Schattner Emanuel, Tishby Orya, Wiseman Hadas
School of Social Work, Hebrew University of Jerusalem, Israel.
Department of Psychology, Hebrew University of Jerusalem, Israel.
Clin Psychol Psychother. 2017 Mar;24(2):555-568. doi: 10.1002/cpp.2019. Epub 2016 May 17.
A systematic case study approach was taken to explore the impact of client and therapist relational patterns on the development of the therapeutic alliance and symptom reduction in two cases of psychodynamic psychotherapy treated by the same therapist. The cases were selected from a larger sample and represent two distinct trajectories of alliance development: improvement versus deterioration. The comparison was based on participants' ongoing narratives about each other and about significant others, using the Relationship Anecdote Paradigm (RAP) interview. The qualitative findings were triangulated with process and outcome measures assessed at four time points during the year of treatment. We hypothesized that different therapeutic processes, including different handling by the therapist of interpersonal difficulties as they arose in treatment, could explain the two distinct trajectories of alliance development and symptom change within the caseload of one therapist. Results indicate two linked elements that may explain a steady increase in alliance and decrease in symptoms in one case, compared with the second case that started with an increase in alliance and symptom improvement, but gradually reached an impasse and a setback in symptoms. One element was the extent to which client's and therapist's relational patterns clashed, impacting each other negatively. The second was the extent to which differences and disagreements were stated openly and negotiated so that the therapist could flexibly adapt to meet the client's relational patterns in one case versus inability to do so in the other. Implications for training and other psychotherapy orientations are discussed. Copyright © 2016 John Wiley & Sons, Ltd.
The interaction of client and therapist relational patterns may be a key factor in the development of the therapeutic alliance and might potentially impact client outcome. Therapeutic practice will likely be improved if therapists are more aware of their own relational patterns and the ways these interact with their clients' relational patterns. Striving for this awareness should probably be a main focal point for therapists throughout their careers, in their training, supervisions and personal therapies.
采用系统案例研究方法，探讨在同一治疗师进行的两例心理动力心理治疗中，来访者与治疗师的关系模式对治疗联盟发展及症状减轻的影响。这些案例从一个更大的样本中选取，代表了联盟发展的两种不同轨迹：改善与恶化。比较基于参与者对彼此及重要他人的持续叙述，采用关系轶事范式（RAP）访谈。定性研究结果与治疗期间四个时间点评估的过程和结果测量数据进行了三角互证。我们假设，不同的治疗过程，包括治疗师在治疗中出现人际困难时的不同处理方式，可以解释在一位治疗师的案例中联盟发展和症状变化的两种不同轨迹。结果表明有两个相互关联的因素，与第二个案例相比，第一个案例中这两个因素可能解释了联盟的稳步增加和症状的减轻。第二个案例开始时联盟增加且症状改善，但逐渐陷入僵局且症状出现反复。一个因素是来访者与治疗师的关系模式冲突的程度，这种冲突对彼此产生负面影响。另一个因素是差异和分歧被公开表达并协商的程度，这样一来，在一个案例中治疗师能够灵活调整以适应来访者的关系模式，而在另一个案例中则无法做到。文中讨论了对培训及其他心理治疗取向的启示。版权所有© 2016约翰威立父子有限公司。
来访者与治疗师关系模式的相互作用可能是治疗联盟发展的关键因素，并可能潜在地影响来访者治疗结果。如果治疗师更了解自己的关系模式以及这些模式与来访者关系模式的相互作用方式，治疗实践可能会得到改善。在整个职业生涯中，无论是在培训、督导还是个人治疗中，努力培养这种意识都应该是治疗师的主要关注点。
