In most conversations about improving mental health care, the therapeutic alliance is treated as a soft skill. Important, yes, but secondary to the “real” work of diagnosis and medication. Myleme Ojinga Harrison thinks that framing has the order backwards.
Dr. Myleme Ojinga Harrison, a board-certified psychiatrist and president of The Carter Clinic, P.A., which operates twelve locations across North Carolina, treats the alliance as infrastructure. Not a warm addition to clinical care, but the surface on which clinical care actually runs. Without it, he argues, the accuracy of the diagnosis degrades, medication adherence drops, and outcomes plateau regardless of how sophisticated the treatment plan looks on paper.
What the Alliance Actually Does
The therapeutic alliance determines what a clinician is permitted to know. An adolescent who does not trust their psychiatrist will not disclose substance use, self-harm, or the family dynamics that are driving their anxiety. An adult who feels condescended to will nod through a medication review and quietly stop taking the prescription on the way home. In both cases, the clinician is operating on incomplete data, and the resulting decisions reflect that gap.
Harrison frames this directly. When clinicians lead with pathology rather than partnership, patients disengage, and disengagement looks like treatment failure even when the underlying clinical reasoning was sound.
“Therapeutic alliance in this population must be earned. That starts with attunement to power dynamics and language use.”
What Builds It
At The Carter Clinic, alliance-building is trained, not assumed. Clinicians are expected to use developmentally appropriate language with adolescents, to remember and use preferred names, and to ask about non-clinical goals as part of every intake. Harrison has discussed the specifics of building trust with adolescent patients in previous interviews, where he emphasized that remembering a preferred name or asking about a non-clinical goal is not small talk, it is the mechanism by which a young person comes to believe they are being treated as a whole person rather than a diagnosis.
Consistency matters as much as content. Myleme Ojinga Harrison emphasizes that the same clinician should be present for the same patient across visits wherever operationally possible. Follow-ups are scheduled deliberately. Messaging between visits is held to the same standard as in-person conversation. These are not relational flourishes; they are the mechanics by which predictability, and therefore safety, get communicated.
When Resistance Shows Up
A patient who is guarded, dismissive, or openly hostile is often treated as a clinical obstacle. Harrison reframes resistance as clinical data. It is the patient telling the clinician something about prior experiences, about fear of judgment, about the stigma they are carrying from family or community.
The response he trains into his clinicians is steadiness rather than escalation. Do not try to break resistance. Do not lecture. Follow through on whatever was promised at the last visit, because that is the single most efficient trust-builder available. Adolescents in particular notice when an adult keeps a small commitment, and they notice when one is quietly dropped.
The Family as Part of the Alliance
Especially in adolescent care, the alliance extends beyond the patient. Parents who feel pathologized, blamed, or bypassed often sabotage treatment, sometimes without realizing it. Harrison’s model brings families in from the outset, with structured psychoeducation sessions and clearly defined roles in monitoring and reinforcement.
The framing is strengths-based rather than deficit-based. Families are not told what they are doing wrong. They are equipped with language and strategies that make the clinical plan implementable at home. In conditions like ADHD or mood disorders, this is often what determines whether treatment gains hold between visits or evaporate.
Why This Belongs in Operational Planning
Harrison’s argument, ultimately, is that the alliance cannot be sustained by individual clinician effort alone. It has to be protected at the organizational level. Scheduling systems that constantly shuffle patients between providers undermine it. Visit lengths that foreclose meaningful conversation undermine it. Documentation burdens that push clinicians to stare at a screen rather than a patient undermine it.
Leaders who treat alliance as soft, and therefore expendable, end up with clinicians who are technically competent but relationally unable to do the work their training actually requires. The gap does not show up in the quarterly dashboard. It shows up in the patients who do not come back, and in the ones who come back worse.
For Myleme Ojinga Harrison, building alliance into infrastructure is what separates a mental health system that functions from one that merely processes volume. It is also, he would argue, what separates psychiatry from any other kind of prescribing.
Sources & Further Reading
• Dr. Myleme Ojinga Harrison — Official Site
• Building Trust in Adolescent Psychiatry (The Hype Magazine)