The helping relationship between clinicians and patients moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be “on tap, not on top”.
It has been suggested that the working alliance and the therapeutic relationship are not the same thing, rather that the alliance is a way of looking at the relationship through a lens of goal-directed work and asking whether the relationship promotes collaborative working with improved outcomes, or whether it could detract from the work (Hatcher, 2010). Similarly, Davidson (2008) suggests that as the relationship between practitioners and their clients moves away from one of expert–patient to one of partners on a journey, treatment is viewed through ‘recovery glasses’ to see whether it empowers people or takes power away from them.
Best et al. (2009) describe how the recovery agenda is not just about addressing the stigma and social exclusion experienced by problematic substance users and about empowering drug users, but that it also challenges the status of drug workers as ‘professionals’. They suggest that the dichotomy of ‘patient’ and ‘professional’ is not only using the wrong language, but creating the wrong relationship, and that drug workers need to learn new skills to support new roles.
In the mental health field, the Improving Access to Psychological Therapies (IAPT) programme was established in 2008 with the intention of enabling more people to access NICE-approved psychological therapies for common mental health problems such as anxiety and depression (NHS, 2010). As part of this, the role of Psychological Wellbeing Practitioners (PWPs) was developed to provide people with low intensity interventions, and can be likened to a coaching role such as athletics coach or personal fitness trainer, where the coach devises a plan, monitors progress and provides encouragement, motivating the client rather than doing the work for them (NHS, 2010). This reflects Davidson’s (2008) suggestion about how clinicians should be ‘on tap, not on top’. PWPs take a collaborative approach, focus on self-guided help and are:
Explicitly educated and skilled in ‘common’ as well as ‘specific’ therapeutic factors, so they know how to establish, develop and maintain therapeutic alliances with patients, [and] are able to respond to and deal with real or potential ruptures in the alliance.
(NHS, 2010: 5)
BEST, D., GROSHKOVA, T. & MCTAGUE, P. (2009). The politics of recovery. Druglink, 24, (4), 14-19.
HATCHER, R. L. (2010). Alliance Theory and Measurement. In: MURAN, J. C. & BARBER, J. P. (eds.) The Therapeutic Alliance: An Evidenced-Based Guide to Practice. (pp. 7-28). New York: The Guilford Press.
NHS. (2010). Psychological Wellbeing Practitoners: Playing a key role in maintaining the nation's wellbeing - Best Practice Guide [Online]. Available: http://www.iapt.nhs.uk/silo/files/psychological-wellbeing-practitioners--best-practice-guide.pdf