Along the same lines, Zetzel () defines the therapeutic alliance as a a distinction between transference and the therapeutic (or working) alliance, and this . capacity, patient commitment, therapist understanding and involvement, .. When the outcome was worse, the curvilinear pattern was weaker. The terms 'transference' and 'countertransference' have developed a wide use in the therapy framework, emotional responses of clients and therapists to each . empathy and understanding, the client . repeated patterns of relationship, as. The Pattern System can help you understand what might be going on in into power struggles with clients with a Controlling or Rebel Pattern. Or the client might have a pattern that is undermining their therapeutic alliance.
Unlike Kivlighan and Shaughnessy, these authors considered therapies consisting of 8 and 16 sessions, using the ARM to rate the therapeutic bond, partnership, and confidence, disclosure, and patient initiative. No significant correlation was observed between any of the four patterns and the therapeutic outcome. However, the authors observed a cycle of therapeutic alliance rupture—repair events in all cases: On the basis of this characteristic, the authors hypothesize that the V-shaped alliance patterns may be correlated with positive outcomes.
In particular, Stiles et al. The results of the study by De Roten et al. According to De Roten et al. De Roten et al. According to Castonguay et al.
This has supported the idea that therapeutic alliance may be characterized by a variable pattern over the course of treatment, and led to the establishment of a number of research projects to study this phenomenon. Discussion and Conclusion According to their meta-analysis based on the results of 24 studies, Horvath and Symonds demonstrate the existence of a moderate but reliable association between good therapeutic alliance and positive therapeutic outcome. More recent meta-analyses of studies examining the linkage between alliance and outcomes in both adult and youth psychotherapy Martin et al.
Thus, it is not by chance that in their meta-analysis, Horvath and Luborsky conclude that two main aspects of the alliance were measured by several scales regardless of the theoretical frameworks and the therapeutic models: This accounts for the difficulties associated with the concept of alliance, which is built interactively, and so any assessment must also consider the mutual influence of the participants.
In a helpful contribution, Hentschel points out that the problematic aspect of empirical studies investigating the alliance is their tendency to view the alliance construct as a treatment strategy and a predictor of therapeutic outcome: The use of neutral observers or the creation of counterintuitive studies is therefore recommended.
From this historical excursus, it is clear that research into the assessment of the psychotherapeutic process is alive and well. The development of a dynamic vision of the concept of therapeutic alliance is also apparent. The work of theorists and researchers has contributed toward enriching the definition of therapeutic alliance, first formulated in Research aimed at analyzing the components that make up the alliance continues to flourish and develop.
Numerous rating scales have been designed to analyses and measure the therapeutic alliance, scales that have enabled us to gain a better understanding of the various aspects of the alliance and observe it from different perspectives: Attention has recently turned toward the role of the therapeutic alliance in the various phases of therapy and the relationship between alliance and outcome.
So far, few studies have regarded long-term psychotherapy involving many counseling sessions. This topic, along with a more detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects.
Equally important, in our opinion, will be the findings of studies regarding drop-out and therapeutic alliance ruptures, which must necessarily consider the differences between that perceived by the patient and that perceived by the therapist.
Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Acknowledgments The authors thank Mauro Adenzato for his valuable comments and suggestions to an earlier version of this article. A Research Handbook, eds Greenberg L. Guilford Press;— Bibring E. On the theory of the results of psychoanalysis. The generalizability of the psychoanalytic concept of the working alliance.
Clinical Applications of Attachment Theory. Routledge and Kegan Paul Budman S.
Patterns of Transference and Countertransference
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Each pattern has typical transference issues. For example, clients with the Caretaking Pattern may try to take care of their therapist, while clients with an Entitled Pattern often push the therapeutic boundaries by asking for special treatment. Therapists also know that it is important to recognize when our countertransference reactions to a client are interfering with their therapy or undermining the therapeutic alliance.
You know you are being more reactive to a client than you like. The Pattern System can help you understand what might be going on in these situations in two ways. For example, therapists can get into power struggles with clients with a Controlling or Rebel Pattern.
Therapists can become overly involved with clients with a Dependent Pattern. By seeing clearly the interpersonal patterns of any given client, you can be on the lookout for reactions of yours that might be interfering with their therapy.
Patterns of Transference and Countertransference - Personal Growth Programs
For example, if you have a Caretaking or Dependent Pattern, you might try to connect with a defended client too quickly because of your need for connection or your need to take care of them, thus frightening the client. If you have a Prideful Pattern, you might become dependent on having your clients idealize you. This gives you important insight into issues of yours to work on outside of your sessions with clients. The client may have one particular pattern that is blocking their going deeper into the issues they need to explore or is keeping them from changing.
Or the client might have a pattern that is undermining their therapeutic alliance with you or triggering certain reactions in you that are waylaying the therapy. In the descriptions below, I will assume that you are the therapist.
Dependent Pattern Transference of Dependent Client The client sees you as a nurturing mother or father and becomes overly dependent on you. Countertransference Toward Dependent Client You become overly involved in caring for the client. Countertransference of Therapist with Dependent Pattern You become too emotionally involved with your client because of your dependency needs. The client picks up on clues about your pain or life struggles and tries to engage you in talking about them.
The client notices your insecurities and tries to assuage them.