not mean that my therapist doesn't care about me and my goals or that we no longer have a productive relationship. Personally, I think these moments are good opportunities to take a lesson in communication and trust-building. Although it was scary for me to express my doubts, it was also a step forward in our partnership. 

I Gained a New Understanding of My Relationship and Mental Illness via My Frank Discussion with My Therapist

When I asked my therapist to explain his reasons for delving into my relationship with my boyfriend, I was able to better understand my own impulses in my love life and was given a lot to think about. He pointed out that I have a tendency to view my relationships like safety nets; who will stick around when things go south, is one of my first concerns when choosing a partner. I am beginning to delve into an even more unsettling concern: do I view myself as unworthy of intimacy because of my disease, and do I keep partners at an arm's length as a result? Had I not given my therapist the benefit of the doubt and asked for clarification, I might not have stumbled upon these questions. 

APA Reference
Card, M. (2019, October 8). Therapeutic Alliance and Taking Charge of Mental Illness, HealthyPlace. Retrieved on 2024, April 14 from

Author: Miranda Card

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