Stage 2: Building the Therapeutic Alliance

Building relationships with patients is an art form, which requires that a therapist be more interested in the healing qualities of the relationships than in techniques. I use a phenomenological approach in which the therapist attempts to understand the patient's world as it is presented in the therapeutic relationship. This does not mean simply understanding the content of what the patient says, but also the process by which the patient relates to the therapist.

The term I use when training therapists to build therapeutic relationships with patients is "presence." Having a sense of presence in the privacy of the therapy room means that you are there totally for the patient. You bring all of your attention, insight, training, skills, and humanity to the service of the person sitting with you.

Of these, your attention, interest, acceptance, and ability to avoid judgment are the most important. Almost any therapist can learn techniques, but it requires more intense work and much practice to develop this sense of here-and-now presence with a patient. Being present with patients allows them to bond with you in a way that is unavailable to them in other relationships. This is the uniqueness of the therapeutic alliance.



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