Summary of The Therapeutic Relationship Lecture

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