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23 October 2024

Therapeutic alliance: an under-rated skill

Dawn Miller

Dawn Miller (BSc (Hons), MSc, PgDip) is a Psychotherapist at Cygnet Hospital Beckton, working in total for Cygnet for 13 years, firstly as an Assistant Psychologist before furthering her training.  

 

Dawn initially completed her BSc in Psychology (2.1) and MSc in Forensic Psychology (Distinction) at the University of Kent before starting her career in mental health as a Support Worker over 17 years ago.

On completion of her Post Graduate Diploma in Cognitive Behavioural Therapy at the University of Hertfordshire in 2017, Dawn graduated with Distinction and received the PgDip Cognitive Behavioural Therapy University Prize in recognition of her outstanding results.  

Dawn is a fully accredited member of the BABCP (British Association for Behavioural and Cognitive Psychotherapies). 

Dawn has also been a trained Dialectical Behaviour Therapist for 16 years, having facilitated both group and individual interventions, and has presented at the Society for DBT Annual Conference.  

Dawn co-developed an Adapted DBT Programme at Cygnet Hospital Beckton after recognising the need to improve access to NICE-recommended treatment for those with a learning disability and diagnosis of personality disorder.  

The Programme was awarded the APT Award for Excellence in DBT in 2019 and published in the February edition of CBT Today magazine. 

With a keen interest in integrating third-wave CBT practices such as Dialectical Behaviour Therapy and Compassion Focused Therapy (trained in 2018) alongside both a professional and personal interest in mindfulness, Dawn has a passion for working with those diagnosed with mental health difficulties, specifically Personality Disorder, and the psychological treatment of the associated problems that make life challenging.  She has a desire to widen access to psychological services for those with personality disorders, promote psychological well-being and reduce the stigma associated with mental health difficulties.

Dawn recently wrote a blog entitled; Therapeutic alliance: an under-rated skill?

Her thoughts are below…


‘’Sometimes I’m still surprised when service users say to me ‘Wow, you really understand me’, often after a shared individualised formulation.  It just reminds me that potentially we are the first person who has really listened to them and heard them.  Fully listened to their experience without judgement, heard their perception of things and been able to reflect this back to them in a manner that means they feel heard, understood and validated.  

 

We don’t just listen to the words that are being spoken but we listen to the nuances of what is being said.

 

We, the psychological community and indeed the psychiatric community, often talk about different therapies, different treatment modalities, and different treatment protocols, as we should. But the one thing that is common across all, is the need for a strong and consistent therapeutic alliance, and not just that, but a therapist that is skilful in utilising this alliance and the therapeutic relationship as a vehicle for change.

Unfortunately, I think this is a skill that is widely dismissed and seen as less important than the therapy itself, and yet without the therapeutic alliance, therapy itself cannot take place in a manner that is going to bring about change and ultimately recovery. 

I believe the most important part of therapy is our ability to construct a space in which individuals feel safe enough to explore their experiences.  Where we are able to be a sounding board for them, without judgement, in order for them to be able to make their own connections to shape their understanding to move towards acceptance and/or change.

The therapeutic alliance allows us to stand alongside our service user as an ally, and confidently say ‘we’ve got this, we will find a way forward’.  I think at times this can be translated by individuals outside of the therapeutic space, as us always agreeing with our service users and blindly taking their side of disagreements with others.  But an ally isn’t somebody who just agrees with them, an ally isn’t somebody who just says they’re right.  An ally is somebody who holds them to account and an ally is somebody who helps them reflect on things that need to be changed.  The therapeutic alliance allows for these challenges while maintaining a therapeutic relationship. 

 

Sometimes we are there to be the voice of those who have not been heard before until they get the required skills to be heard on their own.

 


Sometimes people listen, but do they truly hear what is being said to them, and allow the other to be heard?  

That is our superpower as a skilled psychotherapist.

 

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