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Week 3 Question 5 Sara Schouten posted Feb 11, 2026 11:12 AM

It is extremely important that a psychotherapist takes the proper steps to develop a therapeutic relationship with their new patient upon starting an assessment. In Chapter 3 Wheeler mentions how even your introduction to the patient can aid you into setting up a therapeutic alliance. By making a patient feel comfortable, you are allowing them to be open and honest. Getting an accurate assessment on the patient is vital for an accurate diagnosis and treatment plan. Wheeler states that the more engaged the patient and therapist are during the assessment process, the more valid the data obtained (Wheeler, 2022).

One way to facilitate a therapeutic alliance with a patient is to give them open-ended questions where they are able to answer freely. With open-ended questions, the patient feels they have some control and can help to build the rapport (Wheeler, 2022). These opening minutes of an assessment are very important because what the patient states first typically ends up being their chief complaint and the therapist must work to explore that topic.

Another way for a therapist to build the therapeutic alliance is by showing empathy when appropriate throughout the assessment. Through showing empathy, the therapist is proceeding to take a history and is then able to assess how the patient responds to statements like: That must have been very upsetting to see. or It must have been so hard for you to raise your younger siblings. Without showing empathy, the patient may not sense an openness from their therapist and may then withhold information.

I think a therapist also builds a therapeutic relationship through treating each patient assessment as its own individual experience and not necessarily as an algorithm for best practice. For example, Wheeler mentioned time frames within the assessment and what is commonly done, but depending on the patient they may need more time during the free speech section and less time on the MSE. I think a therapist is strengthening the therapeutic alliance by recognizing the needs of each individual patient. Wheeler mentioned this as well in her example with Beth, stating that Beths family history would have been covered earlier in the session as her chief complaint (Wheeler, 2022).

Wheeler, K. (2022). Psychotherapy for the Advanced Practice Psychiatric Nurse, third edition: A how-to guide for evidence based practice. Springer.