The Importance of Therapeutic Alliance in Addiction Recovery

Many addicts believe that no-one understands them, creating a sense of isolation that leads to a bunch of adverse consequences—the biggest being an aversion to getting into a recovery program. It’s hard to take the mask off and get the help you need when you feel like you can’t trust anyone.

Substances and alcohol lead to changes in brain chemistry that affect the addict’s headspace, their emotions, and their actions. The onset of co-occurring mental health disorders becomes a real risk for addicts, and the anxiety, paranoia, and psychosis brought about by addiction to hard drugs like opioids and stimulants may cause the addict to resist treatment.

Even if they do decide to get help and enter an inpatient recovery program. They might not receive full value for the time they spend in it because they don’t trust their therapist, or they don’t have the courage to reveal their darkest trauma or emotions driving their addiction.

The “therapeutic alliance” in recovery programs refers to the bond formed between the therapist and the patient during treatment. AUD and SUD recovery programs are specifically structured to help patients overcome their addiction to drugs and alcohol and achieve their goal of living a sober life.

Recovery programs vary in the intensity and variety of services offered. Inpatient programs provide the highest continuum of care, where the patient lives in a residential treatment center and receives ongoing individual and group therapy to learn coping strategies to deal with stressors when they transition to the outpatient phase of their treatment.

There are several other partial treatment models, such as IOP (Intensive Outpatient Programs), PHP (Partial Hospitalization Programs) and outpatient programs. All of these treatment programs have value, and the choice of program largely depends on the extent of the patient’s addiction and what they need to achieve from the recovery process.

Recovery isn’t just about stopping the use of drugs and alcohol, it also includes discovering and working on the patient’s mental health problems driving their addictive behavior. The therapeutic alliance between the therapist and patient creates a collaborative and trusting relationship which plays a key role in the efficacy of the patients treatment program and the results they receive.

The basis of the therapeutic alliance is mutual respect, empathy, and a shared commitment between the therapist and patient to see them make a lasting recovery. The duo build this alliance through open communication and active listening, setting goals that align with the patients experience and the challenges they must face and overcome in their mission to stay sober.

Understanding Therapeutic Alliance in Substance Abuse Recovery

Every addicts story is unique, and there are a million reasons why people end up addicted to drugs and alcohol. The recovery journey is as unique, and while it follows a structured program, the work undertaken in each phase of treatment—particularly in their therapy—is deeply personal.

While medical detox cleans out the patient’s system, making them no longer physically dependent on their substance of choice, the real work occurs in the mind during their therapy sessions.

Addicts committed to an inpatient program undergo intensive individual and group counseling to dig down to the root of the problem causing their addiction. It’s only through addressing these deep-seated problems that the addict can gain clarity over their situation and identify the thoughts and emotions causing them to use.

The therapeutic alliance formed between the patient and therapist during these counseling sessions forms the foundation of trust between the parties and enables the addict to break through their emotional barriers to reveal the causes of their addictive behavior.

Patients struggle with feelings of shame, guilt, and self-doubt. When they form a strong therapeutic alliance with their therapist they build confidence in the process and learn to trust them with their recovery, motivating them to live a life of lasting sobriety.

Research shows that well-established therapist-patient bonds improves the patients engagement in their treatment while lowering the risk of relapse to create lasting behavioral change.

Definition and Key Components of the Therapeutic Alliance

In recovery, patients form a bond with their therapist who guides them through their counseling. Both the therapist and the patient collaborate on reaching the shared goal of making a complete recovery.

Conventional doctor-patient relationships lack a personalized touch and can feel clinical or detached, reducing the patients ability to share what’s really going on with them. It’s a surprising fact, but people will often lie to doctors to conceal shame, even with the risk of their concealment leading to adverse health outcomes.

In contrast, the therapeutic alliance is characterized by a mutual understanding between the therapist and patient, leading to a foundation of respect, and shared decision-making in the relationship.

Patients in SUD or AUD recovery programs must feel that they can trust their therapist. The therapist will build rapport with the patient by showing they have a genuine concern for their well-being and health. By creating  judgment-free safe space for the patient the therapist lets’ the patient open up without feeling shame or anxiety about their situation.

Empathy strengthens the alliance. Patients who feel understood and validated by their therapist engage deeply in therapy sessions and aren’t afraid to go deep into the murky waters of their mind to reveal their darkest traumas and concerns.

It’s common to find AUD and SUD patients battling trauma and the emotional pain and mental health issues that come along with it. If the therapist is critical of the patients situation, they’ll retreat and fail to engage in the session.

Therapeutic Alliance – Theoretical Foundations

Carl Rogers gets the credit for developing the modern iteration of the therapeutic alliance. He based his theory around three techniques or factors that establish trust between the therapist and their patient. These elements of the therapeutic alliance are congruence, unconditional positive regard, and empathy.

Congruence refers to the therapist’s authenticity and transparency in the session they engage with the patient on a personal level rather than taking the standard clinical approach of initiating a professional relationship between the parties.

Unconditional positive regard lets the patient feel accepted by their therapist regardless of the mistakes they’ve made or their current struggle with SUD or AUD.

Empathy involves the therapist getting a complete, deep understanding of the patient’s emotions and perspectives without bearing judgment on them.

These principles align the therapist and patient in achieving a common goal of seeing the patient getting sober. By creating an environment of acceptance and support, the therapist helps the patient slowly and steadily rebuild their self-worth and develop healthy coping mechanisms to handle triggers when they arise, empowering the patient to take control of their recovery.

When patients truly feel that they can trust their therapist and that they understand what they’re going through they’ll work with them, rather than against them, leading to better recovery outcomes.

How the Therapeutic Alliance Affects SUD and UD Recovery Programs

The therapeutic alliance increases patient engagement, building motivation and momentum in the recovery process to ensure a lasting recovery. It improves treatment retention, giving the addict the motivation they need to stay sober. Unfortunately, the reality is that many patients drop out of recovery. Frustration, hopelessness, or resistance to change are common factors causing patients to give up on their recovery and fall back into their old habits.

A strong therapist-client relationship makes patients feel supported and understood, making them more likely to stay engaged and studies show that patients who receive a positive therapeutic alliance are more likely to complete their inpatient and outpatient programs, continue with their aftercare plan, and attend support groups.

Overcoming the Challenges of Forming the Therapeutic Alliance

Building a therapeutic alliance isn’t always a rose garden of positivity, patient resistance, therapist burnout, cultural differences, and the need to balance support with professional boundaries all take a toll on the formation of the alliance and its maintenance during the recovery process.

Addressing and overcoming these challenges requires the therapist to develop exceptional awareness, maintain adaptability throughout the treatment plan, and commit to building a positive, ethical therapeutic relationship with the patient.

Client Resistance

While patients may have the courage to enter recovery, many of them resist opening up to their therapist. They might think that their story is too embarrassing or dark to share. They might have trauma making them hesitate in building a relationship with their therapist and engaging in their treatment.

Some might be in denial about the state of their addiction or feel that their family coaxed them into treatment, but they don’t really need it—so why should they share with their therapist when they feel there’s nothing wrong with their behavior?

Overcoming patient resistance requires the therapist to have exceptional patience, outstanding consistency with how they handle the patient, and a non-confrontational approach to therapy sessions.

The therapist should meet the patient’s emotional state and allow them to process the emotions that rise from the dark corners of their mind without forcing the patient into the reveal. Motivational techniques emphasizing autonomy and intrinsic motivation reduce patient resistance in sessions and improves their engagement with their treatment.

Therapist Bias and Burnout

Therapists have personal beliefs, biases, and emotional limitations just like everyone else and they might find it challenging to stay objective and emotionally resilient during the treatment program.

If the therapist has an unconscious bias they might make false assumptions about their patient’s background, motivation, or their likelihood of success in navigating the recovery program to completion. The therapist must persist with ongoing self-reflection, supervision, and professional development to ensure they take an unbiased approach to every session with their patients.

Burnout is also a problem for therapists working in the addiction recovery industry. The emotional strain of counseling and supporting their patient through revealing and reliving their trauma can wear them out. When the therapist experiences burnout they lose empathy for their patients and increase relapse risk due to ineffective treatment.

Therapists must practice self-care strategies to keep them emotionally resilient and engaged in the patient’s recovery. They should seek peer support when they feel overwhelmed and set boundaries with their patients to maintain their mental well-being while continuing to provide the patient with high-quality care.

Cultural and Individual Differences

SUD and AUD don’t recognize cultural or ethnic differences—it ravages people’s health in every country, every religion, and every culture around the globe. The therapist must understand that they’ll deal with patients from all walks of life with different cultural, religious, and personal backgrounds.

What works for one patient might not be an effective strategy for another and the therapist must have the foresight and training to adjust the counseling strategy to the patients’ unique needs. Some patients will display a deeply ingrained mistrust of the healthcare system due to past discrimination or negative service experiences. In these instances, the therapist must build a strong rapport with a focus on displaying cultural humility and sensitivity.

Taking the time to understand the patients values, traditions, and personal identity allows the therapist to integrate these factors into the patients treatment plan. Some clients may see outstanding results in a faith-based recovery program, while others may respond better to evidence-based therapy strategies like cognitive behavioral therapy or somatic trauma therapy.

A culturally competent therapist is inclusive and adaptable, making their patients feel valued, respected, and safe in-session.

The Final Word – Assessing the Therapeutic Alliance and Making Changes

Patients who feel they aren’t receiving the right level of care from their therapist must change the situation or risk their recovery, and that’s challenging to do when they have no reference to work with.

Many inpatient programs let the patient change their therapist if they feel the relationship isn’t giving them any value. If you’re in a similar situation, speak to your case manager about your concerns.

Similarly, if therapists feel they aren’t making progress with a patient, they should bring the situation forth with their colleagues and discuss changing therapists to another professional who can help the patient.