Therapeutic alliance - or how to build trust with your clients

I can spot a McGill trained doctor at 50 paces.

My brother-in-law was trained at McGill. So was the internist who diagnosed my Dad's cancer. And my friend's plastic surgeon wasn't McGill trained, but his father and uncle were, and it clearly rubbed off on him.

So what did they learn at McGill that enables them to be such extraordinary doctors? Therapeutic alliance.

As a lay person, I can't speak with any authority on this. I can only share what I've observed.

Take my brother-in-law. Despite practicing obstetrics - the most litigious medical specialty in the States - for the past 30 years, not one of his patients has ever sued him.

Wikipedia says therapeutic alliance

refers to the relationship between a health care professional and a patient. It is the means by which the professional hopes to engage with, and effect change in, a patient.

So what does this have to do with you? And why is it critical to helping your clients?

It has been found to predict treatment adherence (compliance) and concordance and outcome across a range of patient diagnoses and treatment settings.

Here's an example from my own recent past. When my son-in-law Dave was transferred from a trauma hospital to a local hospital after a catastrophic accident, he refused to let the nurses in the new hospital bandage his leg, and so my daughter, Emily, took over. He insisted that Emily was the only one who did the bandages properly, and student nurses were brought in to observe her in action.

Emily has no medical background. In fact, she's a 21-year-old sheet metal apprentice. So I asked how she was able to do this, and she said, "I listen to him. He knows what works, and that's what I do."

Indeed! And that's what's unique about all three McGill-trained doctors: When they're with their patients, they aren't taking notes or lecturing. They're sitting with their patients, giving them their undivided attention, and listening. As one doctor said to me, "Often you don't need a lot of expensive tests. If you really listen to your patients, they'll tell you everything you need to know."

Like Dave, I don't trust professionals who dismiss what I have to say and won't take the time to listen to me.

Therapeutic alliance is usually discussed in the context of health care and therapy. But whether you're a teacher, a nurse or a frontline worker, your success depends on being your clients' ally. And partnering with your clients doesn't mean "knowing what's best" or "knowing how to fix it." It means building a relationship of trust with your clients.

Instead of assuming you know what your clients need and jumping in with solutions that may or may not work, try this:

• Ask questions to find out what your clients really want.
• Listen to what they have to say in a way that respects and honours them.
• Provide them with the information they need, and make suggestions.
• Encourage them to use that information to create their own solutions.
• Trust that, in most cases, the solutions they come up with will be the best solutions for them.

For those of you who want more information, an article entitled Therapeutic Alliance, Focus, and Formulation: Thinking Beyond the Traditional Therapy Orientations by Robert-Jay Green offers great insights into the "flavour" of therapeutic alliance. I would also highly recommend Reality Therapy by William Glasser.

For one week, give up listening to respond, fix and solve, and instead listen to understand. And let me know what happens when you do!