Maintaining motivation and preserving the therapeutic alliance as tools to overcome treatment-resistant depression

Therapeutic alliance plays a key role in understanding and addressing treatment resistance in depression, both for psychotherapeutic and pharmacologic interventions. By considering the shared goals, agreed-upon tasks, and trusting bond between therapist and patient, it is possible to identify factors contributing to reduced treatment response. Regardless of the treatment modality, a stronger therapeutic alliance is associated with greater symptom improvement. Interventions that focus on the patient first, acknowledge and manage transference, and help the patient make meaning and work toward understanding and healing enhance therapeutic alliance. These concepts and techniques are equally important whether treatment is done in person or via telehealth or using other technology-based interventions.