This summary includes the The Therapeutic Relationship lecture, which took place at the University of Twente on 12-05-2023. The lecture covered Chapters 7 and 8 of The Individual Book (de Bruin, E., 1st Edition)
Therapeutic Relationship:
“is the basis of everything that happens between client and psychologist”
Alliance
- The Dodo verdict: The factor that most influences the impact of the treatment is the therapist/the alliance
- Alliance consists of the agreement between patient and therapist on the goals of treatment, collaboration on the tasks of treatment, and an emotional bond between patient and therapist (Eubanks, Muran, & Safran, 2018; Bordin, 1979)
- significant predictor of therapeutic outcome (accounts for approximately 7–15%)
Therapeutic alliance, empathy, genuiness:
“Therapeutic alliance is significantly related to therapist empathy and of therapist genuineness (Nienhuis et al., 2018)”
- Alliance work usually involves discussion of therapy goals and means of achieving those goals.
- Empathy expression involves the therapist accounting for the client’s behaviors, emotions, and words, and then reflecting this understanding back to the client.
- Genuineness occurs when the therapist recognizes a “gutlevel” reaction to the client, determines the therapeutic merit of mentioning this reaction, and, if appropriate, divulging this response to the client.”
Building blocks Therapeutic Alliance:
- Collaboration
- Confidentiality
- Clear, goal-directed process
- Managing expectations
The role of the psychologist
- Use your background as a resource in thinking
- Inner experience is not exactly the same as what is verbalized to the client
- This does not mean that the therapist has to be impersonal
Alliance rupture
“when things do not go smooth”
- Deterioration of the alliance = alliance rupture
- Repaired --> when patient and psychologist resume collaboration
- Ruptures of alliance followed by repair associated relatively strongly with better client outcomes compared to unresolved ruptures or no ruptures at all
- Alliance ruptures do predict premature termination of therapy
Repairing a rupture:
- Acknowledge the rupture directly
- Invite patients to explore their experience
- Accept your own part in the rupture
- Develop your own ability to tolerate and explore your own negative feelings
The Therapy process models:
“The therapeutic process begins from a point where the client is immersed in a problematic narrative or restricted by a muted problematic experience”
- During the therapy the client…
- Develops a more external perspective to their problem
- Learns to observe it differently
- Creates contact with and communication among their experiences
Challenges of the process models:
- Passive stance: client as only a provider of information and recipient of directions
- Often the therapist is ahead of the client, hence it is important to work within the zone of proximal development, introducing effective therapeutic interventions while assisting the client in assuming a self-observing stance
Object position, observer position
- Object position: client’s initial experience that they cannot get a hold of the problem or it controls them and their life
From object position to agency
- During therapy, the object position --> observer position: an empowered relationship to the problem, a subject position or agency
- From observer position to agency? the client needs to start observing in ways that support taking an agentic position
Relationality and positions
“Anthony Ryle (1975): a human being learns to relate to oneself based on the conclusions he draws from reciprocal relationships with his primary caretakers”
- Our psychological functioning is always relational, taking a position to something or someone
- “It is not enough to just describe what a client is feeling --> the question is, in relation to what or whom, what is the object of their experience?”
- Core positioning: client takes turns in critical or mitigated positions
- The Therapeutic Relationship aims to explore a network of positionings
Responsiveness
“How the psychologist responds to an emerging context in a manner that facilitates the aims of the therapeutic work, delivering appropriate interventions at the right time (Friedlander, 2012; Kramer & Stiles, 2015; Stiles et al., 2006) --> also known as attunement
Therapeutic Zone of Proximal Development
- The zone that lies between the current therapeutic developmental level and the potential developmental level
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