Key Points:

• 1. Therapeutic alliance
• 2. Therapeutic fit
• 3. Compass for change

In the space of mental health, the importance of the therapeutic alliance is essential. It can be described as the trusting and collaborative relationship between a client and therapist that forms the cornerstone of successful therapy outcomes (Cuncic, 2023). This bond goes beyond professional interaction; it is a dynamic connection that fosters an environment where personal development and change can prosper (Ardito & Rabellino, 2011).

One key aspect of this alliance is the concept of the right therapeutic fit. Just as every individual is unique, so too are their needs and preferences in therapy. The right therapeutic fit is the interplay between a client and therapist where personalities, communication styles, and therapeutic approaches align. Like a tailor-made outfit, the right fit ensures that the therapeutic process is not only effective but also comfortable for the client.

When clients feel a genuine connection with their therapists, it creates a safe space for vulnerability, authenticity, and self-exploration – which serves as the greatest indicator of therapeutic success. A mismatch, conversely, can impede progress and leave clients feeling unheard, unresolved, or misunderstood.

Therapists who prioritize establishing a strong therapeutic alliance demonstrate empathy, trust, respect, active listening, and a genuine commitment to their clients’ well-being. The therapeutic alliance is not established overnight, however as clients navigate the often-challenging journey of self-discovery and growth, the therapeutic alliance becomes the compass guiding them toward healing and resilience. Research shas shown that the quality of therapeutic alliance acts as a dependable predictor of positive therapeutic engagement, motivation and clinical outcome – independent of the psychotherapeutic approach used (Ardito et al., 2011).

In essence, the therapeutic alliance and the right therapeutic fit are not just abstract concepts; they are the heart and soul of effective therapy. By recognizing and nurturing this alliance, clients and therapists co-create a transformative space where change and personal growth become not only possible, but probable.

Tips to make your therapy experience better include giving it a few sessions before deciding if the therapeutic alliance/fit feels right, not being afraid to ask questions about the process, making sure you feel heard, seen, understood and collaborated with, expressing your needs, providing feedback to your therapist, reflecting on your therapy journey, and keeping the lines of communication open about your changing goals and needs.

Natasha Vujovic, M.Psy, R.P (Q) is a Registered Psychotherapist (Qualifying) at CFIR. She works with individuals and couples experiencing a wide range of psychological and relational difficulties including anxiety and stress, depression, mood and grief, relational conflict, trauma, life transitions, personality, body-image, marital and pre-marital, internal conflicts, family dynamics and self-esteem. Natasha is an integrative therapist pulling from psychodynamic/analytic theories and takes a collaborative and honest approach to session.

References:

Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology, 2, 270. https://doi.org/10.3389/fpsyg.2011.00270

Cuncic, A. (2023, November 30). Why a Therapeutic Alliance Is Important in Therapy. Verywell Mind. https://www.verywellmind.com/the-therapeutic-alliance-2671571

Imagine having to over-explain your experiences of discrimination to a therapist, just to have that very same experience invalidated. It’s as though what you’ve just shared did not happen. You’re left confused, feeling misunderstood, and questioning your reality. Perhaps feeling worse than before meeting your therapist, why would you even continue?  

This surprisingly common experience highlights the importance of cultural competence—the understanding and acceptance of norms other than your own. This requires more than simply following a checklist; it requires the ability to openly embrace different ways of being, which at times, you may disagree with. In Canada, there is a clear—and striking—underrepresentation of ethnic and sexual minorities in the mental health profession. What are, if any, the practical consequences of this, one may ask? 

The Ontario Health Study tells us that mental health services are consistently underutilized in minority communities. Interview-based research gives us some insight as to why. A common thread in these studies is that many individuals encounter varying forms of discrimination (i.e., both “microaggressions” and overt discrimination) from professionals and begin to feel like “therapy is not for them”.

Mental health does not discriminate—and as unfortunate as this is, the data suggests that your care provider may. While there is an active effort to understand and teach the ability to perceive and appreciate subtle differences in the cultural experiences of any given client, at times there simply may be no substitute for shared experience. 

Demographic factors are not the only thing to take into consideration when selecting a therapist, but clients should not be made to feel ashamed if they choose to do so. By and large, most clinicians offer free consultations. Meet with them. See what they are like. Be explicit with your concerns and ultimately, you make the decision if you feel understood—whether the therapist looks like you or not.

Ola Kuforiji, M.A., is a registered psychotherapist (qualifying) at the Centre for Interpersonal Relationships. He provides therapy with for individuals and couples (with a special interest in ethnocultural and sexual minorities) under the supervision of Dr. Lila Z. Hakim, C.Psych.

These days, finding the ‘right’ therapist can be an involved process. Part of the challenge is that there are so many distinct kinds of psychotherapy. Some of the better-known forms of therapy include cognitive-behavioural therapy (CBT), psychodynamic therapy, and client-centered therapy. With so many different approaches, you may find yourself wondering, “How do I know which approach is right for me?”

Fortunately, therapists at the Centre for Interpersonal Relationships (CFIR) are trained in a wide array of major therapeutic approaches. Moreover, many therapists increasingly recognize the value that each approach brings. For instance, CBT can help people develop healthier ways of thinking and behaving, while psychodynamic therapy can help clients better understand their personality and improve their relationships. So, it’s easy to wonder, “Why not take advantage of both approaches?“

Great question! In light of the unique strengths of each form of therapy, therapists are increasingly incorporating elements of different approaches to meet the individual needs of clients; this practice is referred to as ‘integrative therapy.’ In essence, integrative therapy is an evidence-based approach that makes use of the wisdom and tools contained in a variety of other psychotherapy traditions. Importantly, there is also excellent research demonstrating the high value and effectiveness of integrative therapy.

There’s an interesting quote that I believe nicely illustrates the flexible and adaptive nature of this approach:

“If all you have is a hammer, everything looks like a nail.”

Abraham Maslow

By taking advantage of the rich diversity of tools found in the best approaches to therapy, integrative therapists can flexibly respond to the diverse challenges and concerns that clients face. As a result, clients often report feeling understood as a person, instead of as a diagnosis or problem. So, if you’re wondering which type of therapy is right for you, integrative therapy might be just what you’ve been seeking.

Adam Blake, M.Sc., is a therapist at CFIR’s Toronto location. Adam provides individual therapy with adults who struggle with anxiety, panic, OCD, depression, trauma, dissociation, attention deficits, issues related to sexuality and relationships, self-worth, assertiveness, spirituality, and vocational/work concerns. His approach to psychotherapy is integrative and draws on empirically-supported principles from well-established traditions, including humanistic, existential, cognitive-behavioural, psychodynamic, and acceptance and commitment therapy.

It is estimated that 1 in 5 Canadians will experience mental health difficulties each year (https://cmha.ca/media/fast-facts-about-mental-illness/). These high rates suggest that not only is it important to recognize the symptoms of mental health difficulties, but it is equally important to be aware of treatment options. Treatment for mental health disorders may include self-help (e.g., books, apps, peer support), medication, individual, couple, or group psychotherapy, or a combination of medication and therapy. 

When considering treatment options, recent research indicates that patients with depressive and anxiety disorders were more likely to refuse medication, and more likely to engage in psychotherapy.(1) The researchers thought that this is due to patients recognizing that their problem may not only be biological and that there are no quick fixes for mental health. This is really important data – it tells health care providers and patients that psychotherapy should be offered as front-line treatment. 

Psychology Month, which takes place in February, is a month devoted to highlighting how psychology can help others live a healthy and happy life, improve workplace environments, and help governments to develop good policies (see http://www.cpa.ca/psychologymonth/). In celebration of this month, here are five things to know about seeking treatment through psychotherapy. 

1.  Acknowledge when you need help. It can be really hard to say to ourselves, “okay, I need help.” Naturally, we will try everything we can before we seek help from others. I understand needing psychological help as the equivalent of needing to expand our toolbox. It’s like trying to dig out of a hole when all you have is a shovel. So, what do you keep doing with only a shovel? You keep digging, and digging, and digging, only to keep getting stuck. Give yourself permission that it is okay to need help – and that identifying this is, in fact, a true strength. Once you have begun to see this, don’t wait! Don’t wait until you are no longer able to go to work or see friends. 

2.  Find a good match – and then be authentic. The old adage of “if at first, you don’t succeed, try, try again” is applicable to finding the right therapist. Psychologists and psychotherapists work from many different treatment models, including cognitive-behavioural therapy, acceptance and commitment therapy, emotion-focused, psychodynamic, and integrative models of treatment. (For more information on what these models look like, check out https://cfir.ca/DifferentTreatmentsArticle.php). Therapists will also have their own style with clients. The fundamental piece of finding a good therapist is that you feel connected, understood, and validated by the therapist. We know that a large factor of change that happens in therapy comes from the relationship you have with your therapist.(2) If you do not feel a good relationship within the first few sessions, try addressing it with the therapist, or don’t be afraid to find someone else. Be sure to maintain an open and authentic stance with them – share your thoughts and feelings to help them get to know all of you so that together you can make meaningful change. 

3.  Try out new skills and tools. The media often shows a typical therapist in a sweater vest, sitting in a chair with glasses and a notepad, while their patient lies on a couch and stares at the ceiling. Psychotherapy has greatly changed with the increasing use of tools over and above talk therapy, including learning to calm the nervous system with breathing and mindfulness techniques, challenging unhelpful thoughts or processing difficult emotions, and learning communication tools. Therapy also looks to explore and understand your current perceptions and emotions, and how these relate to your early experiences. This can help to understand key themes contributing to your difficulties today. We are complex beings – with a history of experiences with parents and caregivers, friendships and romantic relationships, and bosses and employers. We carry our early experiences with us, like packaged up suitcases. But sometimes we don’t look in the old luggage to understand it – so we stay stuck. Once you learn new tools and gain new insight, apply these to your everyday life to help make changes.(3)  

4.   It will get harder before it gets better. Clients often feel a sense of relief following the first or second session when they begin to tell their story, acknowledge that they need help, and feel understood by another person. However, therapy can become more challenging as one begins to make changes or is faced with identifying their difficulties or beliefs that are contributing to them getting stuck. 

5.  Change takes time – so stick with it. Research shows that over fifty percent of clients see improvements in their difficulties with an average of 12 sessions.(4) Change does not happen immediately, and it will depend on the severity and chronicity of symptoms. A client once disclosed frustration after several sessions, stating that she “should already be better,” and that she must be a failure if she has not already improved. Change in psychotherapy is not black or white – nor is it a pass or fail. Allow yourself to get stuck and experience the difficulties that are coming up from therapy, and recognize some of the small pieces that are changing in your life. 

To find out more information about seeking services from a psychologist or psychotherapist at CFIR, visit https://cfir.ca/WhatToExpect.php .

REFERENCES

1. Swift, J.K., Greenberg, R.P., Tompkins, K.A., & Parkin, S.R. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy, 54, 47-57.

2. Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277.

3. Ronan, K. R., & Kazantzis, N. (2006). The use of between-session (homework) activities in psychotherapy: Conclusions from the Journal of Psychotherapy. Journal of Psychotherapy Integration, 16(2), 254-259.

4. Hansen, N. B., Lambert, M. J. and Forman, E. M. (2002), The Psychotherapy Dose-Response Effect and Its Implications for Treatment Delivery Services. Clinical Psychology: Science and Practice, 9: 329–343. doi:10.1093/clipsy.9.3.329