Therapeutic Alliance can be Helpful or Harmful in Early Psychosis, Depending…


Research lead by Richard Bentall of the University of Liverpool finds that the quality of the therapeutic alliance (TA) in treating early psychosis, long known to be instrumental in achieving positive outcomes, can also lead to poorer outcomes when the quality is negative. “This is the first ever demonstration that TA has a causal effect on symptomatic outcome of a psychological treatment, and that poor TA is actively detrimental, these effects may extend to other therapeutic modalities and disorders,” the authors conclude.

Article →

Previous articleCherokee Nation Sues J&J Over Risperdal Deception
Next article“10 Things I’d Tell My Former (Medicated) Self”
Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. …so how can forced incarceration and drugging be good for a patient? There is certainly no positive therapeutic alliance there.

    Ditto for forced “outpatient care” with depot drugging and the like. It is purely torture and is actively designed to harm a person, and yet psychiatry has managed to get it mandated into law!

    …..and further, how can be going to see a psychiatrist who uses “diagnoses” which amount to little more than abusive labels possibly be good for a person – even if there appears to be a “positive alliance” it operates purely in the service of making the the patient complicit in their own destruction.

    I freely acknowledge that some therapies/therapists can be helpful if there truly is freedom and respect in the process, but as soon as psychiatry, diagnoses, and drugging come into it, it can only harm the patient.

    Report comment

    • Good points, this study is evidence all forced psychiatric “care” is, of course, harmful. And all of humanity, except seemingly the psychiatric industry, knew defaming people with invalid “mental illnesses,” then torturing and killing people, was grotesquely unethical behavior after WWII. Let’s hope today’s psychiatrists wake up and realize the impropriety of their behavior soon.

      Report comment

  2. Why are they even concerned whether therapy can be either “helpful or harmful” in “first psychosis” since it is now mostly determined and, of course, denied by Big Pharma and the “mental illness industry” including psychiatrists, LCSW therapists, and NAMI that most psychoses are caused by the anti-psychotics, anti-depressants, benzos, mood stabilizers and all the other drugs and stuff they try to coerce and “force feed” into to us “for our own good.”

    Report comment

    • The only time I got anything that could be defined as psychosis was after the anti-psychotics, anti-depressants, benzos, mood stabilizers…

      So if they can cause psychosis in someone that didn’t have it before how can they really do anything but make the condition chronic ?

      Why with all these new treatments the “Psychopharmacology revolution” do we have MORE mentally unwell people than ever before ???

      The treatments themselves is the only logical answer.

      Report comment

    • My first “psychosis” was after I was prescribed an “antidepressant” and an “antipsychotic.” Apparently, the psychiatric industry is unaware of the fact that poly pharmacy with such psych drugs, or the benzos for that matter, are known to cause anticholinergic toxidrome, a symptom of which is “psychosis.”

      This is particularly disconcerting now that the “standard of care” for depression is to add Amblify (an antipsychotic) to the antidepressants.

      Report comment

  3. I read the Article → and its Gobbledygook !

    -Language that is meaningless or is made unintelligible by excessive use of abstruse technical terms; nonsense.

    Of course those hell holes called hospitals destroy the therapeutic alliance.

    They are prisons complete with strip searches, locked doors, threats to coerce awful drugs or assaults to force them… The “therapeutic alliance” , they have got to be kidding me.

    You go in with “psychosis” and come out a drugged up zombie with PTSD !

    Why all this gobbledygook ? Use real words please.

    Report comment

  4. Though common sense, this is an important line of research. Talk therapies are a billed as nonharmful, benign, and effective. They can have cause iatrogenic harm like psychotropics. There is rarely any mention by clinicians of risk of worsening which limits informed consent. Many psychotherapists also see some worsening as an indicator of progress and are encouraged by it. Hopefully more of such research will push clinicians to have more honest and thorough conversations about the potential risks of treatment and whether or not the benefits of such treatment outweigh the risks for an individual and lead to less active treatments by clinicians.

    Report comment