It is widely agreed among mental health practitioners that the “therapeutic alliance”, or the relationship between patient and clinician, is one of the strongest predictors of a positive outcome. Be this a psychiatrist or psychologist, this means it’s the quality of the relationship between them and their patient that may impact their treatment most. Research has shown this to be more important than the duration of care, type of therapy used and whether appointments are in-person or online, among a number of other factors. So how do you know if you and the clinician you are seeing meet the criteria for a good therapeutic alliance?

Written by Nadine Seif BSc, Assistant Psychologist, Sloane Court Clinic

With all relationships in life, you will get along well with some people and less well with others. This also applies to the clinicians you see! Ilse du Preez, Clinical Psychologist at SCC, highlights the importance of “using what you know about yourself and your preferences in your daily interactions to help you choose a psychologist.” Despite our greatest efforts to pair you with your “best fit”, it is not uncommon for people to see a few clinicians before they find one who they truly click with, and who is the best fit for them.

In the context of psychology, some people may immediately click with their therapists, while for others, it may take time to completely feel at ease with them - they are initially strangers after all! Here are a few factors to consider that might help you assess whether you and your therapist are a good fit:

• They display good listening skills

• They seem interested in you as a whole

• You feel that that you and your feelings are understood by your therapist

• They show you compassion

• You trust and respect them and their thoughts/ input

• They help you feel at ease

• You feel respected by them and that they respect your boundaries

• You feel able to discuss any problems that you have with your therapist, even if this is about the therapeutic alliance itself

• Feeling like you are an active partner in “the work”

• You don’t feel your therapist says anything that irritates you or rubs you the wrong way* (This can sometimes be confused with therapists ‘challenging’ you / your thinking, which is ultimately positive and productive)

"Most of the time you can tell quite quickly whether you and your therapist are a good fit; it's often a gut feeling”, comments Ms du Preez. “Before making a judgement, however, it can be helpful to consider your knowledge of your relationships with others in your life. If you know you usually need more time to build trust with someone, or you tend to feel uncomfortable around others, I would urge you to give your therapist a chance to see if you might be able to work well together."

Having read the above, if you feel you and your therapist are not well suited, it might be worth thinking about why. If you feel comfortable to do so, you can bring this up with them. For example, if you responded negatively to anything your therapist said or did in session, a good therapeutic alliance will promote raising and discussing this with them the session after. These kinds of conversations help to break down barriers in your relationship and allow you to benefit most from your work together.

If you just do not feel comfortable with your therapist, do not trust them or want to stop seeing them for any reason, this is also okay, and you are not obligated to continue your treatment with them. Therapists are trained with the knowledge that a therapeutic relationship is extremely personal and will not take offense if you decide to cease your care with them. It is likely they will have also felt at least an element of your unease or mistrust and may even be able to recommend someone else for you based on your time working together. Once you do decide to stop seeing your existing psychologist, they will formally discharge you so you will no longer be under their care.

Although addressing this directly with your clinician is our most strongly recommended course of action, we understand this may feel too uncomfortable in some instances. Alternatives would be contacting the doctor (psychiatrist or GP) who originally referred you, if applicable, to let them know why you feel the fit was not right. They may have an alternative therapist in mind to refer you to next. If you self-referred and would like to continue your care at SCC, you can email Patient Services explaining the situation, and they can advise as to other psychologists’ availability for you. You don’t need to justify a change in clinician, but it is useful for us to know if there is a specific reason you no longer want to see someone to ensure we maintain the best possible standards of practice.