I think I heard this old Beatles song on the radio not too long ago, and it made me think about therapy. Is it possible that, to overcome difficult mental health problems, all you really need is love? Not creepy love from a creepy therapist but caring, attention, responsiveness, warmth, empathy and all that good stuff that makes up a strong therapy relationship. Indeed, some of the research on how therapy works suggest the therapy alliance is very important. A good therapy alliance predicts stronger outcomes across several different mental health problems, types of therapy, and ways to deliver therapy (e.g., Internet-delivered therapy) (Flückiger et al., 2020).
In some cases, though, the type of treatment you receive could be a better predictor of your outcomes. Moreover, instead of a good relationship predicting better outcomes, sometimes better outcomes/symptom change predict a better relationship (Strauss et al., 2018). This makes sense. If a therapist were really helping me, I might feel closer to and work better with them. If I’m noticing that my mood is improving, I might be more willing to collaborate with the therapist and take their suggestions seriously, and I might feel more understood (they must understand me if they’re helping me). Consistent with this research, in DBT, we view the therapy relationship as necessary but not sufficient to help people learn to build lives worth living.
We believe that, in order to learn to build a life that’s worth living, most people need to learn new things. We refer to these new things as skills or behaviours.
Imagine if you were in training to be an air traffic controller.
In Training School #1, they provide you with book knowledge and hands-on training and practice in various technical skills (operating equipment, making sense of radar, making calculations that determine appropriate take off and landing windows, etc.). They also take you through simulations of disastrous events, and you get practice in how to avoid or manage them. Your instructors are kind and understanding, and you have the sense that they’re invested in you as a student.
In School #2, the instructors tell you that, to be an effective air traffic controller, all you need is a supportive training environment. You’ll blossom on your own, as long as your instructors are warm, caring, empathetic, and responsive. If you feel accepted and respected as a student, you’ll finish your training with all you need to jump into a high-pressure job at a busy airport.
Which group of students is likely to succeed on the job? While those from School #1 will have the technical skills to smoothly execute their job functions, students from School #2 will watch in dismay as planes crash and miss the runway, balls of fire erupt, people run screaming, and the airport starts to look like some kind of post-apocalyptic nightmare.
If you’re in DBT, it’s really important for you to have a therapist that you connect with, feel understood by, and are willing to work with. This is essential.
If the instructors in School #1 were a bunch of jerks, and the students couldn’t trust or stand to be around them, they’re probably not going to learn the skills they need. Similarly, in DBT, you need a good therapy alliance.
To piece together a life you’re happy with, though, you also probably need to learn new things. It’s crucial to learn to be a competent air traffic controller, as lives are in your hands.
When you’re learning to build a life worth living, your own life is in your hands. Make sure you have the skills to take good care of it. ~Alexander L. Chapman, Ph.D., R.Psych.