The global COVID-19 crisis is radically reshaping mental health care delivery. High touch services are compelled to instantly migrate to high tech. There is a frenzy to master new telehealth modalities and meet prerequisite regulatory requirements. Let’s take a deep breath and refresh our most cherished resource: the working alliance.
Counseling is a “partnership for change” conspiracy. [1] Let’s place the accent on how important it is to maximize the benefits of that partnership; whether conversing in shared personal space or cyberspace. Taking the alliance online represents a substantial challenge. This need not threaten progress if helpers take stock of conditions and give attention to the core components of the alliance.
Mistrust spreads as rapidly as a virus. Consider these alliance risks:
The prevailing national suspicion and skepticism are contagious. This could dampen the interpersonal connection between counselor and client.
The pandemic is anxiety-provoking. Clients in the midst of a mental health crisis will undoubtedly absorb the widespread panic when facing this tidal wave of unknowns. Phrases such as “stay-at-home”; “shelter-in-place”; and “safer-at-home” are common. These public health strategies promote social distancing- the best strategy to inhibit the spread of this disease. These messages run counter to the common interventions that MHPs prescribe, namely, the movement towards greater social engagement and support.
Furthermore, clients in our care must push through relational turbulence with those sharing their home. Conforming to the new normal means remaining sequestered in close quarters without community contacts to provide relief or active social routines to generate renewal. These realities strain clients and subtly contaminate therapeutic partnership.
Finally, let’s bear in mind that telehealth means serving clients directly in the environment where echoes of conflict may still be reverberating.
The therapeutic alliance is not merely a sentiment of goodwill or easiness in conversation. Counseling partners join forces to achieve change. The alliance represents an earned mutuality that thrives on a nurtured bond of affirmation, a cooperative approach to tasks, and clear communication regarding goals and outcomes. [2] As helping conversations transcend physical distance via technology, it is critical to apply our attuned listening skills and practice immediacy. In short, the counselor and client must attend to novel obstacles undermining the working alliance.
The COVID-19 preventive strategy is to Do the Five: 1. Hands: wash them often; 2. Elbow: cough into it; 3. Face: don’t touch it; 4. Feet: stay 3 feet apart; and, 5. Feel sick? stay home. [3]
Intentional therapists will strive to apply the Therapeutic Five to successfully take the alliance online:
Tasks. Adjust, be reasonable, realistic, and check for agreement.
Bond. Nurture connection by verbally expressing empathy using explicit statements.
Goals. Show how coping now with immediate circumstances builds long-term skills.
Review. Identify strong partnership moments and celebrate the accomplishment.
Reflect. Keep learning how each unique partnership works best in these new conditions.
[1] See Chapter 10 “Therapeutic Alliance and the Significant Self” in Assessment for Counseling in Christian Perspective. [2] These alliance features derive from the model by Edward Bordin (1994). [3] World Health Organization (WHO). https://www.who.int/news-room/detail/23-03-2020-pass-the-message-five-steps-to-kicking-out-coronavirus