Running head: THERAPEUTIC ALLIANCE
You Had me at Hello: Building a Therapeutic Alliance Within a Helping Relationship
Natasha Dharshi
University of Calgary
SOWK 625 Practice with Individuals, Families and Groups
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‘“She pulled me out of the gutter, if it wasn’t for her I would probably be in the hospital,
but she pulled me out and I’m so glad she came into my life,” said Billie Graham’ (Franks,
2017). Billie is one of many success stories I have seen within my practice and has been a client
that has made an imprint on my career. He has defied adversity and increased his resilience by
capitalizing on his abilities and developing prosocial interactions in his life. In the beginning of
our therapeutic relationship, Billie was very resistant on working with me. He had been in and
out of many interactions with the system and had become jaded with the whole process. Despite
his quality of life deteriorating as he sat isolated in his unit, he believed that working with me
was going to be exactly what he had experienced before. His hope had dimmed and his drive to
fight the systemic oppression he had been facing was lost. This is when it dawned on me that
despite being in the helping profession not everyone is going to want to work with you and the
therapeutic relationship itself will never be seamless. No matter what demographic you may be
working with there will always be barriers, setbacks, miscommunication, lies, differing opinions
and preconceived notions and beliefs. The beauty of a therapeutic alliance is building a
foundation from the essence of just being human. Connecting from one being to the next and
understanding that each individual trajectory is a story that must be carefully read is the
beginnings of a helping relationship.
In my previous experiences, the personal skills that have been beneficial to building
helping relationships have been honesty and genuineness. Clients are very intuitive to both
personal characteristics and rapport is often steadily built when they truly believe that you care
and will be truthful with them about their situation and available options. Professionally, I have
found that when you are detail oriented, thorough in your research and documentation, practice
active listening and have been open to exploring different methods and suggestions it helps the
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client to feel confident in your skill set and believe in the consistency and stability you will
provide them.
Some factors that I have found to interfere or challenge the development of a therapeutic
alliance has been the transience of a population. When working in the homelessness sector I
found that clients were often battling scarcity in obtaining resources. Not being able to meet their
needs and provide for themselves deterred from any rapport or relationship building. The
relationships built were scarce and intermittent, with clients only engaging when a basic need
was to be met and they had no other options during desperate measures. Not having food, shelter,
clothing, water or substances to function would significantly impact the development of any
relationship leading to very shallow engagements. Some of the challenges involved in
developing as well as maintaining a helping relationship is a lack of trust. For most vulnerable
populations, they have consistently engaged in some realm of the system and have encountered
poor experiences or results. They have succumbed to their oppression in society and no longer
want to engage in any ‘help’ they can access. Not having lived experience to all the concerns or
issues your clients may face can be a struggle as many individuals feel that if you haven’t
experienced it yourself it is too difficult to understand. I found this particularly relevant in
mandated populations. Establishing a therapeutic alliance is an imperative part of building
rapport within a client relationship, although it is important to be mindful of our reactionary
responses as practitioners when working with hard to serve populations.
Caplan and Thomas (2002) discuss the idea of a ‘forgotten moment’ when working in a
group setting with difficult clients and expressing a reactionary response to something that has
been said within the session. This concept is about an awareness of your defensive reactions to
moments of emotional conflict and using emotionally mindful techniques during anxiety
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provoking events. Rather than bypassing these moments by ‘forgetting’ them, it is important to
practice therapeutic resiliency by developing confidence in your ability to sit in the emotions
long enough to process what is happening. Resisting reactionary responses by reflecting on the
implications of your actions, promotes vulnerability in the client and the practitioner. Processing
these moments reinforces the appropriate boundaries of responsibility in the client doing the
work. The underlying premise is exhibiting attitudinal resilience that can be between the
supervisor, the practitioner, the seasoned and new group members. The ability to maintain
centered in this therapeutic alliance reinforces more appropriate behavioral responses resulting in
empathic and supportive dialogue when gathering information (Caplan & Thomas, 2002).
Working with difficult clients in an individualized or group setting can be stressful for the
practitioner to maintain a therapeutic alliance and often leads to burnout. After continuously
dealing with acerbic behaviors, combativeness or a client’s lack of willingness to work through
their concerns we often feel frustrated or hopeless ourselves. Our jobs become less rewarding
and can become a burden or emotionally taxing. Navigating through systemic barriers when
developing this alliance can evoke reactionary responses of frustration and anxiety. It is
important to allow ourselves the opportunity to recognize our emotions, hold them close, be
aware of the outcomes they have on our thoughts, verbal and non-verbal cues and find a way to
release them, either within a session or apart from it. When building such fragile relationships, it
is important to be mindful of the resilience of both practitioner and client and the dynamics that
may be beneficial or detrimental to both parties.
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References
Caplan, T., & Thomas, H. (2002). The forgotten moment: Therapeutic resiliency and its
promotion in social work with groups. Social Work with Groups, 24(2), 5-26. doi:
10.1300/J009v24n02_02
Franks, C. (2017, October 16). Back on my feet. The Salvation Army Ottawa. Retrieved from
http://salvationarmyottawa.ca/2017/10/back-on-my-feet/