Lavik Kristina Osland, McAleavey Andrew Athan, Kvendseth Eli Karoline, Moltu Christian
Department of Psychiatry, District General Hospital of Førde, Førde, Norway.
Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States.
Front Psychol. 2022 Jul 7;13:915932. doi: 10.3389/fpsyg.2022.915932. eCollection 2022.
To explore how therapists and clients act dyadically to establish a therapeutic relationship during the first five sessions of psychotherapy. The study aimed to identify both relational facilitative and hindering processes occurring in routine care.
Using the method 'interpersonal process recall' (IPR), we videotaped the third and fifth session of 12 psychotherapy dyads, and conducted video-assisted interviews with each therapist and client separately. In total, the data material consist of 47 IPR interviews. Data were analyzed using a thematic approach.
The analysis process revealed two main groups. The first group consisted of dyads with a positive relational outcome, and the second group consisted of dyads with a troubled or frail relational outcome. During the initial phase of therapy, clients described feeling overwhelmed by fear and shame. Positive relational development occurred when these emotions were successfully accommodated and replaced with a growing sense of safety with the therapist. However, the relationship became troubled when the client experienced an increase in shame and/or fear during the first sessions. When forming a therapeutic relationship, it is vital that the client experience the therapist as genuine and skilled, and that the therapist is able to engage and connect deeply with the client on a person-to-person level. The article further provides a discussion on how these dyadic experiences align with the working alliance and real relationship, and how the two consolidate during the first sessions of psychotherapy.
The current study explored the complex relational processes underlying the formation of the therapeutic relationship. Core aspects of the real relationship are prerequisites to forming a collaborative working alliance in which both therapist and client are actively engaged. Facilitating a positive relationship is crucial in the early phase of psychotherapy, and therapists can actively identify and repair ruptures at this time.
探讨治疗师与来访者在心理治疗的前五节疗程中如何以二元方式互动以建立治疗关系。该研究旨在识别常规治疗中发生的促进和阻碍关系的过程。
我们采用“人际过程回忆”（IPR）方法，对12对心理治疗二元组的第三节和第五节疗程进行录像，并分别对每位治疗师和来访者进行视频辅助访谈。数据材料总共包括47次IPR访谈。采用主题分析法对数据进行分析。
分析过程揭示了两个主要类别。第一类是关系结果积极的二元组，第二类是关系结果存在问题或脆弱的二元组。在治疗初始阶段，来访者表示感到被恐惧和羞耻压得喘不过气来。当这些情绪得到成功处理并被对治疗师日益增强的安全感所取代时，就会出现积极的关系发展。然而，当来访者在最初几次疗程中羞耻感和/或恐惧感增加时，关系就会出现问题。在建立治疗关系时，来访者体验到治疗师真诚且有能力，以及治疗师能够在人际层面与来访者深入互动并建立联系至关重要。本文进一步讨论了这些二元体验如何与工作联盟和真实关系相契合，以及两者在心理治疗的最初几次疗程中如何巩固。
本研究探讨了治疗关系形成背后复杂的关系过程。真实关系的核心方面是形成治疗师和来访者都积极参与的合作工作联盟的先决条件。在心理治疗早期促进积极关系至关重要，治疗师此时可以积极识别并修复关系破裂之处。
