• Jonathan Pittam

Why all managers need to understand the 'therapeutic alliance'



“Everybody has won, and all must receive prizes”


The above is a well-known line from chapter three of Lewis Carroll’s ‘Alice’s adventures in wonderland’. It's famously been applied to the world of psychological research into which talking therapies are the most effective, with it seeming that they all have an equal moderate effect. None any more so than the others.


It goes by the name of the 'Dodo bird conjecture'


Introducing the Dodo bird


Clinical psychologist, and researcher Dr Richard Bentall in his 2009 book ‘Doctoring the mind’, states that, “The evidence supporting the Dodo bird conjecture suggests that non-specific factors, and specifically the quality of the relationship between the patients and the therapist, have a significant influence on outcomes”.


Obviously, we must be careful not to imply a cause where there may only be an ‘effect’, but relationship quality definitely appears to play a larger than once thought role in therapeutic outcomes.


Into the laboratory


In describing research that he conducted personally into the matter, Dr Bentall says, “Using conventional statistical techniques we found, as expected, that the quality of the alliance as rated by the patients predicted improvements in both positive and mood symptoms, eighteen months after the start of treatment”.


There are obviously other factors that have an influence, such as the competence of the therapist, but the above research adds to the previous literature the importance of a strong relationship and working alliance between the therapist and the person struggling.


So, what exactly is a therapeutic alliance?


Dr Bentall describes the therapeutic alliance as, “the willingness of the patient and therapist to work together on the basis of a shared understanding of the patient’s problems”.


This alliance appears to be a powerful predictor of outcomes from therapy. Although we have to be careful not to assume its everything and forget other elements, it definitely needs to be considered if we want a successful outcome.


What does this mean for managers?


Whilst managers aren’t counsellors, there is definitely something to be taken away from the Dodo bird conjecture and therapeutic alliance and brought into the workplace.


Good relationships are a key component of leadership, and a key foundational component of providing support for struggling team members. Managers who are wise to this fact will be better placed to reduce mental health related absenteeism and staff turnover.


According to Dr Bentall, “The ability to form a strong therapeutic alliance is undoubtedly a skill that is likely to affect the outcomes of any kind of treatment”. If part of the therapeutic alliance involves showing respect, giving hope, and empathising with those struggling, which it appears to do, these are skills essential for all managers to carry in their toolboxes, not just nice-to-haves.


On the flipside


With the research showing that how well a patient views their relationship with the therapist to be a key predictor of a successful outcome, the reverse also seems to be true. Those that struggle to relate to their patients have worse outcomes.


A 2018 article in the British journal of psychiatry, examined the mental health outcomes of those in inpatient care, and found that those with poor relationships with the staff experienced worse outcomes. Particularly factors such as staff being overly critical and controlling had a negative impact on health outcomes. Food for thought managers...


Taking this into the workplace


As I mentioned earlier, managers aren’t therapists, and their team members are not their patients. But the Dodo bird conjecture highlights the importance on the effects a good relationship can have on how quickly and well an individual recovers from their struggles.


A manager who can form a strong alliance with a struggling team member, based on empathy, respect and the ability to instil hope, is likely to be the manager (all other things being equal) that sees the lowest levels of mental health-related absenteeism, presenteeism, and staff turnover.


A win for employees and businesses…



Jonathan Pittam Mental Health Educator