Relational interventions in psychotherapy: development of a therapy process rating scale (original) (raw)
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Terms of the Social V: Relational Psychology and Therapy
Psychiatric Times, 2024
Key Takeaways * Relational theory addresses the lack of consensus in psychology and psychiatry by focusing on relational dialogue, self, and psychology. * Relational psychology emphasizes the self-in-relation, socialization, and social skills, positioning it as a social science. * Relational therapy values authenticity, conviviality, and dignity, aiming to contextualize suffering through relational dialogue and empathy. * The theory critiques existing methodologies and proposes relational therapy as a bridge between individual and social dimensions.
Relationship Formation and Change in Psychotherapy: An Analysis of Cases
1995
This study investigates the ne_ure of therapist-client interactions within and acror.s seven actual psychotherapy cases to investigate the assertion within interactional theories that positive therapeutic outcome i.. the result of a transition from relational incongruence to relational congruence. Counselor/client verbal utterances were coded using Stiles' verbal response taxonomy. A measure of counselor and client response redundancy (patterning) served as an index of relational congruence, with higher levels of redundancy reflecting greater congruence. Therapeutic outcome, operationalized in terms of symptom reduction, was assessed using the SCL-90-R psychological symptomology instrument. The Working Alliance Inventory was used as a construct vali-lation measure for the index of relational congruence. A transition from incongruence to congruence was not evidenced in the cases, nor was a relation found between relational congruence and the Working Alliance Inventory. However, there was some support for the hypothesis that therapeutic change (symptom reduction) is related to relational congruence/incongruence. Further research to address the issues raised by this study is needed. (Contains 40 references.) (Author/KW)
2011
Aim: When the duration of therapy is not preset and the outcome is a matter for negotiation, the decision to end psychotherapy will be an experiential concern for the two participants. This case study draws attention to how ambiguities may be settled in a process where ending is initiated by the therapist and resisted by the patient. Method and analysis: The actual case was strategically selected as exceptional owing to a combination of circumstances. The patient and the therapist had developed a ‘good enough’ alliance (WAI) and reached a ‘good enough’ outcome (OQ-45), and still the patient felt she was far from finished. A close inspection of interactional data in sessions together with both patients’ and therapists’ reflections in post-therapy interviews elicited both substantial and structural aspects of this complicated process of ending. Findings and discussion: The discrepancy between therapist and client was not addressed, but rather postponed and actualized again later. Stru...
Behavioural and Cognitive Psychotherapy, 2004
Cognitive analytical therapy (CAT) is becoming increasingly popular in clinical practice, especially in treating patients who receive a diagnosis of personality disorder. This book introduces the principles of CAT, provides a practical description of the tools and techniques involved and explains its relevance to a wide range of mental health problems. I approached the book as someone who has researched the cognitive processes involved in psychological disorders and begun to carry out cognitive therapy in a clinical context. I wanted a better understanding of how cognitive processes might be conceptualized within the context of interpersonal relationships. Like cognitive therapy, CAT is a time-limited psychotherapy that involves the collaborative formulation of current psychological problems in the context of present experiences and past events. Both CBT and CAT also involve active challenging of pre-existing ways of relating to the world, both using techniques of exposure, cognitive reappraisal, problemsolving and role-play. It could be argued that CAT differs from CBT in that its main focus is on relationships, or "reciprocal roles" rather than on the link between thoughts, emotions and behaviour. According to CAT, "the 'permeable' self is seen to have been formed in, and to be maintained through, interactions with others; the internalized relationship dialogue from the past is constantly expressed in, and may be maintained or modified by current relationships" (p. 200). In practical terms, people act out different roles in different situations based on earlier relationships, and CAT helps the patient identify, control and modify these roles both within and between therapy sessions. Introducing cognitive analytical therapy is organized in a user-friendly manner. It first describes the way in which CAT is used within a clinical context, and then explains the main principles of the therapy and their theoretical foundations. Subsequent chapters explain key components of CAT such as the assessment interview, the formulation process (which is in the form of a letter and a diagram of sequential stages), the use of the therapeutic relationship, including the "goodbye letters", that the therapist and patient exchange, and the role of supervision. The last three chapters explain the use of CAT in a range of client groups such as anxiety disorders, eating disorders, substance abuse, psychosis, personality disorders, and "difficult" patients. The end of the book includes a glossary of the main terms, a summary of the evidence-base and the "Psychotherapy File". The Psychotherapy File is an extended questionnaire given to the patient at the start of therapy to allow them to identify key problems in their life ("dilemmas", "traps" and "snags"). Dilemmas reflect apparently irresolvable decisions that are couched in dichotomous terms (e.g. "Either I look down on other people or I fear they look down on me"). Traps are vicious cycles that perpetuate interpersonal problems (e.g. "Feeling uncertain about myself I try to please other people, but this means other people
Psychotherapy Relationships That Work II
This article introduces the special issue of Psychotherapy devoted to evidence-based therapy relationship elements and traces the work of the interdivisional task force that supported it. The dual aims of the task force are to identify elements of effective therapy relationships (what works in general) and to identify effective methods of adapting or tailoring treatment to the individual patient (what works in particular). The authors review the structure of the subsequent articles in the issue and the multiple meta-analyses examining the association of a particular relationship element to psychotherapy outcome. The centrality of the therapy relationship, its interdependence with treatment methods, and potential limitations of the task force work are all highlighted. The immediate purpose of the journal issue is to summarize the best available research and clinical practices on numerous elements of the therapy relationship, but the underlying purpose is to repair some of the damage incurred by the culture wars in psychotherapy and to promote rapprochement between the science and practice communities.
Journal of Contemporary Psychotherapy, 2018
The present study unpacks an important dimension of clinical practice from the therapists' vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists' lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.
Psychotherapy Relationships That Work III
This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome. The expert consensus deemed 9 of the relationship elements as demonstrably effective, 7 as probably effective, and 1 as promising but with insufficient research to judge. What works-and what does not-in the therapy relationship is emphasized throughout. The limitations of the task force work are also addressed. The article closes with the Task Force's formal conclusions and 28 recommendations. The authors conclude that decades of research evidence and clinical experience converge: The psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment. Clinical Impact Statement Question: What, specifically, is effective in the powerful psychotherapy relationship? Findings: Clinicians can use these meta-analytic conclusions and the practice recommendations of the Task Force on Evidence-Based Relationships and Responsiveness to provide what works in the relationship and simultaneously to avoid what does not work. Meaning: Based on original meta-analyses, experts deemed nine of the relationship elements as demonstrably effective, seven as probably effective, and one as promising. Next Steps: Future directions are to disseminate these findings to practice communities, to implement them in training programs, and to examine the interrelations of the effective elements of the relationship.