Gelso Charles J, Kline Kathryn V
Department of Psychology, University of Maryland, College Park.
Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, MD, USA.
Res Psychother. 2019 Jul 30;22(2):373. doi: 10.4081/ripppo.2019.373. eCollection 2019 Aug 9.
Jeremy Safran has presented seminal and widely applicable clinical theory and research around the therapeutic alliance and ruptures in the alliance. We explore areas of agreement with and departure from some of Safran's key conceptualizations on these topics, focusing on overlap and distinctions between two constructs theorized to be fundamentally significant elements of all therapeutic relationships: the working alliance and the real relationship. We share Safran's view that the alliance centrally implicates an emotional bond between patient and therapist, as well as an agreement about the goals of treatment and the tasks needed to attain those goals. We depart from Safran, however, in his belief that the real relationship should be seen as part of the emotional bond of the working alliance. Instead, we argue that the real relationship and the working alliance (including the bond aspect of the alliance) are best viewed as highly interrelated but distinct aspects of the therapeutic relationship. In addition, a distinction is made between the working bond (part of the working alliance) and the personal bond (part of the real relationship). Hence, we examine the concept of rupture in the working alliance, and in the real relationship as well. The nature of ruptures is discussed, as well as what therapists can do to repair them. A more limited definition of ruptures than the broader conception that has evolved in recent years is proposed. It is suggested that, whereas ruptures in the working alliance generally can be repaired to the benefit of the work, ruptures in the real relationship are likely to be more damaging to the treatment.
杰里米·萨夫兰围绕治疗联盟及联盟中的破裂情况，提出了具有开创性且广泛适用的临床理论与研究。我们探讨了在这些主题上与萨夫兰一些关键概念的共识与分歧，重点关注两种被理论化为所有治疗关系中根本重要元素的结构之间的重叠与区别：工作联盟和真实关系。我们认同萨夫兰的观点，即联盟核心涉及患者与治疗师之间的情感纽带，以及关于治疗目标和实现这些目标所需任务的共识。然而，我们与萨夫兰不同的是，他认为真实关系应被视为工作联盟情感纽带的一部分。相反，我们认为真实关系和工作联盟（包括联盟的纽带方面）最好被视为治疗关系中高度相关但又不同的方面。此外，还区分了工作纽带（工作联盟的一部分）和个人纽带（真实关系的一部分）。因此，我们考察了工作联盟中的破裂概念，以及真实关系中的破裂概念。讨论了破裂的性质，以及治疗师可以采取哪些措施来修复它们。我们提出了一个比近年来发展出的更宽泛概念更有限的破裂定义。有人认为，虽然工作联盟中的破裂通常可以修复并有利于治疗工作，但真实关系中的破裂可能对治疗造成更大损害。
