The Therapeutic Alliance in Mental Health Services: A Politico-Critical Analysis of Knowledge and Power

The therapeutic alliance in mental health services has been researched extensively especially with regards to care provider and care receiver characteristics that may affect therapeutic outcomes. In the literature, it seems to be commonly assumed that the alliance has an inherent power imbalance in favour of the professional. Beyond this assumption, research on the knowledge-power balance in the alliance is limited.
The aim of the study was to explore the dominant discourses related to the balance of knowledge and power in the therapeutic alliance in mental health services. An additional interest was the role that these identified discourses may play in the positions occupied by care providers and care receivers in the alliance. A final objective was the identification of care provider and care receiver knowledge needs in relation to the management of the knowledge-power balance in the alliance in a manner that may enhance therapeutic effects.
Ten semi-structured interviews were conducted involving individuals who were receiving psychiatric care in the inpatient setting at the state psychiatric hospital in Malta. The second phase of this study involved the analysis of the Medical and Nursing records that pertained to the ten participants who had been interviewed. A Foucauldian Discourse Analysis framework was used to guide the study and Foucault’s concepts of knowledge and power served as the theoretical underpinning of the study.
The care receivers’ contribution to the discourses pertaining to the knowledge-power balance in the alliance led to the identification of four different types of alliances with distinguishable knowledge-power characteristics. Three discursive themes were identified from the Medical and Nursing records and these were perceived as being complementary to the findings that emerged from the care receivers’ interviews. Finally information related to the potential knowledge required by care receivers and care providers in order to manage the knowledge-power balance in an effective manner was extracted from the data and presented together with recommendations