Harvard Mental Health Letter

The therapeutic alliance: Its effect on other relationships

Even psychotherapy that is helpful in other ways can interfere with the patient's social support system — the advice and comfort, encouragement and moral support of family, friends, and others. That suggestion comes from an article in the Harvard Review of Psychiatry. Its author, Harvard psychiatrist Richard Schwartz, says that it's a subject mental health professionals don't think about but should.

One reason they don't pay much attention to the issue is that psychiatric disorders themselves are often so damaging to human connections that it seems almost self-evident that any therapeutic effort can only improve them. In fact, there is good evidence that psychotherapy for major depression strengthens social connections — which is not surprising since isolation is a common result of depression. And couples therapy usually improves the couple's relationship, although less is known about its effect on their relationships with outsiders.

But beyond that, the evidence is scarce. Swedish investigators, reviewing studies of psychotherapy and psychoanalysis, found that although patients usually benefited in the long run, their social relationships (as measured by a questionnaire called the Social Adjustment Scale Self-Report) tended to deteriorate somewhat at the beginning of treatment and never recovered fully.

To continue reading this article, you must login.
  • Research health conditions
  • Check your symptoms
  • Prepare for a doctor's visit or test
  • Find the best treatments and procedures for you
  • Explore options for better nutrition and exercise
Learn more about the many benefits and features of joining Harvard Health Online »