Podolan Martin, Gelo Omar C G
Faculty of Psychotherapy Science, Sigmund Freud University, Vienna (Austria).
Department of Human and Social Sciences, University of Salento, Lecce (Italy).
Clin Neuropsychiatry. 2024 Oct;21(5):403-417. doi: 10.36131/cnfioritieditore20240505.
The significance of the psychotherapeutic relationship in promoting psychotherapeutic change is widely recognized. In this paper, we contribute to the relational orientation of psychotherapy through a transtheoretical exploration of safety. We aimed to identify and integrate those relational and change-promoting principles and aspects of safety that are school-independent.
We conducted an overview and synthesis of the clinical-theoretical and empirical literature that we believe has significantly addressed the role of safety in regulating change-promoting therapeutic relationships.
The relational and change-promoting aspects of safety form a dynamic system involving the therapist, the client, and the relationship. These interact, influence each other, and perform multiple homeostatic functions: they allow to resist change, assimilate small changes that do not disrupt the client's way of functioning, regulate major changes that disrupt and alter the client's way of functioning, and regulate adjustments in the way the therapist and client work together. From an integrative-relational perspective, a safe therapist is a precondition for co-creating a safe environment. This establishes trust and fosters an affective bond that provides additional sources of safety for the therapeutic relationship and the client. To promote change, however, the relational aspects of safety need to be fine-tuned (calibrated and personalized) for each therapy in terms of intensity, duration, timing, scope, and sources, accommodating developmental, individual, and situational differences. Crucially, the safety of the therapist, the client, and the relationship must be neither perfect, steady, or static, but rather and , leaving space not only for self-discovery and self-awareness but also for the co-regulation of tolerable frustrations, disappointments, and insecurities that facilitate the client's resilience and adaptation.
Focusing on school-independent, safety-based relational principles and understanding how they evolve and adapt over time and across circumstances can make a significant contribution to the current relational orientation in psychotherapy. This has important implications for psychotherapy practice, training, and research.
心理治疗关系在促进心理治疗改变方面的重要性已得到广泛认可。在本文中，我们通过对安全性的跨理论探索，为心理治疗的关系取向做出贡献。我们旨在识别并整合那些与学校无关的关系性及促进改变的安全性原则和方面。
我们对临床理论和实证文献进行了综述与综合，我们认为这些文献显著探讨了安全性在调节促进改变的治疗关系中的作用。
安全性的关系性及促进改变的方面构成了一个动态系统，涉及治疗师、来访者和治疗关系。它们相互作用、相互影响，并执行多种稳态功能：它们允许抵制改变，同化不会扰乱来访者功能方式的小变化，调节会扰乱并改变来访者功能方式的重大变化，以及调节治疗师和来访者共同工作方式的调整。从整合关系的角度来看，一个安全的治疗师是共同创造安全环境的前提条件。这建立了信任并培养了情感纽带，为治疗关系和来访者提供了额外的安全来源。然而，为了促进改变，安全性的关系方面需要针对每种治疗在强度、持续时间、时机、范围和来源方面进行微调（校准和个性化），以适应发展、个体和情境差异。至关重要的是，治疗师、来访者和治疗关系的安全性既不能是完美、稳定或静态的，而应是动态的、灵活的，不仅要为自我发现和自我意识留出空间，也要为可容忍的挫折、失望和不安全感的共同调节留出空间，这些有助于来访者的恢复力和适应能力。
关注与学校无关的、基于安全性的关系原则，并理解它们如何随时间和情境演变与适应，可为当前心理治疗的关系取向做出重大贡献。这对心理治疗实践、培训和研究具有重要意义。
