This post explores three key objectives that usually need to be satisfied in order to successfully engage people in supportive relationships and build a 'therapeutic' or 'working alliance'.
During the first phase, which takes place over about the first five sessions, satisfactory levels of trust and collaboration need to be established; the client needs to view their practitioner / drug worker / support worker as a participant in the therapeutic journey; and an agreement on goals needs to be established. This first phase focuses on the assessment of need; maximising client engagement; and establishing the roles and responsibilities of the service provider and the expectations of the service user.
Essentials for Engagement & Alliance Building
During the engagement phase of treatment, practitioners need to meet three essential objectives in order to engage service users successfully and develop a therapeutic working alliance:
- They must create a ‘safe space’ so that service users can talk to them.
- They must establish a collaborative partnership so that service users will talk to them.
- They must reach a preliminary agreement that a problem exists so that the service user has a reason to talk with them.
- Barriers to the creation of a safe space can include a judgmental or confrontational attitude on the practitiomners' part; poor confidentiality, which might relate to the environment in which discussions are taking place, or from a lack of trust in the practitioner or the wider service to maintain appropriate confidentiality
- Leading on from the first barrier, collaborative partnerships aim to be partnerships of equals in which power differentials are minimised. It should not be confrontational and the process should feel more like dancing than wrestling. The practioners' aim is to support people and explore their concerns rather than trying to persuade them. They should work alongside the client rather than in front of them, or opposed to them. Poor adherence to a collaborative stance would see the key worker viewing the client as deficient in some manner and attempting to provide what is missing, often using an expert stance to do so.
- An essential part of the therapeutic working alliance is an agreement on the goals of treatment (the purpose) and the task of treatment (the ways in which these goals will be reached). If the client does not perceive that they have a problem, then the goals of the support or treatment intervention will not be aligned. For this reason, once the first two objectives are attained, it is essential to establish agreement that a problem exists, otherwise engagement will not prove possible.
[In the second phase the practtioner begins to challenge the client’s previous pattern of behaviour and the client may experience this as a reduction in sympathy and support, reactivating past dysfunctional behaviours and beliefs and causing a ‘strain’ or ‘rupture’ in the alliance. Strains or ruptures used to be referred to in the broader psychotherapeutic literature as resistance, placing the responsibility for the breakdown in the relationship on the client. But in reference to the therapeutic working alliance they are breakdowns in the collaborative relationship between client and practitioner and usually require exploration to resolve. More details on strains and ruptures can be found here.]