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Private Consultant Psychiatry
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Practical Optimisation of the patient outcomes – the therapeutic alliance

Psychiatry in action – the way Ahed Therapies in London works.

In clinical practise the provision of an environment of security and safety is most beneficial for the patient.  A key component is the basis of true empathy, listening to the sufferer’s point of view and carefully listening to their agenda, hopes and aspirations.

As part of the Assessment of patients during the first interview, the subjects are asked their aims and objectives.  This is integral to a true listening approach.  This compliments the true basis of developing an empathic therapeutic relationship, rather than the adoption of an approach from a clinician’s perspective as the principal modality.

Sometimes practical clarification, education specific to their issues and guidance is provided to obtain realistic potentially achievable objectives.

The 3 phase model is applied as suggested by Christine Courtois and John Ford.

The first phase includes;

  • safety,
  • trust,
  • genuine interest in the sufferer,
  • client engagement, education and
  • skill building.

The second phase includes:

  • processing the trauma and
  • managing the emotional dysregulation.

The final phase is  applying realistic changes that the subject has taken ownership of the beneficial tasks.

The mechanism to implement is that of motivational interviewing and utilisation of the principles of transactional analysis, applied through the whole therapeutic process. The 3 phases are fluid, integrative and dependent upon needs of the individual, through the whole therapeutic engagement. At every interview to ensure an optimum therapeutic alliance, constant enquiry to the clients mind set is required. This involves understanding from the patients perspective:  their questions, doubts, conception and their point of view is most useful. The use of open and closed questions, conformational questions and statements ensure the therapeutic alliance.

The nature of the therapeutic alliance is the best predictor of outcome across many models of psychotherapy. This has 3 components: the therapeutic bond, agreement about the task and agreement about the goals.