Patient Perspectives on the Military Uniform in Psychotherapy and the Influence on Therapeutic Bond Alliance

Background: Individual treatment outcome in mental healthcare strongly correlates with the therapeutic relationship. Healthcare studies show that therapist clothing influences patients’ trust. In military mental healthcare, wearing a military uniform may facilitate the therapeutic bond. However, previous findings suggest that a military uniform may also negatively influence therapy and openness about sensitive themes like substance use. This study therefore compared the influence of military and civilian attire on the therapeutic bond alliance in military mental healthcare. Methods: Before start of therapy, 142 Dutch military mental healthcare patients completed the Bond Alliance subscale of the Working Alliance Inventory together with four extra questions about confidence in the therapist, discussing personal topics and discussing substance use specifically. Respondents completed all items both for a military uniform and civilian attire. Results: Average ratings showed very small differences between clothing styles. For Bond Alliance, civilian attire ratings were slightly more positive, although most respondents (79%) showed no preference for either clothing style. Confidence and comfort in discussing personal topics and substance abuse was rated more positive for the military uniform; while the majority of respondents (65% and 77%) remained neutral to clothing style, of patients with a preference, most favored the military uniform (29% and 17%). Conclusion: Military or civilian clothing style did not substantially influence the anticipated therapeutic bond. Interestingly, a military uniform does not harm and may even help military patients to discuss sensitive themes including substance use. Further research is needed to understand the impact of clothing style in relation to other factors like military rank, symptomatology and therapist behavior.