Abstract
Intro: The therapeutic alliance (TA) is a well-established predictor of treatment outcomes, yet traditional conceptualizations are usually dyadic. For individuals with severe mental illness (SMI), contemporary care is primarily delivered in multidisciplinary teams, raising questions about how the TA is established when responsibility is shared across providers. Qualitative research on this topic remains scarce. Methods: We aimed to: 1) conceptualize the modern TA; 2) identify factors that facilitate TA development; 3) provide an initial exploration of a treatment team alliance; and 4) formulate practice-oriented recommendations for TA development. N=13 mental health professionals (MHPs), including peer support workers (PSWs), participated in in-depth, semi-structured interviews. Data were analysed using inductive thematic analysis, supported by iterative coding, researcher triangulation, member-checking, and peer-debriefing. Results: Participants described the TA as dynamic, reciprocal, and context-dependent and identified the relational component as its foundation. Key facilitators included genuine listening, authenticity, transparency, reliability, balanced professional boundaries, and collaborative decision-making. Protocolization, time constraints, and authority were identified as barriers. In team-based care, participants emphasized consistency, effective communication, and self-reflection among MHPs, and a designated point of contact for service users. Conclusion: Our findings emphasize the importance of establishing a connection before starting protocol-centric treatment.